menotropins and Azoospermia

Elevated plasma gonadotropins were associated with desensitization of Sertoli and Leydig cells in the male testis. Testis spermatogenesis ability would be improved via inhibiting high endogenous gonadotropin in patients with severe oligozoospermia. Whether it would be beneficial for non-obstructive azoospermia (NOA) patients was still unclear.. Goserelin, a gonadotropin releasing hormone agonist (GnRHα) was used to suppress endogenous gonadotropin levels (gonadotropin reset) in the NOA patients, improving the sensitization of the Sertoli and Leydig cells. Then human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) were injected to stimulate them to ameliorate the ability of testicular spermatogenesis. The main outcome measure was the existence of spermatozoa in the semen or by testicular sperm extraction (TESE). Elevation of inhibin B and/or ameliorative expression pattern of ZO-1 was the secondary objective.. A total of 35 NOA men who failed to retrieve sperm via TESE were enrolled. Among these, 10 patients without treatment were selected as control group and secondary TESE was performed 6 months later. Of the 25 treated men, inhibin B was elevated in 11 patients in the first 4 weeks (Response group), while only 5 patients had constant increase in the following 20 weeks (Response group 2). Of the 5 men, 2 men acquired sperm (Response group 2B), while 3 failed (Response group 2A). Immunofluorescence of mouse vasa homologue (MVH) and ZO-1 showed that both positive MVH signals and ZO-1 expression were significantly increased in the Response group 2, but only Response group 2B showed ameliorative ZO-1 distribution.. Gonadotropin reset, a new therapeutic protocol with GnRHα, was able to improve the ability of testicular spermatogenesis in the NOA patients through restoring the sensitivity of Sertoli and Leydig cells, which were reflected by elevated inhibin B and ameliorative ZO-1 expression and distribution.. ClinicalTrials.gov identifier: NCT02544191 .

Topics: Adult; Azoospermia; Case-Control Studies; Chorionic Gonadotropin; Gonadotropin-Releasing Hormone; Goserelin; Humans; Inhibins; Male; Menotropins; Middle Aged; Pilot Projects; Spermatogenesis; Zonula Occludens-1 Protein

To investigate whether the trigger effect of human menopausal gonadotropins (hMG) and human chorionic gonadotropins (hCG) attributes to the treatment of unexplainable non-obstructive azoospermia (NOA).. We retrospectively analyzed the clinical data about 282 cases of unexplainable NOA treated in the Maternity and Child Health Hospital of Guizhou Province from January 2010 to May 2017. All the patients underwent trigger treatment by intramuscular injection of hMG at 75 IU 3 times a week for 2 weeks, followed by hCG at 2 000 IU twice a week for another 2 weeks, and meanwhile took vitamin E, Levocarnitine and Tamoxifen as an adjunctive therapy. The treatment lasted 3－12 months.. Fifty-eight of the 255 patients that completed the treatment were found with sperm in the semen after treatment, all with severe oligoasthenospermia. Forty-seven of the 58 cases received assisted reproductive technology (ART), of which 18 achieved clinical pregnancy. Semen centrifugation revealed no sperm in the other cases, of which 6 were found with epididymal sperm at epididymal and testicular biopsy after treatment and 3 of them achieved clinical pregnancy after ART. Sperm was found in the semen or at epididymal or testicular biopsy in 64 of the patients after treatment, with an effectiveness rate of 25.1%.. Trigger treatment by injection of hMG and hCG combined with adjunctive oral medication has a certain effect on unexplainable NOA.. 目的： 探索尿促性腺素(HMG)联合绒促性腺素(hCG)的扳机作用对于不明原因的非梗阻性无精子症患者的治疗是否有效。方法： 回顾性分析2010年1月至2017年5月间在贵州省妇幼保健院就诊的282例不明原因的非梗阻性无精子症患者资料，扳机治疗方法为每例患者第1周和第2周进行HMG每次75 IU肌肉注射，每周3次。第3周和第4周hCG每次2 000 IU肌肉注射，每周2次，并结合维生素E、左卡尼汀、他莫昔芬口服辅助治疗，治疗3个月至1年。结果： 接受治疗的282例非梗阻性无精子症患者，27例未完成治疗而失访，完成治疗的255例患者治疗后精液中发现有精子的58例，均为严重少弱精子症，其中47例接受辅助生殖技术助孕，2例失访，女方获得临床妊娠18例；其余197例治疗后精液检查中未发现有精子，其中25例行附睾或睾丸穿刺活检，有6例发现精子，均接受辅助生殖助孕，女方获得临床妊娠3例。共64例精液中或附睾、睾丸穿刺发现精子，有效率25.1%。结论： HMG联合hCG药物扳机治疗结合口服药物辅助治疗对不明原因的非梗阻性无精子症有一定效果。.

Topics: Azoospermia; Chorionic Gonadotropin; Drug Administration Schedule; Epididymis; Female; Fertility Agents, Male; Humans; Injections, Intramuscular; Male; Menotropins; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Retrospective Studies; Sperm Retrieval; Spermatozoa; Testis

