| ObjectiveThe purpose of this study was to observe whether combination gonadotrophintherapy with hCG and FSH and pulsatile LHRH therapy could effectively inducespermatogenesis and sexual development in male patients with idiopathichypogonadotropic hypogonadism(IHH). Furthermore, we also wanted to find outwhether the pulsatile LHRH therapy was a more optimal therapy than combinationgonadotrophin therapy for male patients with IHH.Methods16male patients with IHH recruited from Departement of endocrinology, RuijinHospital, School of Medecine, Shanghai Jiaotong University were treated withcombination gonadotrophin therapy with hCG and FSH. HCG2000IU wasadministered by intramuscular injection(IM) twice a week for6months, and thenadditional administration of FSH was added by IM tree times a week.90malepatients with IHH were treated with pulsatile LHRH thearapy by subcutaneousinjection of LHRH10~15μg every90minutes. Hormonal levels, sexual development,spermatogenesis and natural pregnancy were analyzed.48male patients diagnosed with IHH were devided into two groups with a numberratio of1:2.16patients were treated with combination gonadotrophin therapy withhCG and FSH while32patients were treated with pulsatile LHRH therapy. Wewanted to find out whether there were differences in hormonal levels, sexualdevelopment, spermatogenesis and natural pregnancy between two groups after18months’ treatment.Results After combination gonadotrophin therapy, testosterone level rose to normal rangeand puberty started.11of14patients had positive sperm counts with a spermconcentration of3.03×106/ml at the end of18months.After pulsatile LHRH therapy, levels of LH and FSH fluctuated with an increase ofT level. Sperm production rate was60.81%at one year with a median spermconcentration of2.75×106/ml and rose to76.47%at two year with a medianconcentration of14.04×106/ml. The time to achieve first sperm and a spermcontration of20×106/ml were associated with initial testis volume before therapy (r=-0.448, P=0.001; r=-0.600, P=0.001). After treated for12and18months, therewas a statistical difference of initial testis volume between patients with and withoutpositive sperm counts.8of9married patients’partners conceived naturally duringtreatment. The married pregnancy rate was88.89%and the median time for inductionof pregnancy was15.38±1.92months.When we compared the effects of combination gonadotrophin therapy and pulsatileLHRH therapy, we found that the level of testosterone of all the patients maintainedin the normal range with an increase of testis volume and sexual development.78.6%of the gondadotrophin group and77.0%of the LHRH group had a spermconcentration1×106/ml. The sperm concentration of LHRH group was higher thanthat of gonadotrophin group(21.57×106/ml vs3.03×106/ml, P=0.11). There was nodifference in the time for the induction of pregnancy(11months vs13months, P>0.05).One patient in the gonadotrophin group was married and became father successfully.8patients in the LHRH group were married and7of their partners had naturallyconceived with a married pregnancy rate of87.5%.ConclusionBoth of combination gonadotrophin therapy with hCG and FSH and pulsatile LHRH therapy could effectively induce sexual development and spermatogenesis inmale patients with IHH, which were safe and effective therapies to improve fertilitycapacity. The time for induction of spermatogenesis by pulsatile LHRH therapy wasassociated with initial testis volume. The time needed for sperm induction wasshorter in patients with larger initial testis volume.There were no differences in the time for sperm induction, final spermconcentration and sexual development between two kinds of treatment. Patients canchoose either of them according to their own needs. We consider the pulsatile LHRHtherapy as a more optimal one for its relatively higher sperm concentration, effect topartial patients with poor reponse to gonadotrophin therapy and better tolerance andcompliance. |
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