menotropins and Infertility--Male

Subfertility is defined as the condition of being less than normally fertile though still capable of effecting fertilization. When these subfertile couples seek assistance for conception, a thorough evaluation of male endocrine function is often overlooked. Spermatogenesis is a complex process where even subtle alterations in this process can lead to subfertility or infertility. Male endocrine abnormalities may suggest a specific diagnosis contributing to subfertility; however, in many patients, the underlying etiology is still unknown. Optimizing underlying endocrine abnormalities may improve spermatogenesis and fertility. This manuscript reviews reproductive endocrine abnormalities and hormone-based treatments.

Topics: Adrenal Hyperplasia, Congenital; Androgen-Insensitivity Syndrome; Aromatase Inhibitors; Chorionic Gonadotropin; Clomiphene; Follicle Stimulating Hormone, Human; Humans; Hyperprolactinemia; Hypogonadism; Infertility, Male; Male; Menotropins; Obesity; Reproductive Control Agents; Selective Estrogen Receptor Modulators; Tamoxifen; Thyroid Diseases

Infertility is generally defined as a couple's inability to conceive after 1 year of unprotected intercourse. When infertile couples seek assistance, a male factor will be identified half of the time. Once the male has been evaluated, there are four main categories to describe his infertility: (1) idiopathic, (2) post-testicular/obstructive, (3) primary-where the Sertoli and/or Leydig cells of the testis fail, and (4) secondary-where there is a problem with the hypothalamus and/or pituitary. The last, hypogonadotropic hypogonadism (HH), accounts for up to 2% of infertile men. HH is either congenital or acquired and usually can be successfully treated by medical intervention. This review will focus on the hypothalamus-pituitary-gonadal axis, specific defects of this coordination center, and potential interventions for improving male-factor fertility.

Topics: Chorionic Gonadotropin; Follicle Stimulating Hormone; Gonadotropins; Hormone Replacement Therapy; Humans; Hypogonadism; Hypothalamus; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Pituitary Gland; Recombinant Proteins; Testis

Topics: Chorionic Gonadotropin; Fluoxymesterone; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Hypothalamo-Hypophyseal System; Infertility, Male; Leydig Cells; Luteinizing Hormone; Male; Menotropins; Prognosis; Reproductive Techniques, Assisted; Testosterone

Our aim is to evaluate the efficacity of intrauterine insemination in male infertility after controlled ovarian hyperstimulation. 96 cycles were carried out. 16 pregnancies were achieved, the pregnancy rate per cycle is 16.7% (43.3% per couple) and 12.5% ongoing pregnancies. Six cycles were proposed and the higher cumulative probability of pregnancy is obtained at the 4th cycle. The best pregnancy rate per cycle is obtained with 5.10(6) to 10.10(6) inseminated. The success rate is not associated with the number of sperm abnormalities in our study.

Topics: Adult; Female; Fertility Agents, Female; Humans; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Prospective Studies

Male feminization is an uncommon and complex phenomenon which occurs as a consequence of an imbalance in the effective oestrogen/androgen relationship. One of the many approaches used in the treatment of idiopathic male infertility is hCG/hMG stimulation. This paper reports one case of an infertile male treated with hCG/hMG after surgical correction of a varicocele, which resulted in a feminization effect evidenced by gynaecomastia and severe spermatogenesis blockade. When therapy was discontinued the feminization disappeared, a rebound phenomenon with normalization of most of the seminal parameters being seen. No other fully documented cases were found in the literature. Finally, the pathoetiological mechanisms involved in the feminization are analyzed and a revision is made of the causes that may cause it.

Topics: Adult; Chorionic Gonadotropin; Feminization; Humans; Infertility, Male; Male; Menotropins

Topics: Adult; Bromocriptine; Chorionic Gonadotropin; Drug Therapy, Combination; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Infertility, Male; Infusion Pumps; Male; Menotropins; Testosterone

We conclude that, although many therapies have been advocated, no regimen has proved to be consistently effective in the treatment of idiopathic male infertility. Couples in which the husband is identified as having idiopathic infertility should be advised of the inconsistent and often low conception rates obtained with medical therapy. This should be weighed against the possibility of greater success with in vitro fertilization and the likelihood of success with artificial insemination by donor. Matson and colleagues performed in vitro fertilization on 75 couples in which the husband was oligospermic. When the husband was moderately (5.1 to 11.9 million motile sperm per milliliter) or severely (less than or equal to 5 million motile sperm per milliliter) oligospermic, fertilization rates were 56 and 30 per cent, respectively. This is in comparison to a fertilization rate of 72 per cent in normospermic couples. Following embryo transfer, pregnancy rates were similar in all groups. In vitro fertilization, although expensive and often not covered by insurance policies, may yield results in 1 month. Pharmacologic treatment of the male, which is less expensive, requires several months before improvement might be expected. The decision as to which course to recommend should be made after careful consultation with the couple. If empiric therapy is decided upon, the choice of an agent is somewhat arbitrary. Reasonable initial choices for the oligospermic patient are tamoxifen (or clomiphene citrate) or HCG (HCG may also be used in the patient with idiopathic asthenospermia). Testosterone rebound, with its risk of permanent azoospermia, is not an acceptable initial therapy. Similarly, the results of studies of testolactone, GnRH, pentoxifylline, and kallikrein either demonstrate low pregnancy rates or are too preliminary to recommend at this time. Regardless of the choice of therapy, it should be administered for at least 3 months to include the length of one spermatogenic cycle. The performance of randomized, double-blind, placebo-controlled, cross-over studies of present and future treatments will allow more definite conclusions to be drawn.

Topics: Chorionic Gonadotropin; Clinical Trials as Topic; Clomiphene; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Kallikreins; Male; Menotropins; Oligospermia; Phosphodiesterase Inhibitors; Pregnancy; Tamoxifen; Testolactone; Testosterone; Time Factors

Increasing numbers of patients are seeking treatment for infertility. The primary care physician is often the first professional to face this diagnostic challenge. Recent developments in the diagnosis and treatment of the infertile man have led to increased success in management of the infertile couple. This article reviews these developments.

Topics: Chorionic Gonadotropin; Chromosome Aberrations; Chromosome Disorders; Clomiphene; Drug-Related Side Effects and Adverse Reactions; Gonadal Steroid Hormones; Humans; Infertility, Male; Male; Medical History Taking; Menotropins; Physical Examination; Prednisone; Semen; Sex Chromosome Aberrations; Substance-Related Disorders; Testicular Diseases; Urologic Diseases

Specific and effective medical treatment is available for some subfertile males. Reproductive physiology should be reviewed with all patients and exposure to drugs and toxins known to impair testicular or accessory sex gland function should be terminated. Appropriate treatment of retrograde ejaculation, chronic infections of the genital tract, or gonadotropin deficiency is indicated. Accurate diagnosis and treatment of the impotent patient may restore potency and fertility. Pregnancies have been achieved in association with each of the empirical regimens; however, we believe that each must be viewed as experimental at this time, since results may be no better than those observed in the absence of treatment. It is our experience that patients with elevated serum levels of FSH, peritubular fibrosis, and hyalinization are unlikely to achieve fertility regardless of treatment; however, there are exceptions. As our knowledge of basic reproductive biology and clinical pathology increases, it is hoped that better guidelines and more rational and effective medical treatment for the subfertile male will evolve.

Topics: Chorionic Gonadotropin; Clomiphene; Erectile Dysfunction; Gonadotropins; Humans; Infections; Infertility, Male; Male; Menotropins; Oligospermia; Testosterone

Studies testing the effectiveness of GnRH antagonists in controlled ovarian stimulation (COS) for intrauterine insemination (IUI) have provided controversial results. The present study was undertaken to evaluate, whether the use of a half of the conventional dose of the GnRH antagonist cetrorelix can be effective in increasing the successful rate of IUI cycles. Patients started COS with human menopausal gonadotropin (hMG) on day three of the menstrual cycle. Cetrorelix was started when at least one follicle of ≥14 mm, was detected at the ultrasound scan, according to the flexible multiple daily dose protocol, and continued until the trigger day with recombinant hCG. Patients adopting GnRH antagonist at low dose had a pregnancy rate (21.7%) that was significantly higher (p < 0.05) in comparison to women receiving hMG only (8.7%). These results suggest that adding a reduced dose of GnRH antagonist to the COS for IUI cycles significantly improves the outcome of the procedure.

Topics: Adult; Chorionic Gonadotropin; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Hospitals, University; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Italy; Male; Menotropins; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins

Can controlled ovarian stimulation with low-dose human menopausal gonadotrophin (hMG) improve the clinical pregnancy rate when compared with ovarian stimulation with clomiphene citrate (CC) in an intrauterine insemination (IUI) programme for subfertile couples?. Ovarian stimulation with low-dose hMG is superior to CC in IUI cycles with respect to clinical pregnancy rate.. IUI after ovarian stimulation is an effective treatment for mild male subfertility, unexplained subfertility and minimal-mild endometriosis, but it is unclear which medication for ovarian stimulation is more effective.. A total of 330 women scheduled for IUI during 657 cycles (September 2004-December 2011) were enrolled in an open-label randomized clinical trial to ovarian stimulation with low-dose hMG subcutaneous (n = 334, 37.5-75 IU per day) or CC per oral (n = 323, 50 mg/day from Day 3-7). Assuming a difference of 10% in 'clinical pregnancy with positive fetal heart beat', we needed 219 cycles per group (alpha-error 0.05, power 0.80).. We studied subfertile couples with mild male subfertility, unexplained subfertility or minimal-mild endometriosis. Further inclusion criteria were failure to conceive for ≥12 months, female age ≤42 years, at least one patent Fallopian tube and a total motility count (TMC) ≥5.0 million spermatozoa after capacitation. The primary end-point was clinical pregnancy. Analysis was by intention to treat and controlled for the presence of multiple measures, as one couple could have more randomizations in multiple cycles. Linear mixed models were used for continuous measures. For binary outcomes we estimated the relative risk using a Poisson model with log link and using generalized estimating equations.. When compared with ovarian stimulation with CC, hMG stimulation was characterized by a higher clinical pregnancy rate (hMG 48/334 (14.4%) versus CC 29/323 (9.0%), relative risk (RR) 1.6 (95% confidence interval (CI) 1.1-2.4)), higher live birth rate (hMG 46/334 (13.8%) versus CC 28/323 (8.7%), RR 1.6 (95% CI 1.0-2.4)), low and comparable multiple live birth rate (hMG 3/46 (6.5%) versus CC 1/28 (3.6%), P > 0.99), lower number of preovulatory follicles (hMG 1.2 versus CC 1.5, P < 0.001), increased endometrial thickness (hMG 8.5 mm versus CC 7.5 mm, P < 0.001), and a lower cancellation rate per started cycle (hMG 15/322 (4.7%) versus CC 46/298 (15.4%), P < 0.001).. We randomized patients at a cycle level, and not at a strategy over multiple cycles.. This study showed better reproductive outcome after ovarian stimulation with low-dose gonadotrophins. A health economic analysis of our data is planned to test the hypothesis that ovarian stimulation with low-dose hMG combined with IUI is associated with increased cost-effectiveness when compared with ovarian stimulation with CC.. T.M.D. and K.P. were supported by the Clinical Research Foundation of UZ Leuven, Belgium. This study was also supported by the Ferring company (Copenhagen, Denmark) which provide free medication (Menopur) required for the group of patients who were randomized in the hMG COS group. The Ferring company was not involved in the study design, data analysis, writing and submission of the paper.. NCT01569945 (ClinicalTrials.gov).

Topics: Adult; Clomiphene; Endometriosis; Female; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Motility

To investigate whether fallopian tube sperm perfusion (FSP) would improve pregnancy rates compared with standard intrauterine insemination (IUI) in cases of male factor infertility.. In a randomized controlled trial at a university teaching hospital in Egypt, 120 couples with mild or moderate male factor infertility underwent a mild controlled ovarian stimulation protocol (clomiphene citrate plus human menopausal gonadotropin). Women were randomly allocated to group 1 (FSP via Foley catheter with 4 mL of inseminate) or group 2 (standard IUI with 0.5 mL of inseminate) (n=60 for both). The main outcome measure was clinical pregnancy rate.. There were no significant differences between the groups in terms of baseline clinical characteristics, semen parameters, or characteristics of stimulation cycles. The pregnancy rate was significantly higher in group 1 than in group 2 (16 [26.7%] vs 7 [11.7%]; P<0.04). There was no significant difference in the incidence of multiple pregnancy, abortion, or ectopic pregnancy between the groups.. Fallopian tube sperm perfusion is an effective technique in the management of mild-moderate male factor infertility and should, therefore, be considered before resorting to more sophisticated techniques of assisted reproduction.

Topics: Adult; Catheterization; Clomiphene; Egypt; Fallopian Tubes; Female; Hospitals, University; Humans; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Sperm Count

To demonstrate the noninferiority of highly purified menotropin (HP-hMG) compared with recombinant FSH (rFSH) regarding clinical pregnancy rate (PR) in intrauterine insemination (IUI) cycles.. Prospective randomized noninferiority trial.. Unit of physiopathology of human reproduction, university hospital.. Five hundred twenty-three patients with unexplained infertility or mild male infertility undergoing controlled ovarian hyperstimulation for IUI.. Patients were randomized for treatment with rFSH (262 patients) or HP-hMG (261 patients). Insemination was performed 34-36 hours after hCG injection.. The primary outcome was clinical pregnancy rate (PR). The secondary outcome was the number of interrupted cycles for high risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.. The clinical PR was 19.7% (95% confidence interval [CI] 15.3%-25.1%) in the HP-hMG group and 21.4% (95% CI 16.9%-26.8%) in the rFSH group [absolute difference -1.7% (95% CI -8.6%-5.2%)]; therefore, the noninferiority was demonstrated. The number of interrupted cycles for OHSS risk and multiple pregnancy was significantLy higher in the rFSH group, 8.4% (95% CI 5.6%-12.4%) than in the HP-hMG group 1.2% (95% CI 0.4%-3.3%) [absolute difference -7.27% (95% CI -11.3 to -3.7)].. HP-hMG is not inferior compared with rFSH regarding clinical PR.

