Pulsatile GnRH or human chorionic gonadotropin/human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism: a review of 42 cases

Institute of Reproductive Medicine of the University, Munster, Germany.

Stimulatory therapy with either GnRH or gonadotropins is an effective treatment to induce spermatogenesis and achieve paternity in men with secondary hypogonadism. However, there is still uncertainty about the optimal treatment modality and schedule, the duration of treatment necessary and the influence of interfering factors such as maldescended testes. We have extended our previous series of men treated for secondary hypogonadism and now present our therapeutic experience with 42 cases. Twenty-one patients with hypothalamic disorders (11 with idiopathic hypogonadotropic hypogonadism (IHH) and 10 with Kallmann syndrome (KalS)) were treated with GnRH (group Ia) or human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) (group Ib), and 21 patients with hypopituitarism (group II) were treated with hCG/hMG. A total of 5 7 treatment courses were initiated for induction of spermatogenesis, 36 of these for the purpose of induction of pregnancy in the female partner. Bilateral testicular volumes doubled within 5-12 months of therapy. Spermatogenesis as evidenced by the appearance of sperm in the ejaculate was induced in 54/57 courses. Pregnancies occurred in 26/36 courses. Unilaterally maldescended testes did not preclude patients with IHH or KalS from gaining fertility under therapy and spermatogenesis could be successfully initiated even in some individuals with bilateral maldescended testes. In general there was a tendency for a longer duration of therapy until induction of spermatogenesis in patients with a history of bilateral cryptorchidism. However, this did not reach statistical significance. In patients with IHH or KalS treated with either hCG/hMG or GnRH there were no statistically significant differences in terms of duration to appearance of sperm or pregnancy rates. Even in KalS patients as old as 43 years spermatogenesis could be induced. In repeatedly treated patients stimulation of spermatogenesis tended to be faster while time until induction of pregnancy was significantly shorter in the second treatment course. In conclusion, GnRH or hCG/hMG are effective therapeutic modalities for patients with IHH or KalS. It remains to be determined whether highly purified urinary gonadotropin preparations or recombinant LH and FSH will provide therapeutic advantages.

This article has been cited by other articles:

				S. Bhasin Approach to the Infertile Man J. Clin. Endocrinol. Metab., June 1, 2007; 92(6): 1995 - 2004. [Abstract] [Full Text] [PDF]

				V K B Prabhakar and S M Shalet Aetiology, diagnosis, and management of hypopituitarism in adult life. Postgrad. Med. J., April 1, 2006; 82(966): 259 - 266. [Abstract] [Full Text] [PDF]

				N. Sato, T. Hasegawa, N. Hori, M. Fukami, Y. Yoshimura, and T. Ogata Gonadotrophin therapy in Kallmann syndrome caused by heterozygous mutations of the gene for fibroblast growth factor receptor 1: report of three families:Case report Hum. Reprod., August 1, 2005; 20(8): 2173 - 2178. [Abstract] [Full Text] [PDF]

				I. Fahmy, A. Kamal, R. Shamloul, R. Mansour, G. Serour, and M. Aboulghar ICSI using testicular sperm in male hypogonadotrophic hypogonadism unresponsive to gonadotrophin therapy Hum. Reprod., July 1, 2004; 19(7): 1558 - 1561. [Abstract] [Full Text] [PDF]

				P.-M. G. Bouloux, E. Nieschlag, H. G. Burger, N. E. Skakkebaek, F. C.W. Wu, D. J. Handelsman, G. H.W. Baker, R. Ochsenkuehn, A. Syska, R. I. Mclachlan, et al. Induction of Spermatogenesis by Recombinant Follicle-Stimulating Hormone (Puregon) in Hypogonadotropic Azoospermic Men Who Failed to Respond to Human Chorionic Gonadotropin Alone J Androl, July 1, 2003; 24(4): 604 - 611. [Abstract] [Full Text] [PDF]

				N. Pitteloud, F. J. Hayes, A. Dwyer, P. A. Boepple, H. Lee, and W. F. Crowley Jr. Predictors of Outcome of Long-Term GnRH Therapy in Men with Idiopathic Hypogonadotropic Hypogonadism J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4128 - 4136. [Abstract] [Full Text] [PDF]

				P. Y. Liu, V. J. Gebski, L. Turner, A. J. Conway, S. M. Wishart, and D. J. Handelsman Predicting pregnancy and spermatogenesis by survival analysis during gonadotrophin treatment of gonadotrophin-deficient infertile men Hum. Reprod., March 1, 2002; 17(3): 625 - 633. [Abstract] [Full Text] [PDF]

				Optimal use of infertility diagnostic tests and treatments Hum. Reprod., March 1, 2000; 15(3): 723 - 732. [Abstract] [Full Text] [PDF]