Gonadotropin administration after gonadotropin-releasing-hormone agonist: a therapeutic option in severe testiculopathies

OBJECTIVE: To evaluate the effect of recombinant human follicle-stimulating hormone (FSH) plus human chorionic gonadotropin (hCG) on seminal parameters and pregnancy rate in severe testiculopathies after high FSH plasma concentrations have been suppressed. DESIGN: Prospective, controlled, randomized clinical study. SETTING: Infertility center at a university hospital. PATIENT(S): Eighty-seven men affected by severe testiculopathy. INTERVENTION(S): We treated 57 men with a gonadotropin-releasing hormone agonist (GnRH-a) and then with recombinant human FSH and hCG, and 30 patients did not receive any treatment. Seminal parameters and sperm aneuploidies were evaluated during and after the treatment period. Couples did not achieve a spontaneous pregnancy received assisted reproduction treatment. MAIN OUTCOME MEASURE(S): Seminal parameters, sperm aneuploidies, testicular cytologic analysis, FSH, luteinizing hormone, testosterone, inhibin B concentrations, and pregnancy rate. RESULT(S): After the therapy period, the treated group showed statistically significant improvement in sperm parameters and sperm aneuploidies. No changes were observed in the untreated group. A trend toward an increase in pregnancy rate also was observed among treated couples (cumulative pregnancy rates 31.6% treated vs. 20.0% untreated), although the increase was not statistically significant. The improvement of seminal parameters in the treated group allowed some patients to undergo in vitro fertilization-embryo transfer instead of intracytoplasmic sperm injection. CONCLUSION(S): Results from this controlled, randomized clinical trial show that FSH therapy improves sperm parameters in severe male factor infertility when endogenous high FSH plasma levels are suppressed. In cases of severely impaired testicles, a rational treatment of male infertility is mandatory to improve the outcome of assisted reproduction techniques.