Topics: Adult; Algorithms; Family Characteristics; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Male; Insemination, Artificial; Male; Menotropins; Menstrual Cycle; Pregnancy; Pregnancy Rate; Recombinant Proteins; Severity of Illness Index; Uterus

Seventy-three couples with male subfertility, which was due to oligo/astheno- and/or teratozoospermia (n = 63) or antisperm antibodies (n = 10), were randomly assigned to sequential timed natural intercourse, intrauterine insemination (IUI) and IUI + mild ovarian hyperstimulation. From the analysis of 384 observed cycles, IUI was shown to be effective in oligo/asthenozoospermia without severe teratozoospermia, when it was associated with moderate multifollicular induction, and in male immunologic subfertility, IUI was highly effective in nonstimulated cycles also.

Topics: Antibodies, Anti-Idiotypic; Asthenozoospermia; Clomiphene; Coitus; Cross-Over Studies; Female; Fertility Agents, Female; Humans; Infertility, Male; Insemination, Artificial; Live Birth; Male; Menotropins; Oligospermia; Ovary; Ovulation Induction; Pregnancy; Pregnancy Rate; Prospective Studies; Spermatozoa; Treatment Outcome

This study evaluates the efficacy of a stimulation protocol with clomiphene citrate (CC)/human menopausal gonadotropin (hMG)/cetrorelix and its effects on oocyte quality and endometrium. One hundred and twenty couples with male-factor infertility who were about to undergo their first intracytoplasmic sperm injection cycles were randomized into two groups. Sixty women were stimulated with the CC/hMG/cetrorelix protocol (cetrorelix group) and 60 received the buserelin long protocol (buserelin group). Fewer oocytes were recovered in the cetrorelix group than in the buserelin group (mean +/- standard deviation (SD): 11.1 +/- 4.0 vs. 17.3 +/- 5.8, p < 0.001); however, the percentages of metaphase II, metaphase I and germinal vesicle oocytes were similar between the two groups. Serum estradiol level was significantly lower in the cetrorelix than in the buserelin group (mean +/- SD: 2600.58 +/- 1189.11 vs. 3293.46 +/- 1221.49 pg/ml, p = 0.006), but the endometrial thickness was similar. The implantation rates (19.2% vs. 17.7%) and the pregnancy rates (41.7% vs. 40.0%) were similar between groups. The ampoules (mean +/- SD: 18.9 +/- 3.0 vs. 38.9 +/- 12.2, p < 0.001) and injections (mean +/- SD: 6.8 +/- 1.1 vs. 15.7 +/- 3.1, p < 0.001) of gonadotropin used were significantly lower in the cetrorelix group than in the buserelin group. No patients in either group developed a premature luteinizing hormone surge. The present study found no statistically significant difference between the two treatment modalities with regard to pregnancy rates.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Clomiphene; Embryo Culture Techniques; Estradiol; Female; Fertility Agents, Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Pregnancy; Sperm Injections, Intracytoplasmic; Treatment Outcome

The introduction of GnRH antagonists such as cetrorelix acetate has made possible the simplification of ovarian stimulation. However, the most effective protocol for their administration has not yet been clearly defined.. Forty women with male-factor infertility undergoing 40 ICSI cycles were included in the study. Clomiphene citrate at 100 mg a day was given from cycle day 3 through day 7. hMG at 150 IU was given on cycle days 4, 6 and 8, and was adjusted from day 9 according to the follicular and hormone responses. Cetrorelix acetate at 2.5 mg was administered when the leading follicle reached 14 mm. The remaining 0.5 mg was divided into two 0.25 mg injections for possible later use. Serum FSH, LH, estradiol and progesterone levels were measured daily from the day of cetrorelix acetate injection until hCG was given.. Serum LH level was suppressed effectively for 4 days. Four patients (10%) needed one or two additional injections of 0.25 mg cetrorelix acetate. No premature LH surge was detected in any of the women treated. Sixteen women became pregnant (40%), of which 14 pregnancies (35%) were ongoing at the time of writing.. This study demonstrates that this new protocol is feasible for couples with male-factor infertility undergoing ICSI.

Topics: Adult; Clomiphene; Drug Administration Schedule; Drug Therapy, Combination; Feasibility Studies; Female; Fertility Agents, Female; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Injections, Intracytoplasmic

Varicocele is the most common disease in infertile men and varicocelectomy remains the main treatment. During the last years a lot of drugs have been proposed in association with surgery. The aim of this study is verify the effects of the association between menotropin and subinguinal varicocelectomy on sperm parameters and pregnancy rate.. 60 patients with left varicocele were randomized in three groups of 20 patients: patients of group A were treated with menotropin since diagnosis for three months; patients of group B were treated with menotropin but started the treatment three months after surgical treatment; patients of group C were treated only with varicocelectomy. We have tested sperm parameters before and after three, six and twelve months from surgical treatment. After six and twelve months from varicocelectomy we have verified the pregnancy rates in the three groups.. After three months from surgical treatment, sperm parameters were significantly improved only in the group A (p < 0.05). After six months we have recorded a similar improvement even in the group B. After twelve months we have confirmed a significant improvement in groups A and B; the values were significantly higher than in the group C (p < 0.05). After six months the pregnancy rate was 42%, 25% and 22.2% respectively in the three groups. After twelve months we have recorded an important improvement of pregnancy rate in groups A and B (47% and 45% respectively) and a little improvement (27.7%) in group C.. Our data show a significant improvement of sperm parameters in the two groups treated with menotropin respect to the group treated with only varicocelectomy. It could be responsible for a similar improvement of the pregnancy rate. The association between varicocelectomy and early use of menotropin seem to improve testis functional rehabilitation.

Topics: Adult; Combined Modality Therapy; Female; Follicle Stimulating Hormone; Follow-Up Studies; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Ligation; Luteinizing Hormone; Male; Menotropins; Pregnancy; Pregnancy Rate; Semen; Sperm Count; Testosterone; Varicocele

In this randomized crossover trial we investigated whether the use of controlled ovarian hyperstimulation with low-dose human menopausal gonadotrophin in couples with male subfertility leads to a higher probability of conception when intrauterine insemination (IUI) is applied. We also investigated whether the efficacy of IUI in natural or stimulated cycles was related to the severity of male subfertility. Seventy-four couples completed 308 treatment cycles. Thirteen pregnancies occurred after IUI in a natural cycle (pregnancy rate per completed cycle: 8.4%) and 21 after IUI in a stimulated cycle (pregnancy rate per completed cycle: 13.7%). The difference between the two treatment modalities was not statistically significant. The efficacy of IUI in stimulated cycles was related to the severity of the semen defect. In couples with a total motile sperm count < 10 x 10(6), ovarian stimulation did not improve treatment outcome, while it did in couples with a total motile sperm count > or = 10 x 10(6). Compared with the expected chance of conceiving spontaneously without treatment, both natural and stimulated cycles improved the probability of conception. We conclude that, for the group as a whole, ovarian stimulation did not improve the probability of conception. However, in couples with less severe semen defects, ovarian stimulation did improve the probability of conception.

Topics: Adult; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Male; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Capacitation

The object of this study was to compare the biological outcome (oocyte maturity, fertilization, cleavage) and the clinical outcome after a 'long' (15-24 days) and a 'long-long' (25-40 days) protocol of GnRH-agonist administration for intracytoplasmic sperm injection. Group A consisted of 51 patients with a 15-24-day down regulation period and Group B consisted of 35 patients with a 25-40-day down regulation period, all of which entered ICSI due to severe male factor infertility. Duration and amount of gonadotropin stimulation, serum E2 on the day of hCG administration, number of oocytes retrieved, oocyte maturity, fertilization rate, cleavage rate and pregnancy outcome were comparable for the two groups of patients. Therefore, a flexible period of pituitary desensitization can be employed, allowing us to simplify planning for patients and for the medical staff without affecting the outcome of the trial.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Male; Male; Menotropins; Microinjections; Ovulation Induction; Pregnancy; Prospective Studies

To compare oocyte maturity, fertilization rate and cleavage rate after a short and long GnRH agonist (GnRH-a) stimulation protocol and intracytoplasmic sperm injection (ICSI).. Retrospective study of 34 sequential ICSI cycles stimulated with a short or long GnRH-a protocol.. A university-based tertiary care center for assisted reproductive treatment.. Significantly more oocytes were mature (metaphase II) after a long GnRH-a protocol then after a short GnRH-a protocol (25.6% and 80.8%, respectively). The long protocol resulted in more cleaving embryos (36/152 versus 9/132) and more cycles of ET (12/17 versus 5/17) than the short group.. A greater percentage of mature oocytes results from ovarian stimulation with a long GnRH-a protocol than a short GnRH-a protocol. Maturity could be assessed accurately after cumulus stripping that is required before ICSI. Fertilization rate and cleavage rate with ICSI was superior after a long GnRH-a stimulation protocol for superovulation.

Topics: Adult; Cleavage Stage, Ovum; Cytoplasm; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Male; Leuprolide; Male; Menotropins; Microinjections; Middle Aged; Oocytes; Ovulation Induction; Retrospective Studies; Spermatozoa

Ovarian stimulation combined with intra-uterine insemination (IUI) is an effective treatment of non-tubal infertility but most women undergo several cycles of treatment to achieve a pregnancy. This prospective study was designed to assess the consistency (or variation) of ovarian responses and the effect of various ovarian stimulation protocols on this consistency in consecutive cycles of ovarian stimulation and IUI in women with non-ovulatory infertility. A total of 86 regularly menstruating ovulating patients each completed three to six cycles of ovarian stimulation and IUI (n = 347 cycles). Ovarian stimulation was achieved by sequential clomiphene citrate/human menopausal gonadotrophin (HMG), HMG-only or combined gonadotrophin-releasing hormone analogue--HMG protocols in 33, 29 and 24 patients respectively, and each patient used the same protocol consistently throughout the study. Standard methods were used to monitor ovarian response and to perform IUI. Using each patient as her own control, repeated measurements analysis of variance revealed consistency of ovarian response in consecutive ovarian stimulation cycles, as shown by the number and mean diameter of maturing pre-ovulatory follicles, peak plasma oestradiol, duration of stimulation and mean HMG requirements. This consistency existed using any of the ovarian stimulation protocols. We conclude that regularly menstruating and ovulating women are likely to have similar ovarian responses in consecutive cycles of ovarian stimulation and IUI if the same ovarian stimulation protocol is used consistently.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cervix Mucus; Chorionic Gonadotropin; Clomiphene; Endometriosis; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies

To determine whether a new ovarian stimulation protocol termed "minimal stimulation" provides pregnancy rates (PRs) comparable with those in a conventional full stimulation protocol for patients undergoing assisted reproductive technologies (ART).. Prospective, nonrandomized study of patients in minimal stimulation or full stimulation, followed by standard IVF and zygote intrafallopian transfer or uterine-ET.. The ART program of the Mayo Clinic, Rochester, Minnesota.. Women (n = 120) 42 years of age or younger with serum day 3 FSH level < or = 15.0 mIU/mL (conversion factor to SI unit, 1.0), normal thyroid-stimulating hormone and PRL levels, normal endometrial cavity as observed on hysterosalpingogram, and partners with a normal semen analysis.. Oral clomiphene citrate, hMG, oocyte retrieval, IVF-ET.. Cancellations, implantation, pregnancy.. The cancellation rate was not significantly higher in minimal stimulation (25.8%) than in full stimulation (14.1%). Minimal stimulation cycles yielded fewer oocytes per aspiration (3.4 +/- 1.6) than full stimulation (10.1 +/- 5.4). There was no difference in the implantation rates per ET (minimal stimulation, 16.4%; full stimulation, 13.3%) or overall clinical PRs per retrieval (minimal stimulation, 31%; full stimulation, 42%).. Minimal stimulation for IVF is less expensive than full stimulation and minimizes monitoring and patient discomfort. In addition, it produces acceptable PRs and represents an attractive alternative to select patients undergoing ART.

Topics: Adult; Clomiphene; Embryo Implantation; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Infertility, Male; Male; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Prolactin; Prospective Studies; Reproductive Techniques; Sperm-Ovum Interactions; Thyrotropin; Treatment Outcome

To study in a randomized and longitudinal manner the efficacy of human menopausal gonadotropin (hMG) superovulation combined with intrauterine insemination (IUI) versus IUI alone in the treatment of various causes of infertility in the presence of normal ovulation.. An initially randomized and subsequently longitudinal study of infertile couples was performed at a university-based clinical research center. One hundred nineteen couples with longstanding infertility (average duration 3.7 years) associated with male factor infertility, unexplained infertility, and/or endometriosis were enrolled. All patients were randomized in the initial cycle to treatment with either hMG/IUI or urine LH-timed IUI alone. They were then followed longitudinally as they alternated subsequent cycles between the two modalities. Outcome indices measured were cycle fecundity, pregnancy outcome, and cumulative pregnancy rates evaluated by life-table analysis.. Human menopausal gonadotropin/IUI therapy was consistently more effective than IUI alone in the treatment of endometriosis, male factor infertility, and unexplained infertility, with cycle fecundities ranging from 7.1-19.0% versus 0-6.7%, respectively, during the first seven cycles.. Human menopausal gonadotropin/IUI is a more effective therapy for enhancing fertility than is IUI alone for the treatment of endometriosis, male factor infertility, and unexplained infertility.

Topics: Adult; Female; Follow-Up Studies; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Longitudinal Studies; Male; Menotropins; Pregnancy; Proportional Hazards Models; Risk

To determine whether intrauterine insemination (IUI) after ovarian stimulation with human menopausal gonadotropin (hMG) gives a better pregnancy rate (PR) than natural intercourse in couples with subfertility because of subnormal semen.. Prospective randomized controlled trial.. University based subfertility clinic.. Couples with subnormal semen as the only identifiable cause of subfertility.. In control cycles, the couples had natural intercourse. In IUI cycles, IUI was performed after ovarian stimulation with hMG and human chorionic gonadotropin.. The clinical PRs and complications of IUI cycles and control cycles were compared.. There were six clinical pregnancies in the 42 IUI cycles, whereas there was no clinical pregnancy in the 42 control cycles. The clinical PR in IUI cycles (14.3% per cycle) was significantly higher than that in control cycles (0%). Six patients (14.3%) developed moderate degree of ovarian hyperstimulation syndrome in IUI cycles.. Intrauterine insemination after ovarian stimulation with hMG is useful in treatment of subfertile couples with subnormal semen.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Humans; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Pregnancy; Prospective Studies; Semen; Sperm Count; Sperm Motility; Spermatozoa

The outcome of in vitro fertilization treatment in male-factor infertility is generally poor, due mainly to poor fertilization rate and hence fewer available embryos for replacement. This study was carried out to assess the value of asthenospermic sperm exposure to a motility enhancing agent, 2-deoxyadenosine (2-DXA), on our in vitro fertilization program in couples undergoing repeat treatment after previous failed fertilization. Following sperm wash and incubation in 2-DXA-supplemented medium, marked significant improvements were observed in the sperm motility pattern and the number of recoverable sperms as compared to control unexposed samples. There was also a significantly better fertilization rate and higher number of replaceable embryos available following sperm wash in 2-DXA as compared to those washed without it. Following embryo transfer, pregnancy rate was comparable to the generally reported pregnancy rates for routine in vitro fertilization and embryo transfer treatment. Three normal babies were born. Our results indicate that 2-DXA enhances fertilization rate in some asthenospermic patients and that it has no adverse effect on embryonic development.

