menotropins and Testicular-Neoplasms

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

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

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

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

Blood samples for hormone analysis were obtained 5 to 20 years post-therapy from 12 men with testicular tumors who were originally treated by unilateral orchiectomy followed by abdominal and/or pelvic irradiation. In nine patients (75%) the levels of FSH and LH, and in one patient (8%) the testosterone values, were outside the ranges found in age- and sex-matched controls. From this retrospective study we conclude that, even when the remaining testis is kept outside the field of radiation, significant radiation damage occurs, mainly through scatter. This damage is more likely to occur if the hemiscrotum is irradiated. Methods of shielding are available to reduce the dose received by the contralateral testis.

Topics: Adolescent; Adult; Dysgerminoma; Follow-Up Studies; Humans; Luteinizing Hormone; Male; Menotropins; Middle Aged; Teratoma; Testicular Neoplasms; Testosterone

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