menotropins and Klinefelter-Syndrome

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

It is known that prostate specific antigen (PSA) is strongly androgen dependent, but little is known about the effects of gonadotropin and testosterone treatments on the prostate and serum PSA levels in male hypogonadism. We have therefore determined serum PSA levels before and 3 months after treatment in 13 patients with idiopathic hypogonadotropic hypogonadism (IHH) and 14 patients with Klinefelter's syndrome. Plasma FSH, LH, testosterone, PRL, testis and prostate volumes were also determined before and 3 months after treatments. Patients with IHH were treated with hCG/hMG and patients with Klinefelter's syndrome received testosterone treatment. PSA levels were determined by a kinetic enzyme immunoassay method. In patients with Klinefelter's syndrome FSH and LH levels were significantly decreased but total and free testosterone and PSA levels were significantly increased after 3 months of treatment. Right and left testicular volumes were not significantly changed whereas prostate volumes were significantly increased after treatment. In this group PSA levels were significantly and positively correlated with the prostate volume both before (r=0.54, P=0.048) and after treatment (r=0.61, P=0.012). In the IHH group total and free testosterone and PSA levels were significantly increased after gonadotropin treatment but FSH and LH levels did not change significantly. Right and left testicular volumes and the prostate volumes were also significantly increased after 3 months of gonadotropin treatment. In this group PSA levels were correlated with prostate volume before (r=0.74, P=0.004) treatment but not after therapy (r=0.35, P=NS). Our results show that serum PSA levels increase after gonadotropin and testosterone treatment in male hypogonadism, but this could not be used as an index for the evaluation of the androgen action in the treatment of male hypogonadism, since PSA levels following treatments were correlated with the prostate volume or T levels only in patients with Klinefelter's syndrome but not in the IHH group.

Topics: Adult; Biomarkers; Biomarkers, Tumor; Chorionic Gonadotropin; Drug Therapy, Combination; Humans; Hypogonadism; Klinefelter Syndrome; Male; Menotropins; Prostate; Prostate-Specific Antigen; Testosterone

It is known that lipoprotein(a) [Lp(a) is an independent risk factor for developing atherosclerosis, whereas the LpA-I particle of high density lipoprotein (HDL) is an antiatherogenic factor. The effects of androgen replacement therapy on lipid and lipoproteins have previously been reported in male hypogonadism. However, no study reported the effect of gonadotropin or testosterone treatment on Lp(a), LpA-I, or LpA-I;A-II levels in make hypogonadism. We, therefore, determined Lp(a), LpA-I, LpA-I:A-II, and other lipoprotein levels before and 3 months after treatment in 22 patients with idiopathic hypogonadotropic hypogonadism (IHH) and in 9 patients with Klinefelter's syndrome. All patients had been previously untreated for androgen deficiency. Plasma FSH, LH, PRL, testosterone (T), estradiol, and dehydroepiandrosterone sulfate levels were also determined before and 3 months after treatment. Patients with IHH were treated with hCG/human menopausal gonadotropin, whereas patients with Klinefelter's syndrome received T treatment. Three months after treatment, mean T levels role to low normal levels in both groups. Triglyceride, LpA-I:A-II, Lp(a), HDL cholesterol, HDL3 cholesterol, and apolipoprotein (apo) A-I concentrations did not change significantly after treatment, whereas total cholesterol, low density lipoprotein cholesterol, LpA-I, and HDL2 concentrations were significantly increased 3 months after treatment in both groups. The apo B concentration significantly increased in patients with klinefelter's syndrome, whereas no change was observed in the IHH group. Lp(a) concentrations were not related to all hormonal and clinical parameters in both groups. LpA-I concentrations were significantly and negatively correlated with free T (r = -0.80; P = 0.010) in patients with Klinefelter's syndrome and were not correlated with all hormonal and clinical parameters in the IHH group. The LpA-I:A-II concentration was only correlated with body mass index (r = -0.83; P = 0.005) in patients with Klinefelter's syndrome, whereas it was correlated negatively with dehydroepiandrosterone sulfate (r = -0.57; P = 0.005) in the IHH group.2 Overall, our study demonstrates that gonadotropin or T treatment has a complex effect on lipids and lipoproteins. This complexity will be resolved when sufficient large scale androgen treatment data are available for assessment of the long term outcome of androgen treatment. The increases in total cholesterol and low density lipoprotein chol

Topics: Adult; Apolipoprotein A-I; Apolipoprotein A-II; Chorionic Gonadotropin; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Follicle Stimulating Hormone; Humans; Hypogonadism; Klinefelter Syndrome; Lipoprotein(a); Lipoproteins; Lipoproteins, HDL; Luteinizing Hormone; Male; Menotropins; Testosterone

Epidermal growth factor (EGF) content in seminal plasma of 17 patients with androgen deficiency (12 Klinefelter's syndrome and 5 hypogonadotropic hypogonadism) was determined before and after hormone replacement. No significant increase of plasma testosterone level was demonstrated after testosterone administration in Klinefelter's syndrome, although the level in 4 of 5 patients with hypogonadotropic hypogonadism reached the normal range. In 16 patients, except 1 with hypogonadotropic hypogonadism with no increase of blood testosterone level, prostate volume increased after hormone therapy, and volumes after treatment were significantly larger than those before treatment. On the other hand, EGF concentration in seminal plasma remained at the pretreatment level in most patients. It is therefore concluded that although the prostate volume increases to almost normal after treatment, prostate function does not improve in most patients, indicating that in patients with hypogonadotropic hypogonadism fertility potential may remain low, even if they obtain normal seminal parameters after treatment.

Topics: Adult; Chorionic Gonadotropin; Epidermal Growth Factor; Humans; Hypogonadism; Klinefelter Syndrome; Male; Menotropins; Prostate; Semen; Testosterone

Free L-carnitine was assayed in semen from patients with various andrologic diseases by an enzymatic-spectrophotometric method. Extremely low concentrations were found in semen from patients with agenesis of the vas deferens (31.8 +/- 18.8 nm/ml). Semen from men with vasectomies contains a higher concentration of free carnitine (105.0 +/- 8.1 nm/ml). When comparing these data with those of ten fertile control subjects (817.0 +/- 200 nm/ml), we assume that seminal free L-carnitine mainly originates from the epididymis. Semen from patients with azoospermia caused by testicular failure also contains a low carnitine concentration. In hypogonadotropic eunuchoids the gonadotropin treatment increased the low basal concentration. A correlation between semen carnitine content and sperm motility and number was also tested in 124 infertile patients. The results show a positive correlation between free L-carnitine and sperm count (r = 0.617; P less than 0.01), between free L-carnitine and sperm motility (r = 0.614; P less than 0.01), and between free L-carnitine and the number of motile spermatozoa per milliliter (r = 0.646; P less than 0.01).

Topics: Adult; Carnitine; Chorionic Gonadotropin; Humans; Hypogonadism; Klinefelter Syndrome; Male; Menotropins; Semen; Sperm Count; Sperm Motility; Vas Deferens; Vasectomy

Topics: Adult; Chorionic Gonadotropin; Erectile Dysfunction; Humans; Infusions, Parenteral; Injections, Intravenous; Klinefelter Syndrome; Luteinizing Hormone; Male; Menotropins; Metabolic Clearance Rate; Time Factors