Topics: Adult; Deoxyadenosines; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Male; Male; Menotropins; Ovulation Induction; Pregnancy; Sperm Motility; Treatment Outcome

Topics: Adult; Chorionic Gonadotropin; Double-Blind Method; Female; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Hypogonadism; Infertility, Female; Infertility, Male; Male; Menotropins; Ovulation Induction; Prospective Studies; Spermatogenesis

We conclude that, although many therapies have been advocated, no regimen has proved to be consistently effective in the treatment of idiopathic male infertility. Couples in which the husband is identified as having idiopathic infertility should be advised of the inconsistent and often low conception rates obtained with medical therapy. This should be weighed against the possibility of greater success with in vitro fertilization and the likelihood of success with artificial insemination by donor. Matson and colleagues performed in vitro fertilization on 75 couples in which the husband was oligospermic. When the husband was moderately (5.1 to 11.9 million motile sperm per milliliter) or severely (less than or equal to 5 million motile sperm per milliliter) oligospermic, fertilization rates were 56 and 30 per cent, respectively. This is in comparison to a fertilization rate of 72 per cent in normospermic couples. Following embryo transfer, pregnancy rates were similar in all groups. In vitro fertilization, although expensive and often not covered by insurance policies, may yield results in 1 month. Pharmacologic treatment of the male, which is less expensive, requires several months before improvement might be expected. The decision as to which course to recommend should be made after careful consultation with the couple. If empiric therapy is decided upon, the choice of an agent is somewhat arbitrary. Reasonable initial choices for the oligospermic patient are tamoxifen (or clomiphene citrate) or HCG (HCG may also be used in the patient with idiopathic asthenospermia). Testosterone rebound, with its risk of permanent azoospermia, is not an acceptable initial therapy. Similarly, the results of studies of testolactone, GnRH, pentoxifylline, and kallikrein either demonstrate low pregnancy rates or are too preliminary to recommend at this time. Regardless of the choice of therapy, it should be administered for at least 3 months to include the length of one spermatogenic cycle. The performance of randomized, double-blind, placebo-controlled, cross-over studies of present and future treatments will allow more definite conclusions to be drawn.

Topics: Chorionic Gonadotropin; Clinical Trials as Topic; Clomiphene; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Kallikreins; Male; Menotropins; Oligospermia; Phosphodiesterase Inhibitors; Pregnancy; Tamoxifen; Testolactone; Testosterone; Time Factors

Topics: Chorionic Gonadotropin; Clinical Trials as Topic; Humans; Infertility, Male; Male; Menotropins; Spermatogenesis

To compare the influences of controlled ovarian hyperstimulation (COH) drugs using recombinant follicular stimulating hormone (rFSH) versus human menopausal gonadotropins (hMG) on morphometry and morphology of MII oocytes in ICSI cycles.. In this prospective study, 363 MII oocytes from 50 ICSI cycles with male factor infertility were evaluated. The patients were divided into two groups according to the protocols of COH: I- rFSH and II- hMG. The immature oocytes were excluded from the study. All oocytes were categorized into four morphological groups of normal, and those with single, double, or multiple defects. The inclusive morphometrical criteria were: areas and diameters of oocyte, ooplasm, and zona pellucida (ZP). Also, circumferences of oocyte and ooplasm were assessed.. The ZP area and ooplasm diameter for both normal and abnormal oocytes were significantly higher in group I (P: .05; P: .028, respectively) compared to group II (P: .023; P: .003, respectively). In abnormal oocytes, ooplasm diameter was higher in group I compared to group II. Furthermore, ooplasm area for abnormal oocytes was significantly higher in group I compared to group II. There was an increasing trend for number of mature oocytes, in abnormal oocytes, for group I (5.53 ± 3.1) in comparison with group II (4.4 ± 2.97; P = .25). The rate of oocytes with normal morphology was significantly higher in hMG, when compared to rFSH groups.. Morphometrical parameters were increased in rFSH group, but the normal morphology of oocytes were significantly enhanced in hMG group. Treatment with proper dosage of ovulation induction drugs may enhance the number of normal sized oocytes.

Topics: Cell Size; Female; Follicle Stimulating Hormone; Humans; Infertility, Male; Male; Menotropins; Oocytes; Ovulation Induction; Prospective Studies; Recombinant Proteins; Sperm Injections, Intracytoplasmic; Zona Pellucida

To determine the impact of sperm morphology on success of intrauterine insemination (IUI) in unexplained and male subfertility.. Basal and post-wash normal percentage of sperm with normal morphology was assessed prospectively in 412 couples with 530 IUI cycles who underwent ovarian hyperstimulation with gonadotropins. The primary outcome was live birth per cycle. Receiver operating characteristics (ROC) curves were used to determine the effectiveness of sperm morphology to predict live birth in IUI cycles.. Normal sperm morphology (%) after preparation was higher in patients with live birth (5.4 ± 4.5 vs 4.3 ± 4.1; respectively, p<.05) in study population. In male subfertile group, normal sperm morphology before and after sperm preparation was higher in patients with live birth (1.3 ± 1.4 vs 0.6 ± 0.9; p<0.001 and 4.6 ± 4.4 vs 1.9 ± 2.2; p<0.01, respectively). However, both basal and post-wash normal sperm morphology (%) were similar in patients with and without live birth in unexplained group. The best cut-off value for normal sperm morphology (%) to predict live birth was 4.5% in male subfertile group with a sensitivity of 50.6% and specificity of 61.7%.. Morphological evaluation is not a reliable parameter alone for predicting pregnancy outcome in unexplained infertility. In male subfertility, post-wash normal sperm morphology percentage higher than 4.5 increases the probability of live birth.

Topics: Adult; Cohort Studies; Female; Fertility Agents, Female; Follicle Stimulating Hormone, Human; Humans; Infertility; Infertility, Male; Insemination, Artificial; Live Birth; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Prognosis; Prospective Studies; Recombinant Proteins; ROC Curve; Spermatozoa; Treatment Outcome; Young Adult

The Kallmann syndrome is a very rare congenital association of gonadotropin-releasing hormone deficiency and hyposmia or anosmia. Clinically it is characterized by low serum concentrations of testosterone and inadequate low levels of luteinizing hormone and follicle-stimulating hormone as well as incomplete sexual maturation, lack of secondary sexual features (facial and body hair growth, deepening of the voice), micropenis and sometimes even cryptorchidism. The reduced or absent sense of smell is typical for the Kallmann syndrome and distinguishes this syndrome from other causes of hypogonadotropic hypogonadism. Additional findings may include synkinesia, hearing loss, unilateral renal aplasia, brachy- or syndactyly, agenesis of corpus callosum, cleft palate and dental agenesis. A 19-year-old man presented to our male infertility clinic with delayed sexual maturation, eunuchoid habitus, micropenis, cryptorchidism, erectile dysfunction and absence of ejaculation, anemia and osteoporosis as well as low serum concentrations of luteinizing hormone, follicle-stimulating hormone and testosterone in combination with hyposmia.

Topics: Cholecalciferol; Chorionic Gonadotropin; Diagnosis, Differential; Drug Therapy, Combination; Follicle Stimulating Hormone; Humans; Infertility, Male; Inhibin-beta Subunits; Kallmann Syndrome; Luteinizing Hormone; Male; Menotropins; Testosterone; Vitamin D Deficiency; Young Adult

Data on the management of male infertility secondary to hypogonadotrophic hypogonadism (HH) are limited. We report our extensive experience with intramuscular injections of gonadotropins, one of the two methods used for this purpose. Eighty-seven married men (median age, 28 years) with either congenital (47 men) or acquired (40 men) HH were treated for a median of 26 months (range, 6-57) with intramuscular injections of gonadotropins (HCG/HMG) three times weekly for the purpose of achieving fertility. The outcome was assessed by achievement of one or more pregnancies. Of the 151 courses of HCG/HMG treatment administered to 87 patients, 85 courses (56.3%) were successful, resulting in 85 pregnancies (median pregnancy rate 2, range 1-10) in 35 patients (40%) while 52 cases did not achieve pregnancy. Responders had larger pretherapy testicular volume (9 +/- 3.6 cc) compared to non-responders [(5.7 +/- 2.0 cc), P < 0.0001], but there was no difference in age, LH, FSH or testosterone levels or doses of HCG/HMG used. The pregnancy rate was similar in those with congenital (51.4%) and acquired causes (48.6%) of HH (P = 0.83). Only testicular size was predictive of conception (P < 0.001, odds ratio 1.5, 95% CI 1.21-1.92) while age, pretherapy levels of testosterone, LH, FSH and doses of HCG/HMG did not predict the success of pregnancy. Gonadotropins are moderately effective in achieving one to several pregnancies in HH. Only testicular size is predictive of success in achieving pregnancy. There is no difference in success between those with congenital and acquired causes of HH.

Topics: Adolescent; Adult; Chorionic Gonadotropin; Follicle Stimulating Hormone; Gonadotropins; Humans; Hypogonadism; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Retrospective Studies; Testosterone; Treatment Outcome; Young Adult

Over the last several decades, as a result of an evolution in manufacturing processes, a marked development has been made in the field of gonadotropins for ovarian stimulation. Initially, therapeutic gonadotropins were produced from a simple process of urine extraction and purification; now they are produced via a complex system involving recombinant technology, which yields gonadotropins with high levels of purity, quality, and consistency.. A retrospective analysis of 865 consecutive intracytoplasmic sperm injection (ICSI) cycles of controlled ovarian hyperstimulation (COH) compared the clinical efficacy of three gonadotropins (menotropin [hMG; n = 299], highly-purified hMG [HP-hMG; n = 330] and follitropin alfa [r-hFSH; n = 236]) for ovarian stimulation after pituitary down-regulation. The endpoints were live birth rates and total doses of gonadotropin per cycle and per pregnancy.. Laboratory and clinical protocols remained unchanged over time, except for the type of gonadotropin used, which was introduced sequentially (hMG, then HP-hMG, and finally r-hFSH). Live birth rates were not significantly different for hMG (24.4%), HP-hMG (32.4%) and r-hFSH (30.1%; p = 0.09) groups. Total dose of gonadotropin per cycle was significantly higher in the hMG (2685 +/- 720 IU) and HP-hMG (2903 +/- 867 IU) groups compared with the r-hFSH-group (2268 +/- 747 IU; p < 0.001). Total dose of gonadotropin required to achieve clinical pregnancy was 15.7% and 11.0% higher for the hMG and HP-hMG groups, respectively, compared with the r-hFSH group, and for live births, the differences observed were 45.3% and 19.8%, respectively.. Although similar live birth rates were achieved, markedly lower doses of r-hFSH were required compared with hMG or HP-hMG.

Topics: Adult; Female; Follicle Stimulating Hormone, Human; Glycoprotein Hormones, alpha Subunit; Humans; Infertility, Male; Male; Menotropins; Pregnancy; Pregnancy Outcome; Retrospective Studies; Sperm Injections, Intracytoplasmic; Treatment Outcome; Ultrafiltration

Gonadotrophin treatment is capable of increasing intratesticular blood flow and improving sperm fertilization potential. A nitric oxide (NO)-mediated mechanism may play a role. This study aimed at evaluating whether the increase in intratesticular blood flow, in response to human menopausal gonadotrophin (hMG) treatment, is accompanied by an increase in seminal plasma NO levels in 20 normogonadotropic males affected by severe oligoasthenoteratozoospermia. Patients received 150 IU of hMG, three times a week for 3 months. Before starting treatment and at month 3 of therapy, levels of NO in the seminal plasma were determined, followed by ultrasound scanning of testis, Doppler evaluation of intratesticular vascular resistance, serum hormone and conventional semen evaluation. Statistical analysis was performed by using Wilcoxon test; the limit of statistical significance was p<0.05. At the end of treatment, seminal plasma concentration of NO, conventional semen parameters and testicular volume did not increase significantly. Follicle-stimulating hormone serum level significantly increased (p=0.014) after treatment, whereas luteinizing hormone, testosterone and oestradiol values did not change. The resistance index of both intratesticular arteries significantly decreased (p=0.012 and 0.005 for right and left testes respectively). The results of this study confirmed the positive effect of exogenous hMG on testicular blood flow, but failed to demonstrate any effect of hMG treatment on NO levels in the seminal plasma in infertile males.

Topics: Adult; Humans; Infertility, Male; Male; Menotropins; Nitric Oxide; Regional Blood Flow; Semen; Testis

Hypogonadotropic hypogonadism (HH) is an uncommon cause of male infertility. Even specialized centers see small numbers of patients and have little experience in restoring fertility in these patients. To explore the phenotypic heterogeneity and treatment outcome of HH, we summarized our 30-year experience.. Medical charts of 36 male patients (age range 11 to 42 years) with HH (81% primary, 19% secondary) treated at university affiliated male infertility centers were reviewed. Pubic hair stage, genital stage, testicular volume (TV), sexual function and sperm production were determined before and after human chorionic gonadotropin/human menopausal gonadotropin (hCG/hMG) treatment. Differences were analyzed statistically.. The population was stratified according to initial TV into a small testis subset (TV less than 4 ml in 23) and a large testis subset (TV 4 ml or greater in 13). Comparison of these 2 subsets revealed significant differences in the incidence of cryptorchidism (39% vs 8%) and Kallmann's syndrome (22% vs 0%), pubic hair stage (1.3 +/- 0.5 vs 3.5 +/- 1.4), genital stage (1.2 +/- 0.4 vs 3.9 +/- 0.9) and TV (1.6 +/- 0.9 vs 7.5 +/- 3.5 ml). Long-term administration of hCG/hMG for 12 to 240 months (average 56 +/- 11) resulted in sperm production in only 36% of the small testis subjects but in 71% of the large testis subjects.. Initial TV values provide insight into phenotypic variables such as time of onset and severity in patients with primary or secondary HH, and may predict sperm output in response to hCG/hMG therapy.