Classical congenital adrenal hyperplasia (CAH), a genetic disorder characterized by 21-hydroxylase deficiency, impairs male fertility, if insufficiently treated.. A 30-year-old male was referred to our clinic for endocrine and fertility assessment after undergoing unilateral orchiectomy for a suspected testicular tumor. Histopathological evaluation of the removed testis revealed atrophy and testicular adrenal rest tumors (TARTs) and raised the suspicion of underlying CAH. The remaining testis was also atrophic (5 ml) with minor TARTs. Serum 17-hydroxyprogesterone levels were elevated, cortisol levels were at the lower limit of normal range, and gonadotropins at prepubertal levels, but serum testosterone levels were within the normal adult range. Semen analysis revealed azoospermia. CAH was confirmed by a homozygous mutation g.655A/C>G (IVS2-13A/C>G) in CYP21A2. Hydrocortisone (24 mg/m(2)) administered to suppress ACTH and adrenal androgen overproduction unmasked deficient testicular testosterone production. As azoospermia persisted due to sustained hypogonadotropic hypogonadism, a combined s.c. gonadotropin replacement with human chorionic gonadotropin (hCG) (1500 IU twice weekly) and FSH (human menopausal gondadotropin (hMG) 150 IU three times weekly) was initiated.. Normalization of testosterone levels and a stable low sperm concentration (0.5 mill/ml) with good sperm motility (85% A+B progressive) were achieved within 21 months of treatment. Despite persisting TARTs, while receiving treatment, the patient successfully impregnated his wife twice, the latter impregnation leading to the birth of a healthy girl.. TARTs in unrecognized (simple virilizing) CAH may lead to unnecessary orchiectomy. In hypogonadotropic, azoospermic CAH, a combined treatment with oral corticosteroids and subcutaneously administered hCG and FSH can successfully restore testicular testosterone production and fertility, even if only one hypoplastic and atrophic testis with adrenal rest tumors is present.

Topics: Adrenal Hyperplasia, Congenital; Adrenal Rest Tumor; Adult; Azoospermia; Chorionic Gonadotropin; Hormone Replacement Therapy; Humans; Hypogonadism; Male; Menotropins; Orchiectomy; Reproductive Control Agents; Testicular Neoplasms

Topics: Azoospermia; Chorionic Gonadotropin; Clomiphene; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Menotropins; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Spermatogenesis; Testosterone

Study Type - Therapy (outcomes) Level of Evidence 2a What's known on the subject? and What does the study add? Clomiphene citrate, hCG and human menopausal gonadotropin (hMG) are widely used in treatment of oligospermia, because they increase FSH and testosterone which are essential for spermatogenesis. Finding a sperm in non-obstructive azoospermia for intracytoplasmic sperm injection is a challenge and much effort is required to reach the optimum method of sperm retrieval. The study shows that a new protocol of clomiphene citrate, hCG and hMG in the treatment of non-obstructive azoospermia achieves an increase in the levels of FSH, LH and total testosterone to the target levels that we set. Our target level of FSH was 1.5 times its initial level and for serum testosterone it was 600-800 ng/dL. Using our described medical treatment protocol in cases of non-obstructive azoospermia, sperm may be found in patients' ejaculate (~11%) and if they remain azoospermic they will have a greater likelihood of sperms being obtained in testicular sperm extraction.. To evaluate the effect of optimizing serum level of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone on sperm retrieval for intracytoplasmic sperm injection.. A total of 612 patients with non-obstructive azoospermia were evaluated with routine history, physical examination and hormonal assessment. Of these, 116 patients underwent microsurgical (micro)-testicular sperm extraction (TESE) without any medical treatment and formed the control group and the remaining 496 patients were administered clomiphene citrate in a titrated dose. Patients were classified into four groups according to their response to clomiphene citrate. Group 1: patients with an obvious increase in FSH and total testosterone (n = 372). Group 2: patients showing an increase in FSH with no or little increase in LH and total testosterone (n = 62). For these patients we continued with clomiphene citrate and added human chorionic gonadotrophin (hCG). Group 3: patients with no increase in the levels of the three hormones (n = 46). Group 4: included patients with continuously decreasing serum testosterone levels in response to the increasing dose of clomiphene citrate (n = 16). Accordingly, patients in groups 3 and 4 discontinued clomiphene citrate and started hCG and human menopausal gonadotropin (hMG). Semen analyses were performed periodically and, in patients who remained azoospermic, micro-TESE was performed.. Sperm were noted in 54 patients (10.9%) in semen analysis after treatment in all groups (with no significant difference) at a mean (sd) concentration of 2.3 (4.1) million/mL. For the 442 patients who remained azoospermic after treatment, successful sperm retrieval was significantly higher (57%) compared with the control group (33.6%).. For patients with non-obstructive azoospermia, clomiphene citrate, hCG and hMG administration, leading to an increased level of FSH and total testosterone, results in an increased rate of sperm in the ejaculate and increased likelihood of successful micro-TESE.

Topics: Adult; Azoospermia; Chorionic Gonadotropin; Clomiphene; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Menotropins; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Spermatogenesis; Testosterone

To describe the case of isolated follicle-stimulating hormone (FSH) deficiency without mutation of the FSHbeta gene.. Case report.. Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.. A 22-year-old man referred for infertility, azoospermia, and isolated FSH deficiency.. The patient's FSHbeta gene was sequenced. Pituitary function at baseline and after repeated GnRH administration was evaluated. Testicular biopsy was performed. The patient was treated with human menopausal gonadotropin (hMG).. Pathologic examination revealed hypospermatogenesis with isolated FSH deficiency without mutation of the FSHbeta gene.. The FSH levels remained below the normal range despite repeated GnRH stimulation. Hypospermatogenesis was confirmed by testicular biopsy. After 6 months of hMG treatment, spermatogenesis was successfully induced.. We report the case of an infertile male with isolated FSH deficiency without any evidence of mutation in the FSHbeta gene.

Topics: Azoospermia; Fertility Agents, Male; Follicle Stimulating Hormone, beta Subunit; Follicle Stimulating Hormone, Human; Humans; Immunohistochemistry; Male; Menotropins; Mutation; Pituitary Function Tests; Spermatogenesis; Testis; Treatment Outcome; Young Adult