Topics: Adolescent; Adult; Child; Chorionic Gonadotropin; Genetic Heterogeneity; Humans; Infertility, Male; Kallmann Syndrome; Long-Term Care; Male; Menotropins; Organ Size; Phenotype; Retrospective Studies; Sexual Maturation; Spermatogenesis; Testis; Treatment Outcome

Topics: Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Male; Menotropins; Ovulation Induction; Recombinant Proteins; Sperm Injections, Intracytoplasmic; Spermatozoa; Triptorelin Pamoate; Zona Pellucida

The goal of the treatment of infertility is to apply therapeutic techniques to patients in a safe manner and at the same time increase the chances for conceiving and delivering healthy babies: basic and clinical research is more and more finalized directed to these goals. The conference "Advances in Infertility Treatment" held in Fort Lauderdale, Florida on January 24-26, 2002 covered many clinical and research aspects of this important therapeutic area. Important discussed issues included the impact of age, lifestyle, and the genetic set-up of patients in the pathogenesis and development of infertility-causing disorders such as male reproductive dysfunction, polycystic ovary syndrome, and ovarian failure. New ovulation induction regimens that may optimize, reduce complications, and lower costs of ovarian stimulation procedures and of assisted reproduction in general were presented. This was the 5th Ferring Pharmaceuticals Conference in the area of reproductive medicine held in Florida.

Topics: Abortion, Spontaneous; Costs and Cost Analysis; Female; Florida; Humans; Infertility; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Oocytes; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Preimplantation Diagnosis; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic

The present study compares the development and quality of blastocysts derived from conventional oocyte insemination with those derived from intracytoplasmic sperm injection (ICSI). Oocytes were collected from patients undergoing ovarian stimulation with human menopausal gonadotrophins for IVF. Patients with normal semen were assigned to conventional oocyte insemination while those with progressive motility <20% and/or normal sperm morphology < or =4% were assigned to ICSI. Resulting embryos were cultured for up to 6 days. The mean number and percentage of embryos reaching the blastocyst stage and the mean number and percentage of blastocysts of high quality on days 5-6 were assessed for both treatment groups and compared. The influence of paternal factors (sperm concentration, motility, progressive motility, morphology) on blastocyst development and quality were assessed by regression analyses. Significantly more ICSI-derived embryos arrested at the 5- to 8-cell stage (P = 0.024) concomitant with the activation of the paternal genome than those derived from conventional oocyte insemination. Significantly fewer ICSI-derived embryos reached the blastocyst stage on days 5-6 (P<0.001) and significantly fewer ICSI-derived embryos were of high quality (P = 0.002) compared with conventional oocyte insemination. When treatment groups were combined and evaluated by regression analysis, progressive motility and sperm morphology were significantly correlated with diminished blastocyst development and quality (P < 0.05). From these data, we conclude that paternal factors and/or performing ICSI in cases of severe male factor infertility may have a detrimental effect on blastocyst development and their quality.

Topics: Adult; Blastocyst; Culture Techniques; Female; Fertilization in Vitro; Humans; Infertility, Male; Male; Menotropins; Ovulation Induction; Regression Analysis; Semen; Sperm Injections, Intracytoplasmic; Sperm Motility; Spermatozoa; Time Factors

Klinefelter's syndrome and spinal cord injury are major causes of male infertility. Intracytoplasmic sperm injection (ICSI) is a relatively new method of assisted reproduction. A testicular biopsy was obtained from a patient with the double complications of non-mosaic 47,XXY Klinefelter's syndrome and spinal cord damage, and motile spermatozoa were collected. ICSI was then performed. Of the four sperm-injected oocytes, three became fertilized and cleaved. Two embryos were implanted, resulting in a single pregnancy with visible evidence of a heartbeat appearing at 6 weeks gestation. The pregnancy is now entering its 20th week. To the best of our knowledge, this is the first case of a pregnancy resulting from the sperm of a patient with double complications.

Topics: Adult; Biopsy; Chorionic Gonadotropin; Embryo Implantation; Embryo Transfer; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Klinefelter Syndrome; Male; Menotropins; Ovulation Induction; Pregnancy; Sperm Injections, Intracytoplasmic; Spermatozoa; Spinal Cord Injuries; Testis; Tissue and Organ Harvesting

To determine if a woman over age 45 with elevated serum follicle stimulating hormone (FSH) levels in the early follicular phase could still successfully conceive.. Female partner was treated with guaifenesin to improve cervical mucus quality and vaginal progesterone in the luteal phase. Careful monitoring of follicular maturation was performed.. A successful pregnancy after 14 months of progesterone therapy was achieved.. It is possible for a 46-year-old infertile woman with elevated serum FSH to achieve a pregnancy even when the male partner is taking calcium channel blockers for heart problems.

Topics: Aging; Calcium Channel Blockers; Clomiphene; Estradiol; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Guaifenesin; Humans; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Middle Aged; Pregnancy; Pregnancy Outcome; Progesterone; Vagina

Natural cycles were abandoned in in-vitro fertilization (IVF) embryo transfer, due to premature luteinizing hormone (LH) surges--and subsequent high cancellation rates. In this study, we investigated the administration of a new gonadotrophin-releasing hormone antagonist (Cetrorelix) in the late follicular phase of natural cycles in patients undergoing IVF and intracytoplasmic sperm injection (ICSI). A total of 44 cycles from 33 healthy women [mean age 34.1 +/- 1.4 (range 26-36) years] were monitored, starting on day 8 by daily ultrasound and measurement of serum concentrations of oestradiol, LH, follicle stimulating hormone (FSH) and progesterone. When plasma oestradiol concentrations reached 100-150 pg/ml, with a lead follicle between 12-14 mm diameter, a single injection (s.c.) of 0.5 mg (19 cycles) or 1 mg (25 cycles) Cetrorelix was administered. Human menopausal gonadotrophin (HMG; 150 IU) was administered daily at the time of the first injection of Cetrorelix, and repeated thereafter until human chorionic gonadotrophin (HCG) administration. Four out of 44 cycles were cancelled (9.0%). No decline in follicular growth or oestradiol secretion was observed after Cetrorelix administration. A total of 40 oocyte retrievals leading to 22 transfers (55%) was performed. In 10 cycles (25%), no oocyte was obtained. Fertilization failure despite ICSI occurred in six cycles (15%). In two patients the embryo was arrested at the 2 pronuclear (PN) stage. The stimulation was minimal (4.7 +/- 1.4 HMG ampoules). A total of seven clinical pregnancies was obtained (32.0% per transfer, 17.5% per retrieval), of which five are ongoing. Thus, a spontaneous cycle and the GnRH antagonist Cetrorelix in single dose administration could represent a first-choice IVF treatment with none of the complications and risks of current controlled ovarian hyperstimulation protocols, and an acceptable success rate.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Phase; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Microinjections; Pregnancy; Progesterone

The purpose of the present study is to determine the efficacy of an artificial intrauterine insemination program with frozen donor sperm and controlled ovarian hyperstimulation as an alternative therapy for infertility cause by hypergonadotropic azoospermia. Two hundred forty three insemination cycles with frozen donor sperm were analyzed. Clomiphene citrate, pure FSH, recombinant FSH or human menopausal gonadotropins were utilized for ovulation induction; human corionic gonadotropin (hCG), 10,000 IU, was administered when one or more dominant follicles with diameter > or = 16 mm were present; intrauterine insemination was performed 36 hours after the hCG injection. The pregnancy rate per cycle was 19.9%, and the cumulative pregnancy rate was 59.3%. It is concluded that intrauterine insemination with frozen donor sperm and ovulation induction is a good alternative for male factor infertility with no available treatment.

Topics: Chorionic Gonadotropin; Clomiphene; Cryopreservation; Female; Follicle Stimulating Hormone; Humans; Infertility, Male; Insemination, Artificial; Male; Menotropins; Oligospermia; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Outcome; Sperm Banks

To determine whether age, diagnosis, and cycle number influence cycle fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI.. Retrospective analysis.. The Center for Reproductive Medicine at the Brigham and Women's Hospital, a tertiary care academic medical center.. Two hundred seventy-four women who underwent controlled ovarian hyperstimulation with gonadotropins and IUI.. Infertility treatment with gonadotropins and IUI.. Pregnancy rates according to patient age, infertility diagnosis, and number of treatment cycles.. Pregnancy rates decreased with increasing patient age. The cumulative pregnancy rates varied greatly by diagnosis from 13% for patients with male factor infertility to 84% for patients with ovulatory factor infertility. Average cycle fecundity was considerably less varied by diagnosis. All pregnancies among patients with male factor infertility and tubal factor infertility were achieved during the first two cycles.. There is a clear age-related decline in fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI. Patients <40 years of age and those with male factor infertility or tubal factor infertility have a particularly poor prognosis.

Topics: Adult; Aging; Anovulation; Endometriosis; Fallopian Tube Diseases; Female; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Retrospective Studies

A prospective study was undertaken to evaluate the efficacy of stimulated in vitro fertilization (SIVF) using Clomiphene Citrate and hMG in different infertilities. The analysis was applied to the first 81 cycles over a period of 9 months in the years 1994-1996 in Sheffield Fertility Centre (SFC). The female patients included in this study were under 40 years of age, and their FSH and LH values were < 10IU/L. Mild and moderate male factor infertilities were included. For tubal factor infertility 16 cases were included with an implantation rate of 0%. The unexplained factor infertility included 33 cases with an implantation rate per embryo transfer (ET) of 41%. For male factor infertility there were 18 cases with an implantation rate per ET of 42%. Out of 3 cases in the ovulatory factor group none reached ET with 0% implantation. For multiple factor infertility 11 cases were included with a 0% implantation rate. The overall implantation per embryo transfer was 27%, while the implantation per cycle started was 15%. We conclude that there are certain infertility factors, i.e. unexplained infertility and mild male factor, which can have good results in IVF using CC/hMG only.

Topics: Adult; Clomiphene; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Infertility, Male; Male; Menotropins

To examine the efficacy of IUI on fecundity and baby-take-home rates in cases of infertility attributable to a male factor with and without a woman's hormone factor.. Retrospective analysis.. Department of Gynecology and Obstetrics at the General Public Hospital, Horn, Austria.. Seventy-eight long-standing involuntarily childless couples.. After a follicular phase GnRH analog (buserelin) protocol with hMG stimulation of the woman and a Percoll gradient preparation and capacitation of the man's semen, an IUI was performed.. Fecundity and baby-take-home rates.. One hundred nine inseminations were followed by 53 pregnancies (48.6%; 95% confidence intervals (CI) 38.9%-58.4%) and 38 deliveries (34.9%; 95% CI 26.0%-44.6%). Forty-nine children were born and 47 are alive (43.1%).. Intrauterine insemination combined with buserelin gonadotropin stimulation, Percoll semen preparation, and sperm capacitation is a feasible solution to the problem of sterility attributable to a male factor with and without a woman's hormone factor.

Topics: Adolescent; Adult; Birth Rate; Buserelin; Female; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Middle Aged; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Retrospective Studies; Sperm Capacitation

Isolated acute unilateral pleural effusion has twice been reported as the only symptom of ovarian hyperstimulation syndrome (Kingsland et al, 1989; Jewelewicz and Vande Wiele, 1975). The pathogenesis of this disorder is not fully understood and the presence of an isolated pleural effusion lends support to the role of systemic factors rather than purely the transudation of fluid from grossly enlarged ovaries in the progression of this disease. This article describes a second case of an isolated pleural effusion following in-vitro fertilization and embryo transfer.

Topics: Adult; Buserelin; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Male; Male; Menotropins; Ovarian Hyperstimulation Syndrome; Pleural Effusion

Idiopathic hypogonadotrophic hypogonadism (IHH) is a potentially correctable cause of male infertility. However hormonal treatment is usually a slow process and artificial reproductive techniques such as intracytoplasmic sperm injection (ICSI) might be resorted to before full testicular response has been achieved. We report here an unusual variant of IHH of post-pubertal onset in which early intervention with ICSI was attempted. Our patient was 37 years old and presented with male infertility due to azoospermia and undetectable serum gonadotrophin concentrations. He had an apparently normal pubertal development, a testicular volume of 8 ml, normal pituitary-thyroid and pituitary-adrenal function, as well as normal computerized tomographic appearance of the sella region. A combination of human chorionic gonadotrophin (HCG) and menopausal gonadotrophins (HMG) was administered. Spermatozoa were first detected in the semen after 3 months and reached a concentration of approximately 2x10(6)/ml after 9 months. ICSI was attempted at this point; the spermatozoa had good fertilizing ability and three embryos were obtained and replaced. Unfortunately no pregnancy resulted. Treatment with 5000 IU HCG and 150 IU HMG three times per week was continued and sperm counts rose rapidly thereafter to reach 28.3x10(6)/ml after 16 months of injections. His wife conceived naturally during this period and the pregnancy is now in the second trimester. This case illustrates the good prognosis of the rare patient with IHH of post-pubertal onset when treated with gonadotrophins, and suggests that ICSI procedures should be delayed until final testicular maturation is attained.

Topics: Adult; Chorionic Gonadotropin; Cytoplasm; Female; Fertilization in Vitro; Humans; Hypogonadism; Infertility, Male; Male; Menotropins; Microinjections; Pregnancy; Sperm Count; Spermatogenesis; Spermatozoa; Testis

Several tests based on semen variables have been proposed to predict the fertilization rate in the presence of male factor infertility, but their significance remains unclear. We investigated the utility of a screening test based on sperm survival (SST) to predict the outcome of in-vitro fertilization (IVF) cycles in the presence of male factor infertility. The SST was considered normal when the percentage of motile spermatozoa 24 h after oocyte insemination was > or =50%. The sperm survival test yielded abnormal results in <90% of cycles which were unsuccessful. The sensitivity of the SST was 87% and specificity 65% with a positive predictive value of 90% in the male factor group. We believe that the SST may be a useful predictor of the IVF cycle outcome and we propose its introduction into the routine preliminary evaluation of semen samples in cases of male factor infertility.

Topics: Adult; Cell Survival; Chorionic Gonadotropin; Female; Fertilization in Vitro; Humans; Infertility, Male; Male; Menotropins; Regression Analysis; ROC Curve; Sensitivity and Specificity; Sperm Motility; Spermatozoa; Time Factors

To investigate whether the consequences of premature P elevation on IVF-ET outcome are modulated by the quality of the ovarian response to controlled ovarian hyperstimulation (COH).. Retrospective analysis.. Assisted Reproduction Unit, Clamart, France.. One thousand twelve women undergoing 1,189 IVF-ET cycles.. Patients underwent COH with a time-released GnRH agonist and hMG. The ovarian response to COH was classified as strong (< or = 50 hMG ampules, peak E2 levels > 2,500 pg/mL, and > or = 10 mature oocytes; n = 340), weak (> 50 hMG ampules, peak E2 levels < or = 1,500 pg/mL, and < or = 5 mature oocytes; n = 285), or intermediate (remaining cases; n = 564). The IVF-ET outcome in each group was analyzed according to whether or not plasma P levels exceeded 0.9 ng/mL.. Pregnancy rates (PRs).. Clinical PRs were similar irrespective of low or high P levels in the strong (30% and 34%, respectively) and intermediate (31% and 30%, respectively) groups. However, in the weak group, P levels > 0.9 ng/mL were associated with lower PRs (3.2% and 23%, respectively).. In the presence of an adequate response to COH, P levels > 0.9 ng/mL were not associated with lower PRs, indicating that good embryo quality may compensate for the adverse endometrial effects of P. Conversely, when the response to COH was weak, premature P elevation led to drastically reduced PRs.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Progesterone; Retrospective Studies

The purpose of the present study is to determine the efficacy of an artificial insemination program with frozen donor sperm as an alternative therapy for male factor infertility. Twenty six women underwent 86 insemination cycles with frozen donor sperm. Clomiphene citrate or human menopausal gonadotropins were utilized for ovulation induction; human chorionic gonadotropins, 10,000 IU, was administered with one or more dominant follicles > or = 16 mm; intrauterine insemination was performed 36 hours after the injection. The pregnancy rate per cycle was 16.6%, and the cumulative pregnancy rate was 58.3%. It is concluded that intrauterine insemination with frozen donor sperm is a good alternative, instead of adoption, for male factor infertility with no available treatment.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Cryopreservation; Evaluation Studies as Topic; Female; Fertility Agents, Female; Humans; Infertility, Male; Insemination, Artificial, Heterologous; Male; Menotropins; Ovulation Induction; Pregnancy; Semen Preservation

A retrospective analysis of 260 completed intrauterine insemination (IUI) cycles was used in an attempt to identify significant variables predictive of treatment success. Couples received a maximum of three IUI cycles for the treatment of anovulation, cervical factors or unexplained infertility. Male factor problems were largely excluded by pretreatment screening. The overall pregnancy rate was 19.6% per completed cycle, the miscarriage rate 15.6%, the multiple pregnancy rate 23.5% and the cancellation rate 19%. Logistic regression identified four significant IUI variables [follicle number (P < 0.005), endometrial thickness (P < 0.005), duration of infertility (P < 0.01) and progressive motility (P < 0.05)] which were the most predictive of IUI success. The chance of conceiving when only one follicle was produced was only 7.6%, whereas with two follicles this chance increased to 26%. These variables were incorporated into a statistical model to allow the prediction of the chance of success in subsequent cycles. We conclude that careful patient selection criteria coupled with successful ovarian stimulation is the model for IUI success.

Topics: Adult; Female; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Models, Theoretical; Ovary; Pregnancy; Pregnancy Rate; Probability; Prognosis; Regression Analysis

We studied the prognostic value of sperm characteristics for the outcome of intra-uterine insemination with partner sperm (IUIPS). A total of 712 cycles of IUIPS following induction of ovulation with gonadotrophin (hMG/hCG) for 277 sterile couples attending the assisted reproductive technology centre of Poissy Hospital (78300-France) between January 1991 and December 1994 was studied retrospectively. Ninety-two clinical pregnancies were obtained giving an overall rate of 12.9% per cycle. None of the characteristics of the sperm as assessed initially correlated with outcome. In contrast, the number of motile spermatozoa given (n) affected outcome: for n < 1 x 10(6) the pregnancy rate was 2%; for n = 5 to 8 x 10(6) the rate was 19%. However, for +/- 8 x 10(6) the proportion of biochemical pregnancies and miscarriages was 40% which was significantly higher than for smaller concentration. The resort of IVF following 4 IUIPS failures leads to a pregnancy rate per cycle of only 6.7%.

Topics: Adult; Female; Fertility Agents, Female; Humans; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Prognosis; Retrospective Studies; Spermatozoa

To evaluate the success of electroejaculation with assisted reproductive technologies (ART) in anejaculate men after retroperitoneal lymph node dissection (RPLND) for testicular cancer.. Retrospective clinical study.. Tertiary care, university-affiliated IVF program.. Anejaculate men after RPLND, spouses.. Electroejaculation, microsurgical sperm aspiration, various assisted reproductive technologies.. Sperm density and motility, fertilization rate, pregnancy rate (PR).. Compared with patients not receiving chemotherapy, patients who received chemotherapy had diminished average sperm densities and motilities (63 x 10(6) and 20% versus 101 x 10(6) 32%, respectively); decreased fertilization rates per cycle for IVF and intracytoplasmic sperm injection (ICSI) (11% versus 26%, respectively); lower PRs per cycle of hMG-IUI and IVF (14% versus 60% and 8% versus 50%, respectively). No pregnancies were achieved with natural cycle-IUI, clomiphene citrate-IUI, or GIFT. Two couples progressed to intracytoplasmic sperm injection with one achieving the successful delivery of healthy twins. The overall PR per cycle was 22%.. Patients receiving chemotherapy had decreased sperm densities, motilities, fertilization, and PRs for each modality used. Rectal probe electroejaculation with ART can help anejaculate men after RPLND achieve biologic paternity. An early move to the more aggressive therapies (hMG-IUI, IVF, ICSI) is supported.

Topics: Adult; Cytoplasm; Ejaculation; Electric Stimulation; Female; Fertilization in Vitro; Humans; Infertility, Male; Insemination, Artificial; Lymph Nodes; Male; Menotropins; Microinjections; Microsurgery; Oocytes; Pregnancy; Reproductive Techniques; Retroperitoneal Space; Spermatozoa; Testicular Neoplasms

To assess the outcome of standard IVF treatment (nonmicromanipulated) with respect to total motile sperm number recovered by swim-up, particularly for couples with severe male factor infertility defined as total motile sperm number < 0.5 x 10(6).. Retrospective study of patients who underwent successful oocyte retrieval in an IVF program from August 10, 1992 to December 31, 1993.. A university-based tertiary referral center (The Toronto Hospital).. All cycles (n = 672) were divided into four groups according to total motile sperm number recovered using standard swim-up: group 1, total motile sperm number < or = 0.50 x 10(6); group 2, total motile sperm number between 0.51 and 1.00 x 10(6); group 3, total motile sperm number between 1.01 and 1.50 x 10(6); and group 4, total motile sperm number > or = 1.51 x 10(6). All patients received the same controlled ovarian hyperstimulation protocol, which consisted of a GnRH analog flare-up followed by parenteral menotropins. Clinical and cycle characteristics in the four groups were analyzed and outcome was evaluated.. There was no significant difference in clinical and cycle characteristics between the groups. The uniformity of the groups justified analysis of their outcome. A fertilization rate of 21.5% was achieved in couples with severe male factor (group 1). Fertilization rate and number of embryos transferred increased directly with the total motile sperm number. There was no significant difference in implantation rate per embryo between the groups.. The results in couples with severe male factor infertility compare favorably with monospermic fertilization rates reported in the literature using partial zona dissection and subzonal insertion but is lower than with intracytoplasmic sperm injection. Therefore, we believe that couples with severe male factor infertility should be considered for standard IVF, as long as adequate total motile sperm can be recovered (100 x 10(3) per dish). If intracytoplasmic sperm injection is available, it should be offered to these couples.

Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Male; Leuprolide; Male; Menotropins; Pregnancy; Retrospective Studies; Sperm Count; Sperm Motility

To investigate the effect of mild ovarian hyperstimulation on hormonal and sonographic variables of the subsequent natural cycle.. Prospective study of three consecutive cycles.. University Hospital, Department of Reproductive Medicine, Division of Obstetrics and Gynecology.. Twelve couples with subnormal semen as the only identifiable cause of subfertility.. Subjects were offered IUI for three cycles. In the second cycle, mild ovarian hyperstimulation with 75 IU IM hMG was applied daily and ovulation was induced with 5,000 IU hCG. In the first and third both natural cycles, serum samples were obtained for hormone measurements and ultrasound (US) scanning of the ovaries was performed.. To determine whether there was a carryover effect of mild ovarian hyperstimulation as applied in the second cycle, hormone levels and US scans of cycle 3 were compared with those of cycle 1.. None of the variables of cycle 3 were significantly different from those of cycle 1.. Because hormonal and sonographic variables in the subsequent natural cycle remain unchanged, a carryover effect of mild ovarian hyperstimulation with gonadotropins seems unlikely.

Topics: Adult; Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Ovary; Ovulation Induction; Prospective Studies

To determine if the controlled ovarian hyperstimulation (COH) regimen may cause sperm to appear subfertile only to improve considerably by changing the COH protocol.. Case report with retrospective review of previous fertilization rates according to COH protocol used.. Fertilization and pregnancy rates (PRs) after IVF-ET.. Known fertile donor sperm failed to fertilize any of 11 oocytes compared with 14 of 18 for processed retrograde ejaculate using the same oocyte pool. Retrospective analysis of other cycles for different female patients but same donor found 16.6% fertilization rate whenever luteal phase leuprolide acetate (LA)-hMG regimen was used compared with 70.6% with short-flare regimen.. Some COH regimens may cause oocyte or zona pellucida changes that create recognition defects for some sperm but not others. Interestingly, the sperm with the binding defect with the luteal phase LA-hMG COH protocol exhibited good fertilization rates with oocytes prepared with the short-flare protocol and demonstrated high in vivo PRs after IUI.

Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Male; Leuprolide; Male; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Zona Pellucida

The fertility potential of human sperm populations can be assessed by the presence of head-directed mannose ligand receptors (mannose-specific lectin) and the occurrence of spontaneous acrosome reactions after incubation under capacitating conditions in vitro. We have reported previously on the interaction between anti-hypertensive medications and their effects on these parameters of male fertility potential. In this report we document the effects of cessation of calcium ion channel blocker medication on male fertility. Motile spermatozoa from a 30 year old infertile patient on a calcium ion channel blocker as anti-hypertensive treatment had subnormal expression of mannose-specific lectin and did not exhibit spontaneous acrosome reactions. Three months following discontinuation of the medications, complete recovery of both the expression of head-directed mannose ligand receptors and the acrosome reaction was documented, though sperm motility and morphology remained unchanged. The couple had 2 years of infertility and previously failed to conceive through seven cycles of Pergonal/intra-uterine insemination. Conception occurred on the second Pergonal/intra-uterine insemination cycle after the husband discontinued calcium ion channel blocker medication. Calcium ion channel blockers may adversely affect sperm fertilizing potential. Discontinuation of such medications enhances the changes for conception.

Topics: Acrosome; Adult; Chorionic Gonadotropin; Female; Humans; Infertility, Male; Insemination, Artificial, Homologous; Lectins; Lectins, C-Type; Male; Mannose Receptor; Mannose-Binding Lectins; Menotropins; Nifedipine; Pregnancy; Receptors, Cell Surface; Sperm Motility; Spermatozoa

Recent studies report that superovulation combined with intrauterine insemination (IUI) is more successful than superovulation alone, IUI alone or superovulation with intracervical insemination in couples with male subfertility. Our study evaluated two superovulation protocols in the management of male factor infertility using IUI: (A) clomiphene citrate and human chorionic gonadotropin (HCG) and (B) human menopausal gonadotropin and HCG. Fifteen couples with severe oligoasthenozoospermia (OAS) were treated with protocol A in 54 cycles, and no pregnancies were achieved. Eight of the 15 couples with severe OAS subsequently received protocol B for 24 cycles and elicited no pregnancies. Thirty-seven couples with moderate OAS received protocol A for 169 cycles, and 2 pregnancies ensued (5.4% per couple and 1.12% per cycle). Twelve of the 35 nonpregnant couples with moderate OAS then received protocol B for 31 cycles, and 4 pregnancies were recorded (33.3% per couple and 12.9% per cycle).

Topics: Adult; Chorionic Gonadotropin; Clinical Protocols; Clomiphene; Female; Humans; Infertility, Male; Insemination, Artificial; Male; Menotropins; Middle Aged; Pregnancy; Superovulation; Treatment Outcome

We performed direct intraperitoneal insemination in combination with superovulation and washed husband's spermatozoa as the treatment of infertility caused by oligospermia, cervical subfertility, or ovulatory dysfunction or idiopathic infertility in 162 couples during 360 cycles.. The pregnancy rate per couple was 21.9% in the cervical-factor group, 20.9% in the idiopathic group, 4.9% in the oligospermia group, and 15.5% in the ovulatory dysfunction group.. The pregnancy rate was 33.3% for all couples and 15.0% for all cycles.

Topics: Adult; Cervix Uteri; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Infertility, Male; Injections, Intraperitoneal; Insemination, Artificial, Homologous; Male; Menotropins; Oligospermia; Ovulation; Ovulation Induction; Superovulation

A retrospective analysis was undertaken in 160 intrauterine insemination with husband's sperm (IUIH) cycles, performed in 45 couples. The male factor represented the main indication (80%). Women who conceived had a lower duration of infertility (4.4 years +/- 3.0 vs 7.7 +/- 2.98). A significantly and pardoxically lower motility (3+ and 2+) was observed in raw specimens within conceptional cycles. However in prepared specimens in conceptional cycles the percentage of motility 3+ and 2+ was significantly increased (80.6% +/- 8.1 versus 70.7% +/- 20.2). The most significant difference was found in regard to a better response to preparation among conceptional cycles, expressed as the percentual increase in motility 3+ and 2+ (55.6% +/- 3.9 vs 41.3% +/- 19.4).

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Menstrual Cycle; Pregnancy; Semen; Sperm Motility; Treatment Outcome

Donor insemination was performed in two fertility clinics using cryopreserved semen from the same sperm bank. Donors were selected in agreement with American Fertility Society recommendations. In the first clinic, cup insemination was combined with intra-uterine insemination in 321 cycles. Follicular development was closely monitored with vaginal echography and serum hormonal measurements. In the second clinic, 1287 insemination cycles were performed using intra-cervical insemination, timed only on basal body temperature. In the first clinic, a total of 53 pregnancies were obtained, of which seven were in 55 unstimulated cycles (12.5%), 21 in 159 cycles with clomiphene citrate stimulation (13.1%, P > 0.1), and 25 in 107 cycles stimulated with clomiphene plus human menopausal gonadotrophin (HMG) (23.9%, P < 0.03). No multiple pregnancies were observed in the latter group. In the second clinic, 159 pregnancies occurred during 1287 insemination cycles (12.4%). It is concluded that neither intra-uterine insemination, nor hormonal and echographic cycle monitoring, nor clomiphene citrate enhances the success rate of artificial insemination with donor semen, but HMG treatment probably exerts a favourable effect.

Topics: Adult; Age Factors; Clomiphene; Cryopreservation; Estradiol; Female; Humans; Infertility, Male; Insemination, Artificial, Heterologous; Male; Menotropins; Ovarian Follicle; Pregnancy; Semen; Semen Preservation; Sperm Motility; Ultrasonography

Topics: Embryonic and Fetal Development; Fertilization in Vitro; Humans; Infertility, Male; Insemination, Artificial; Male; Menotropins; Reproductive Techniques

Exogenous gonadotropins or pulsatile gonadotropin-releasing hormone is now most commonly used to treat male infertility due to hypogonadotropic hypogonadism. We report three cases of hypogonadotropic hypogonadism with variable etiologies and presentations who were successfully treated with exogenous gonadotropins and/or testosterone for their infertility. The diagnosis and clinical presentations of these three patients are summarized as follows. The first patient was a case of Kallmann's syndrome presented with short stature, infantile genitalia and anosmia. The second patient was a case of idiopathic hypogonadotropic hypogonadism presented with small genitalia and impotence. The third patient was a case of acquired hypogonadotropic hypogonadism due to pituitary adenoma presented with impotence, cold intolerance and visual field defect. After adequate therapy with human chorionic gonadotropin, human menopausal gonadotropin and/or testosterone, the secondary male characteristics of these three patients improved and the fertility were all restored.

Topics: Adolescent; Adult; Chorionic Gonadotropin; Humans; Hypogonadism; Infertility, Male; Male; Menotropins; Testosterone

This case report describes the use of GIFT to achieve pregnancy for a man with Kallmann's syndrome who obtained only marginal sperm counts with both the pulsatile GnRH infusion pump and gonadotropin injections. Failure of this man to achieve a pregnancy with hormonal therapy alone and in combination with IUI suggests that assisted reproductive technologies should be considered in male patients with Kallmann's syndrome when suboptimal sperm concentrations are achieved despite exogenous hormonal stimulation.

Topics: Adult; Chorionic Gonadotropin; Female; Gamete Intrafallopian Transfer; Humans; Infertility, Male; Insemination, Artificial, Homologous; Kallmann Syndrome; Male; Menotropins; Pregnancy; Superovulation

To identify male factor infertility among a group of patients in an assisted reproductive program (phase 1) and to evaluate the hemizona assay (HZA) in the diagnosis and prognosis of such a program (phase 2).. The IVF performance of normal gametes in the Tygerberg program were critically evaluated. Female patients were classified as pure tubal factor infertility, having a normal FSH:LH ratio on day 3 of the menstrual cycle. All participating women produced three or more preovulatory oocytes at retrieval and were inseminated with sperm considered normal by all present diagnostic criteria. The total and normal fertilization rate thresholds were defined in that group. Using those thresholds, couples tested for sperm binding in the HZA (n = 48) were used and divided into two groups according to their fertilization rates, namely group 1, low fertilization (< 55%) and group 2, normal fertilization (> 55%).. University-based tertiary care center.. Ninety-nine couples (589 oocytes) with pure tubal factor infertility and normal male factor were used in phase 1. Forty-eight couples with normal and abnormal male factors that had both HZA performed and IVF treatment were included in phase 2.. Investigation of the performance of normal gametes in 99 couples (589 oocytes) revealed the total fertilization rate (total number of oocytes fertilized/total number of oocytes inseminated) was (mean +/- SD) 88.6% +/- 16.8% and the normal fertilization rate (total number of oocytes with normal fertilization/total number of oocytes inseminated) was 81.3% +/- 22%. The minimum total fertilization rate that can be considered normal in the Tygerberg program using mean--2 SD is therefore 55% and for normal fertilization rate is 37%. The group with low fertilization rate (< 55%) showed a mean hemizona index (HZI) significantly lower; nevertheless, the distribution overlapping indicates a low discriminating power of the HZA. A sensitivity of 75% and a specificity of 75% were found; the positive and negative predictive values were 81% and 68%, respectively.. The results indicated the HZA and HZI contribute important information and can serve in conjunction with other semen characteristics as useful tools during the diagnosis of the male factor in assisted reproduction.

Topics: Chorionic Gonadotropin; Clomiphene; Discriminant Analysis; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Menstrual Cycle; Sperm Motility; Sperm-Ovum Interactions; Spermatozoa

A successful zygote intra-Fallopian transfer has been performed using spermatozoa from a patient with Kallmann's syndrome. Spermatogenesis was induced by hormonal treatment but even so, semen quality remained slightly impaired and no pregnancy occurred over 4 years, despite ovulation induction in the patient's spouse. Finally she conceived after assisted procreation by in-vitro fertilization and delivered a healthy baby.

Topics: Adult; Chorionic Gonadotropin; Female; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Kallmann Syndrome; Male; Menotropins; Pregnancy; Sperm Count; Sperm Motility; Spermatogenesis; Zygote Intrafallopian Transfer

Topics: Cervix Uteri; Fallopian Tubes; Female; Humans; Infertility, Male; Insemination, Artificial; Male; Menotropins; Ovary; Perfusion; Sexual Dysfunction, Physiological; Specimen Handling; Sperm Count; Spermatozoa; Testicular Neoplasms; Uterine Cervical Diseases

This case report describes an infertile male patient with panhypopituitarism, presumably caused by traumatic breech delivery. Previous hMG/hCG treatment had failed to induce spermatogenesis. Initiation of the production of motile and morphological normal sperm, despite persisting significant oligozoospermia was established with s.c. pulsatile LH-RH treatment. Spermatogenesis could be maintained with i.m. hCG injections bi-weekly. Later, fruitful in vitro fertilization (IVF) resulted in the birth of a healthy daughter.

Topics: Adult; Chorionic Gonadotropin; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypopituitarism; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Oligospermia; Spermatogenesis; Testosterone

We report a patient undergoing hMG-induced superovulation who demonstrated delayed excretion of hCG, originally believed to be because of successive biochemical pregnancies. However, sequential hCG titers after administration of exogenous hCG demonstrated a longer than normal half-life for the excretion of hCG in this patient. To what extent delayed excretion of hCG contributes to the diagnosis of biochemical pregnancy in assisted reproductive technology programs has yet to be determined.

Topics: Adult; Chorionic Gonadotropin; Female; Humans; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy

A previously hypophysectomized man with azoospermia, who was on androgen replacement therapy since 11 years, was studied with regard to his intratesticular steroid conversion capacity in vitro after which he was given combined hCG/hMG therapy. Before therapy a steroid conversion pattern similar to that seen in prepubertal boys was found, i.e. a high proportion of 20 alpha-dihydroprogesterone was produced while only smaller amounts of 17 alpha-hydroxyprogesterone was produced from the substrate 3H-progesterone. After only five weeks of hCG/hMG treatment, sperm counts and serum testosterone levels increased dramatically and a child was conceived. The steroid conversion pattern simultaneously switched to the mature, adult type with a low production of 20 alpha-dihydroprogesterone and large amounts of 17 alpha-hydroxyprogesterone being produced in vitro. Thus gonadotrophin substitution therapy may still be very effective after long term androgen replacement.

Topics: Chorionic Gonadotropin; Combined Modality Therapy; Craniopharyngioma; Drug Therapy, Combination; Female; Humans; Infertility, Male; Long-Term Care; Male; Menotropins; Oligospermia; Pituitary Irradiation; Pituitary Neoplasms; Postoperative Complications; Seminiferous Epithelium; Sexual Maturation; Sperm Count; Sperm-Ovum Interactions; Spermatogenesis; Testis; Testosterone

In order to study the function of the hypothalamic-pituitary-testicular axis in men referring for severe oligospermia, the hormonal pattern of 57 oligospermic men was compared to those of 19 healthy volunteers. Fourteen patients had plasma gonadotrophin levels in the normal range contrasting with low plasma testosterone (T) levels. An hyperprolactinemia was found in 2 of these men who were treated with bromocriptine. A dramatic increase in sperm count was obtained on month 9 to 12 of the therapy and 5 pregnancies were obtained. Two men with hypogonadotrophic hypogonadism and azoospermia were treated with gonadotrophins. Such a treatment induced a desquamation of immature germinal cells in the sperm on month 6 and the maturation et spermatozoa on month 18. By contrast to the latter patients, 8 men had a decrease in plasma T levels without clinical signs of hypoandrogenism. The spermocytogram showed numerous immature germinal cells. On month 7 of a treatment using gonadotrophins, the sperm count rose and 4 pregnancies were obtained after 3 to 12 months of therapy. In 2 patients an isolated FSH deficiency was suspected on the basis of undetectable FSH levels unresponsive to the infusion of GnRH. These patients were treated with hMG. This treatment induced a sharp increase in sperm count on month 6. Forty-three patients had an increase in either LH and/or FSH: 24 men had plasma testosterone and LH levels in the normal ranges, contrasting with an increase in plasma FSH level. In such men, the mean of testosterone level was significantly (p less than 0.001) lower than in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Bromocriptine; Chorionic Gonadotropin; Estradiol; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Hyperprolactinemia; Hypogonadism; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Prolactin; Sperm Count; Tamoxifen; Testosterone

To examine the usefulness of intrauterine insemination in women with various fertility factors, we retrospectively analyzed data from women treated during 1986 and 1987. Ninety-three patients underwent 1-11 cycles of single or double procedures, for a total of 423 inseminations in 263 treatment cycles. Twenty-six patients (28%) conceived, for a 10% total pregnancy rate per cycle, with 58% of the pregnancies resulting from double inseminations per cycle. An average of two treatment cycles was required to achieve pregnancy. Eight pregnancies (31%) occurred in spontaneous cycles, while 18 (69%) occurred in stimulated cycles. While clomiphene citrate therapy was useful in anovulatory patients, it was of no benefit in ovulatory patients being treated with intrauterine insemination. Human menopausal gonadotropin therapy was of benefit in both ovulatory and anovulatory patients when combined with intrauterine insemination. The live birth rate was higher (75%) in spontaneous cycles than in stimulated cycles (44%). Semen preparation was accomplished by sperm washing in 61% of the pregnancies and by Percoll preparation in 39%. The effectiveness of the discontinuous Percoll gradient for semen preparation for insemination was suggested by a pregnancy rate of 9% per cycle. While the mean sperm count in the pregnant group was 44 million, successful pregnancy was accomplished with a double insemination of 880,000 and 1.16 million rapidly progressive sperm in the first and second inseminate, respectively. The data confirm the important role of intrauterine insemination for the treatment of infertility.

Topics: Adult; Clomiphene; Female; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Menstrual Cycle; Middle Aged; Ovulation Induction; Povidone; Pregnancy; Retrospective Studies; Silicon Dioxide; Spermatozoa; Therapeutic Irrigation; Uterus

To evaluate the effect of hMG-hCG treatment on spermatogenic impairment, DNA/RNA syntheses were measured in 25 patients with idiopathic male infertility by estimating the values of 3H-thymidine and 14C-uridine incorporation into the testicular tissue cultured with or without the hormonal treatment. Without the hormonal treatment, the levels of 3H-thymidine incorporation were in inverse correlation with the progress of spermatogenic impairment, whereas disturbances in responsiveness to the hormonal treatment directly correlated with spermatogenic impairment. Although the 14C-uridine incorporation increased both with and without the hormonal treatment, the values showed different patterns from those of 3H-thymidine incorporation. It would appear that the DNA synthesis in testicular tissue cultured with or without hMG-hCG treatment might predict the responsiveness to hormonal treatment for patients with idiopathic male infertility.

Topics: Chorionic Gonadotropin; Culture Techniques; DNA; Follicle Stimulating Hormone; Infertility, Male; Luteinizing Hormone; Male; Menotropins; RNA; Testis

Most invasive techniques (i.e., in-vitro fertilization, gamete intrafallopian transfer) used for the therapy of unexplained or male-related infertility involve the induction of multiple follicular development (MFD). The efficacy of MFD in conjunction with a non-invasive technique (artificial insemination with husband's semen) was evaluated in a group of 41 couples with long-lasting infertility. MFD was obtained by means of clomiphene citrate and exogenous gonadotropins. Within 6 months of treatment, pregnancy was achieved by 52.2% of couples with male-related infertility and by 54.5% of couples with unexplained infertility. Sperm parameters, age of the female partner and preovulatory estradiol peak did not show any significant difference between couples who conceived and those who did not. It is concluded that induction of MFD represents an effective therapy and might replace invasive techniques for the treatment of the above conditions.

Topics: Adult; Clomiphene; Female; Follicle Stimulating Hormone; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Outcome; Sperm Count; Sperm Motility

Fifty infertile women with oligomenorrhea, anovulation, or luteal phase defects were selected for a combined therapy consisting of a gonadotropin-releasing hormone analog (Buserelin Hoechst AG, Frankfurt/Main, FRG) and human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG). Serving as their own controls, these women had been subjected to a total of 238 hMG/hCG treatment cycles with no pregnancy observed (average, 4.7 cycles; range 2 to 14). Of these 238 hMG/hCG cycles, only 98 (41.1%) appeared normal, while the others showed symptoms consistent with inadequate follicle maturation, luteal phase defects, and premature luteinization. In contrast, 89 cycles from 133 combined buserelin/hMG/hCG treatment cycles (66.9%) appeared to be normal, with no evidence of premature luteinization, and 21 patients became pregnant. These data indicate that the likelihood of group II World Health Organization (WHO) patients becoming pregnant with hMG/hCG therapy may be enhanced when endogenous gonadotropin secretion is suppressed at the same time.

Topics: Buserelin; Chorionic Gonadotropin; Drug Therapy, Combination; Female; Humans; Infertility, Male; Male; Menotropins

Topics: Biopsy; Chorionic Gonadotropin; Humans; Infertility, Male; Leydig Cells; Male; Menotropins; Spermatogenesis; Testis; Testosterone

Topics: Adult; Chorionic Gonadotropin; Humans; Hypopituitarism; Infertility, Male; Male; Menotropins; Sexual Maturation; Testosterone

To investigate the relationship between testicular follicle stimulating hormone (FSH) receptors and the effectiveness of human menopausal gonadotropin (hMG-hCG) treatment in idiopathic male infertility, 48 infertile men were examined. Most of the 14 patients without detectable testicular high affinity FSH receptors did not show any increase in sperm count after the hMG-hCG treatment, whereas 23 of the 34 patients with FSH receptors responded to the treatment. In patients with FSH receptors, patients with a middle or high Johnsen's score count responded more than those with a low score count did. From the above results, it seems that both the presence or absence of testicular FSH receptors and the histological appearance of spermatogenesis predict responsiveness to hMG-hCG treatment in infertile men.

Topics: Adult; Binding Sites; Chorionic Gonadotropin; Humans; Infertility, Male; Male; Menotropins; Middle Aged; Receptors, FSH; Spermatogenesis; Testis

In vivo and in vitro studies were performed to determine the function of Leydig and Sertoli cells of the human testis with various degrees of spermatogenic impairment. The increases in basal and peak serum levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) after LH-RH administration correlated with the degree of impairment of spermatogenesis, and the basal peripheral blood levels of testosterone and that after human chorionic gonadotropin (hCG) administration for patients with moderate or severe impairment were significantly lower than the values for those with mild impairment. The concentration of testosterone in the internal spermatic vein of varicocele patients with or without hCG treatment did not differ between in mild and moderate impairment. In studies on cultured Sertoli cells, the production rate of plasminogen activator in patients with severe impairment was significantly lower than that in patients with moderate or mild impairment. The decrease in testicular high-affinity binding site for FSH correlated with the degree of hypospermatogenesis found in idiopathic male infertility, but, on the contrary, the hCG (LH) receptors showed no correlation with the degree of impairment of spermatogenesis. In the investigation of the relationship between testicular FSH receptors and the effectiveness of human menopausal gonadotropin (hMG)-hCG treatment on idiopathic male infertility, the presence or absence of testicular FSH receptors predicted the responsiveness to the treatment.

Topics: Chorionic Gonadotropin; Follicle Stimulating Hormone; Humans; In Vitro Techniques; Infertility, Male; Leydig Cells; Luteinizing Hormone; Male; Menotropins; Oligospermia; Plasminogen Activators; Receptors, FSH; Receptors, LH; Sertoli Cells; Spermatogenesis; Testosterone; Thyrotropin-Releasing Hormone

A case is presented of a twenty-nine-year-old acromegalic man with sexual problems and fertility disturbance due to pituitary adenoma, who successfully fathered. Various endocrinologic studies, skill x-ray film, and computerized tomography (CT) scan revealed a pituitary adenoma. Testicular biopsy specimen also supported that the cause of sexual problems and fertility disturbance was secondary in origin. One month after transsphenoidal pituitary adenectomy, administration of human chorionic gonadotropin and human menopausal gonadotropin was started. His potency was improved immediately after start of the treatment, and his wife became pregnant five months later.

Topics: Acromegaly; Adenoma; Adult; Chorionic Gonadotropin; Humans; Infertility, Male; Male; Menotropins; Pituitary Neoplasms

Clinical experiences of HCG-HMG therapy for 56 cases of idiopathic male infertility were studied. Serum levels of LH, FSH and testosterone were measured before therapy. Sperm density improved in 25% of all cases. In the low FSH group, sperm density showed a high rate of improvement. The basal FSH was the best indicator to predict the prognosis of fertility. Additional measurements of LH and FSH response to GnRH gave further information on the prospect of fertility.

Topics: Chorionic Gonadotropin; Drug Therapy, Combination; Gonadotropin-Releasing Hormone; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Sperm Count; Testosterone

Topics: Adenoma; Adult; Bromocriptine; Chorionic Gonadotropin; Drug Resistance; Humans; Infertility, Male; Male; Menotropins; Pituitary Neoplasms; Prolactin

Pituitary function studies were performed on a 31-year-old man who had oligospermia and a very low seminal volume (0.1 ml). The low testosterone and gonadotropin levels, the remarkable testosterone response to human chorionic gonadotropin (hCG) stimulation, and the sluggish luteinizing hormone (LH) response to luteinizing hormone stimulating hormone (LH-RH) stimulation suggested the presence of hypogonadotropic hypogonadism. Treatment with a combination of human menopausal gonadotropin (hMG)-hCG resulted in the increase in the volume of seminal fluid and the sperm density. His wife achieved two pregnancies during the treatment. This report indicates that the findings of oligospermia and very low seminal volume should be followed by an investigation of the hypothalamo-pituitary testicular axis. Fertility in men with hypogonadotropic hypogonadism can be effectively induced with a combination of hMG-hCG treatment.

Topics: Adult; Chorionic Gonadotropin; Humans; Hypogonadism; Infertility, Male; Male; Menotropins; Semen; Sperm Count

In order to investigate the relationship between testicular FSH receptors and the effectiveness of hMG-hCG treatment in idiopathic male infertility, 36 infertile men were examined. None of the 13 patients without detectable testicular high affinity FSH receptors showed any increase in motile sperm count after the hMG-hCG treatment, whereas 11 of the 23 patients with FSH receptors responded to the treatment. In patients with FSH receptors, patients with a middle or high Johnsen's score count responded more than those with a low score count did. From the above results, it seems that both the presence or absence of testicular FSH receptors and the histological appearance of spermatogenesis predict responsiveness to hMG-hCG treatment in infertile men.

Topics: Adult; Chorionic Gonadotropin; Humans; Infertility, Male; Male; Menotropins; Middle Aged; Receptors, FSH; Testis

The in vitro conversion of tritiated pregnenolone and progesterone was studied in testicular tissue from three infertile adult males before and during 25-30 weeks of therapy with hCG alone or combined with hMG. Furthermore, the in vitro conversion of pregnenolone was studied in testicular tissue from five prepubertal boys with undescended testes, two of whom had been subjected to hCG treatment for 5 weeks. The gonadotrophic treatment appeared to augment the steroid conversion mediated by the enzymes 3 beta-hydroxysteroid dehydrogenase and 17 alpha-hydroxylase in adult as well as prepubertal testicular tissue. The conversion mediated by C17-20-lyase along the delta 4 metabolic pathway was not increased, causing a "trap" along the delta 4 metabolic pathway. The increased production of testosterone in vitro from tritiated pregnenolone, which was observed during gonadotrophic treatment, probably took place along the delta 5 metabolic pathway through the C17-20-lyase step, whereas C21 steroids converted to the delta 4 metabolic pathway were found to be "trapped" as 17 alpha-hydroxyprogesterone.

Topics: Adult; Biopsy; Child; Child, Preschool; Chorionic Gonadotropin; Cryptorchidism; Gonadotropins; Humans; In Vitro Techniques; Infertility, Male; Male; Menotropins; Pregnenolone; Progesterone; Puberty; Spermatogenesis; Testis; Testosterone

The enzyme 17 alpha-hydroxylase catalyzes the conversion of progesterone to 17 alpha-hydroxyprogesterone in the testis and may be studied with the use of incubation of testicular tissue with [3H] progesterone in vitro. The enzyme 20 alpha-hydroxysteroid dehydrogenase catalyzes the conversion of progesterone to 20 alpha-dihydroprogesterone. These enzymes were studied in testicular tissue from 105 human males regarding the effects of aging, different pathophysiological conditions, and gonadotrophic or estrogenic treatment. 17 alpha-Hydroxylase activity was low in vitro in testicular tissue from prepubertal boys, adult men with pituitary tumors, and estrogen-treated elderly men. In nontreated elderly men and certain infertile adult men, 17 alpha-hydroxylase was more active than in the above-mentioned patient groups, albeit lower than in adolescent and adult men. Gonadotropic treatment increased the conversion mediated by 17 alpha-hydroxylase in prepubertal as well as adult testicular tissue. In conclusion, the activity of 17 alpha-hydroxylase may be influenced by gonadotrophic hormones and may be an indicator of the testicular endocrine state at the moment of biopsy. Testicular 20 alpha-hydroxysteroid dehydrogenase seems to be active during low gonadotrophic influence and might even be inhibited by gonadotrophic stimulation.

Topics: 20-Hydroxysteroid Dehydrogenases; Adolescent; Adult; Aging; Child; Child, Preschool; Chorionic Gonadotropin; Cryptorchidism; Estrogens; Female; Humans; In Vitro Techniques; Infertility, Male; Male; Menotropins; Pituitary Neoplasms; Pregnancy; Progesterone; Puberty; Steroid 17-alpha-Hydroxylase; Testis

We measured testicular FSH receptors in 27 infertile men before, or 1, 3, 5, 7, or 14 days after a single administration of 150 IU of hMG. The administration of hMG reduced Bmax for FSH receptors to about 50% of that in the preadministration testes for 5 days. From the seventh day, Bmax of FSH receptors began to increase and returned to the preadministration level 14 days after the administration.

Topics: Binding Sites; Follicle Stimulating Hormone; Humans; Infertility, Male; Kinetics; Male; Menotropins; Receptors, Cell Surface; Receptors, FSH; Testis; Time Factors

In vitro fertilization and embryo transfer was carried out in a couple that has been infertile for 7 years. High titers of antisperm autoantibodies in the husband's serum are (table, see text) believed to be the main cause of their infertility. Prolonged methylprednisolone treatment of the man combined with artificial insemination remained unsuccessful. In two IVF attempts embryos were obtained and replaced using capacitated sperm of the husband. A pregnancy was established in the second IVF cycle, but a spontaneous abortion followed after 6 weeks of amenorrhea.

Topics: Adult; Agglutination; Agglutination Tests; Antibodies; Clomiphene; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Progesterone; Sperm Capacitation; Sperm Motility; Spermatozoa

We evaluated the efficacy of gonadotropin treatment in stimulating spermatogenesis in men with hypogonadotropic hypogonadism. When 21 men with hypogonadotropic hypogonadism were treated with human chorionic gonadotropin, the sperm count increased to within the normal range in the 6 in whom hypogonadism had begun after puberty, but in only 1 of the 15 in whom it had begun before puberty (P less than 0.002). When the remaining 14 men with prepubertal hypogonadism were treated with human menopausal gonadotropin in addition to human chorionic gonadotropin, the sperm count increased to normal in 5 of the 7 who had not had cryptorchidism, but in only 1 of the 7 who had (P less than 0.05). The need for human menopausal gonadotropin as a replacement for follicle-stimulating hormone could not be predicted by pretreatment serum and urinary levels of follicle-stimulating hormone. We conclude that gonadotropin treatment will usually increase the sperm count to normal in men with hypogonadotropic hypogonadism, unless cryptorchidism has occurred. The need for human menopausal gonadotropin treatment appears to depend on the time of onset of hypogonadism.

Topics: Adult; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Gonadotropins; Gonadotropins, Pituitary; Humans; Hypogonadism; Hypothalamic Diseases; Infertility, Male; Male; Menotropins; Middle Aged; Pituitary Diseases; Pregnancy; Sperm Count; Spermatogenesis; Stimulation, Chemical

The effect of sperm concentration and follicular stimulation protocol on in vitro fertilization of human oocytes is not well established. Comparison was made of three inseminating concentrations (250,000, 375,000, and 500,000 progressively motile sperm/oocyte) and three protocols (human menopausal gonadotropin [hMG], clomiphene citrate [CC], and combination hMG/CC) on the fertilization rate of mature and immature oocytes in couples with male factor and non-male factor infertility. In non-male factor couples, total fertilization rates for CC, hMG, and hMG/CC were 70.3%, 54.5%, and 68.8%, respectively, while total fertilization rates at the varying number of inseminating sperm were not significantly different. Mature oocytes were more likely than immature oocytes to fertilize. Among semen male factor couples, there was no difference in fertilization by stimulation protocol; however, insemination with the higher number of inseminating sperm resulted in an increased fertilization rate.

Topics: Clomiphene; Female; Fertilization in Vitro; Humans; Infertility, Male; Male; Menotropins; Ovulation Induction; Sperm Count; Sperm Motility

The use of HMG is only justified to obtain a pregnancy, and cannot be used until after an investigation which excludes other causes of sterility, and necessitates careful surveillance. The contraindications should be respected. The author discusses the present indications for the administrations of HMG.

Topics: Amenorrhea; Anovulation; Female; Fertilization in Vitro; Humans; Infertility, Female; Infertility, Male; Insemination, Artificial; Male; Menotropins

Changes in sex hormone levels, testicular volume and sperm count during hCG/hMG therapy were studied in 44 cases of idiopathic male infertility. These patients were divided into two groups and treated for 12 weeks. In group I, which consisted of 5 cases of azoospermia, 10 cases of severe oligozoospermia (less than 10 X 10(6)/ml) and 12 cases of mild oligozoospermia (10-50 X 10(6)/ml), 1,000 IU of hCG and 75 IU of hMG were both administered once a week. In group II, which consisted of 3 cases of azoospermia, 7 cases of severe oligozoospermia and 7 cases of mild oligozoospermia, 1,000 IU of hCG and 150 IU of hMG were both administered once a week. After 12 weeks, increase in sperm count was observed in 7 cases (26%) in group I and 4 cases (24%) in group II. Pregnancy was ensued in 4 cases in group I. There was no significant changes in testicular volume or sex hormone levels during hCG/hMG therapy.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Follicle Stimulating Hormone; Humans; Infertility, Male; Injections, Intramuscular; Luteinizing Hormone; Male; Menotropins; Prolactin; Sperm Count; Testis; Testosterone

Two men with primary infertility after 6 to 11 years of marriage were found to have isolated follicle-stimulating hormone deficiency syndrome (IFDS). Their endogenous gonadotropin secretion was compared with that of two other infertile men with hypothalamic disease (Kallmann's syndrome) and pituitary tumor with hyperprolactinemia. Treatment with intramuscular gonadotropin was given to produce circulating and 24-hour urine levels of luteinizing hormone and follicle-stimulating hormone at or above the upper limit of the normal male range to ensure continued gonadal stimulation. Sperm counts increased in IFDS men within 6 to 26 weeks, with maximum total sperm counts of 33.5 and 20 million after 9 to 80 weeks. Pregnancy occurred after 20 weeks' therapy in one patient's wife with the subsequent delivery of a normal male infant. IFDS may be a treatable cause of male infertility given adequate gonadotropin therapy.

Topics: Adult; Chorionic Gonadotropin; Follicle Stimulating Hormone; Humans; Hypothalamic Diseases; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Pituitary Neoplasms; Prolactin; Sex Hormone-Binding Globulin; Sperm Count; Spermatogenesis; Time Factors

Out of 49 patients who received gonadotropic therapy, 29 presented with FSH less than 1.5 mIU/ml and 20 had more than 1.5 mIU/ml. The success rate (as determined by semen analysis) in the former group was 86% (25 patients - 22 of those patients fathered one or more children) and in the latter - 5% (only 1 patient). The mean FSH level in the 20 patients who showed improvement following HMG/hCG therapy was 0.9 mIU/ml and in the 25 patients in whom gonadotropic therapy was ineffective - 2 mIU/ml.

Topics: Chorionic Gonadotropin; Follicle Stimulating Hormone; Gonadotropins; Humans; Hypogonadism; Infertility, Male; Luteinizing Hormone; Male; Menotropins

Testicular biopsy specimens from 11 infertile men were incubated in vitro with [3H]progesterone before and during long term gonadotrophic treatment. The main metabolites along the delta-4 metabolic pathway and 20 alpha-dihydro-progesterone were determined and the ratio between 20 alpha-dihydro-progesterone and 17 alpha-hydroxyprogesterone formed in vitro was calculated. In 5 patients with originally high ratios (indicating gonadotrophic understimulation), steroid metabolism changed significantly towards a more stimulated pattern. Three of these patients also showed a significant increase in sperm output and 2 of them fathered children. In 6 patients with an originally low ratio (indicating adequate gonadotrophic stimulation) no change in steroid metabolism in vitro or spermatogenesis was seen during therapy. Thus, this ratio between formed 20 alpha-dihydro-progesterone and 17 alpha-hydroxyprogesterone in vitro seems to be of value in predicting whether gonadotrophic treatment will be of clinical benefit.

Topics: Adult; Chorionic Gonadotropin; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Steroids; Testis

Topics: Adult; Gonadotropins, Equine; Hormones; Humans; Infertility, Male; Male; Menotropins; Mesterolone; Middle Aged; Oligospermia

Topics: Chorionic Gonadotropin; Clomiphene; Drug Evaluation; Drug Therapy, Combination; Fertility Agents, Male; Humans; Infertility, Male; Male; Menotropins; Mesterolone; Spermatozoa

Topics: Adult; Arginine; Chorionic Gonadotropin; Dihydrotestosterone; Drug Therapy, Combination; Follicle Stimulating Hormone; Gonadotropins, Pituitary; Humans; Infertility, Male; Kallikreins; Luteinizing Hormone; Male; Menotropins; Mesterolone

Amoung 95 cases of infertility due to oligo-asthenospermia with normal or low FHS, treated by the association HMG/HCG, 13 cases could be considered a success. From this particularly favourable slries, the author attempts to codify the indications of gonadotrophines in male sterilities. He suggests that such an indication, obvious in case of hypogonadotrophic hypogonadism could be expanded to some normoor hypogonadotrophic hypofertilities.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Humans; Hypogonadism; Infertility, Male; Male; Menotropins; Oligospermia

Topics: Chorionic Gonadotropin; Female; Humans; Infertility, Male; Male; Menotropins; Pregnancy

The paper reports on the response to gonadotrophic hormone treatment in cases of male infertility. The report includes 119 cases treated between 1971 and 1975. The evaluation of the results of gonadotrophic hormone treatment led to the following conclusions. Treatment with Praedyn has been relatively successful and the rate of success was directly dependent on the number of applied ampoules. Pergonal 500 brought a considerable improvement in all the treated patients. A meaningful comparison of the effect of Praedyn and Pergonal 500, respectively, was not possible because of the relatively small number of patients treated with Pergonal. Treatment with gonadotrophic hormones, especially Pergonal 500, seems to be indicated in cases of oligoasthenospermia, hypogonadotrophic hypogonadism (or secondary hypogonadism) and at least a short-dated correction of the spermiogram to normal can be expected in approximately one fourth of cases. A long-term testosterone (Agovirin) administration has a beneficial effect on the qualitative aspect of the treatment in that it enhances sperm motility.

Topics: Chorionic Gonadotropin; Drug Therapy, Combination; Female; Gonadotropins; Humans; Infertility, Male; Male; Menotropins; Pregnancy; Testicular Diseases; Testosterone

Topics: Adult; Chorionic Gonadotropin; Humans; Hypophysectomy; Infertility, Male; Male; Menotropins; Time Factors

786 subfertile men received hormonal treatment in order to improve their semen quality and concentration. Most of the patient's semen was characterised as idiopathic oligo or asthenozoospermia. No cases of hypothalamohypopituitary-hypogonadism were included in this study. 117 men received human chorionic gonadotropin (hCG); 47% showed improvement in semen quality mainly in motility and morphology: 10 pregnancies were recorded among 44 couples (23%). 37 received human menopausal gonadotropin (hMG) + hCG; 46% improvement in semen quality, mainly in the motility and concentration was seen: 3 pregnancies were recorded among 20 couples (15%). 60 men received clomiphene citrate; 47% showed improvement in semen quality mainly in the concentration and motility: 2 pregnancies were recorded among 33 couples (6%). 270 men received androgen, usually in small doses; 61% had improvement in semen quality, mainly in the motility and morphology: 24 pregnancies were recorded among 58 couples (41%). 262 men received pregnant mare serum (PMS; Gestyl) and testosterone; 71% had improvement in semen quality in all the parameters measured especially in motility and vitality, but only 24 pregnancies were recorded among 87 couples (28%). 40 men received treatment for improvement of potency which included androgen, yohimbine and strychnine; 60% improvement in sexual potency, 65% showed a significant improvement in semen quality: 4 pregnancies were recorded among 15 couples (27%). The parameters for improvement of sperm quality were motility, concentration, morphology and vitality. Improvement in semen quality was not necessarily correlated with impregnation of the wives.

Topics: Androgens; Chorionic Gonadotropin; Clomiphene; Female; Gonadotropins, Equine; Humans; Infertility, Male; Male; Menotropins; Pregnancy; Sperm Motility

Topics: Androgens; Arginine; Chorionic Gonadotropin; Clomiphene; Cortisone; Ejaculation; Humans; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Semen; Testosterone; Thyroid Hormones

The biopsies of 3 men, aged 27, 32, and 39 years, suffering from infertility lasting 4, 5, and 8 years, respectively, revealed spermatogenesis inhibition. 2 of the patients showed azoospermia and 1 showed 3rd-degree oligospermia. The patients were administered a daily dose of the postmenopausal gonadotropin Pergonal (75 IU follicle stimulating hormone and 75 IU luteinizing hormone and 6000 IU of the chorionic gonadotropin Biogonadyl weekly. All 3 patients showed a marked improvement of fertility and sperm count. During the period of remission, 2 of the patients conceived pregnancies, from which were born healthy, normal children.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Humans; Infertility, Male; Male; Menotropins

Certain defects in the intratesticular androgen biogenetic system may lead to a significant impairment of gonadal function in total in the human male. In the present investigation, four males with impaired reproductive performance were analysed before and after long term treatment with gonadotrophic hormones with regard to their in vitro metabolism of 3H-progesterone in testicular incubates; one of whom representing the first instance of an XYY-male studied in some detail with regard to intratesticular steroidogenesis. A steroid metabolisc pattern of an "immature" type, i.e., possibly indicating a relative understimulation of the gonads by gonadotrophic hormones, in vivo, was found in one of the four patients, i.e., the XYY-male, inspite of normal levels of gonadotrophic hormones in the peripheral circulation. Gametic output was found to increase significantly during the course of gonadotrophin substitution therapy, and the individual steroid metabolic pattern also changed drastically towards a more mature type subsequent to therapy. In a second patients, who originally presented with completely immotile sperm, a certain shift in the steroid metabolic pattern was observed after the gonadotrophin therapy in favour of increasing relative amounts of 17a-hydroxyprogesterone, concurrent with a decreasing proportion of dead sperm, and a certain, though minimal, improvement in sperm kinetics. The last two patients, with originally mature types of in vitro steroid metabolism in testicular incubates, displayed no changes in steroid metabolic patterns or spermiogram qualities subsequent to the gonadotrophin therapy. However, one of them might have been azoospermic because of anatomical reasons. The present demonstration that an individual steroid metabolic pattern in testicular incubates under certain conditions may be deliberately modified as expected, by long term gonadotrophin therapy, further supports our previous suggestion that the relative proportions of newly synthesized and recovered deltal4-3-oxo-C21-steroids in testicular incubates, especially 20a-dihydroprogesterone and 17a-hydroxyprogesterone, may well reflect the actual gonadotrophic stimulation in a particular individual at the time of testicular biopsy. Investigations of individual steroid metabolic patterns in testicular incubates may therefore contribute useful information for the adequate selection of patients with disturbed gonadal function, who may benefit from gonadotrophin substitution therap

Topics: 20-alpha-Dihydroprogesterone; Adolescent; Adult; Algestone; Chorionic Gonadotropin; Follicle Stimulating Hormone; Gonadotropins; Humans; Hydroxyprogesterones; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Progesterone; Sex Chromosome Aberrations; Sperm Motility; Testis; Testosterone

Topics: Cervix Uteri; Chorionic Gonadotropin; Clomiphene; Cyclofenil; Female; Follow-Up Studies; Humans; Infertility, Female; Infertility, Male; Male; Marriage; Menotropins; Pregnancy

Topics: Adult; Chorionic Gonadotropin; Drug Combinations; Drug Therapy, Combination; Humans; Infertility, Male; Male; Menotropins

In mammals, pituitary control of spermatogenesis varies with age. In the rat, before puberty FSH is highly active whereas LH is not; after puberty it seems that LH alone is able to support spermatogenesis. The mode of action of hormones is discussed. In the human, in case of infertility due to hypogonadotrophic hypogonadism, spermatogenesis can be restored by HCG or HMG. The best results are obtained after simultaneous treatment with both hormones, LH activity being predominant.. A review of the hormonal regulation of spermatogenesis in experimental animals and in man is presented. In the rat, the roles of follicle stimulating hormone (FSH) and luteinizing hormone (LH) vary with the age of the animal. FSH is effective in the prepubertal rat in the support of spermatogonial multiplication. LH is active in the hypophysectomized adult. FSH acts by binding specifically to receptor sites on cellular membranes of the seminiferous epithelium inducing biochemical changes. The development of a system which limits the response to FSH according to age is suggested. Information on the action of LH is less understood. In the human, information on spermatogenesis comes from treating disorders. In treating infertility, gonadotropins are used from human origin: 1) human pituitary extracts (HPG); 2) human chorionic gonadotropin (HCG); and 3) human menopausal gonadotropin (HMG). In the prepubertal testis, spermatogenic activity can be initiated with HCG or HMG. Spermatogenesis proceeds only to primary spermatocytes. Morphological maturation of Sertoli cells occurs as long as LH-like activity exceeded FSH-like activity. In hypogonadotropic hypogonadism, FSH has been shown to be inactive on germ cells while LH allows resumption of meiosis after hypophysectomy. HMG or HCG given simultaneously often provoke a noticeable stimulation of spermatogenesis which progresses to the release of some sperm. Further research is needed to elucidate the relationship between different testicular compartments in the production of sperm.

Topics: Age Factors; Animals; Chorionic Gonadotropin; Follicle Stimulating Hormone; Humans; Hypogonadism; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Rats; Spermatogenesis

Topics: Chorionic Gonadotropin; Humans; Infertility, Male; Male; Menotropins; Oligospermia; Spermatogenesis; Testicular Diseases; Testis

Topics: Adult; Age Factors; Amenorrhea; Biopsy; Brain Neoplasms; Chorionic Gonadotropin; Endometrium; Female; Follicle Stimulating Hormone; Gonadotropins; Humans; Infertility, Female; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Ovary; Pregnancy; Stimulation, Chemical

Topics: Adult; Androgens; Androstenedione; Biopsy; Cell Count; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Infertility, Male; Leydig Cells; Luteinizing Hormone; Male; Menotropins; Metabolic Clearance Rate; Metabolism, Inborn Errors; Oxidoreductases; Pregnancy; Progesterone; Testis; Testosterone; Tritium

Topics: Adult; Biopsy; Chorionic Gonadotropin; Female; Follicle Stimulating Hormone; Humans; Infertility, Male; Luteinizing Hormone; Male; Menotropins; Spermatozoa; Testis

Topics: Adult; Chorionic Gonadotropin; Drug Evaluation; Female; Humans; Infertility, Male; Male; Menotropins; Pregnancy; Spermatogenesis

Topics: Adult; Cell Movement; Humans; Infertility, Male; Male; Menotropins; Middle Aged; Spermatogenesis; Spermatozoa

Topics: Adult; Chorionic Gonadotropin; Humans; Infertility, Male; Male; Menotropins; Teratoma; Testicular Neoplasms

Topics: 17-Ketosteroids; Chorionic Gonadotropin; Gonadotropins, Equine; Humans; Infertility, Male; Injections, Intramuscular; Male; Menotropins; Sperm Capacitation; Spermatogenesis

Topics: Adult; Age Factors; Chromatography, Thin Layer; Drug Combinations; Gonadotropins, Pituitary; Humans; Infertility, Male; Male; Menotropins; Methods; Middle Aged; Spermatozoa; Testis; Testosterone

Topics: Adult; Chorionic Gonadotropin; Gonadotropins, Pituitary; Humans; Hypogonadism; Infertility, Male; Male; Menotropins; Semen; Sperm Capacitation; Spermatogenesis; Spermatozoa; Testosterone; Thyroid Hormones

Topics: Androgens; Anti-Bacterial Agents; Cell Movement; Humans; Infertility, Male; Male; Menotropins; Spermatozoa; Vitamin A; Vitamin B Complex; Vitamin E

Topics: Adult; Humans; Infertility, Male; Male; Menotropins; Oligospermia

Topics: Arginine; Dihydrotestosterone; Follicle Stimulating Hormone; Humans; Infertility, Male; Male; Menotropins; Methane

Topics: Adult; Androgens; Cell Movement; Chorionic Gonadotropin; Evaluation Studies as Topic; Female; Humans; Infertility, Male; Ligation; Male; Menotropins; Middle Aged; Pregnancy; Semen; Spermatozoa; Surgical Procedures, Operative; Testis; Time Factors; Varicocele; Veins

Topics: Chorionic Gonadotropin; Female; Gonadotropins; Humans; Infertility; Infertility, Male; Male; Menopause; Menotropins; Spermatozoa