Gonadotropins in Infertile Men with Idiopathic Hypogonadotropic Hypogonadism

Background: Stimulatory therapy with gonadotrpins is an effective treatment to induce spermatogenesis in men with idiopathic hypogonadotroptic hypogonadism (IHH). The aim of this study was to assess the effectiveness of human chorionic gonadotropin / human menopausal gonadotropin on hypogonadotropic infertile men. Materials and Methods: This study included fifty-six azoospermic infertile men with IHH treated with hCG / hMG. All patients received hCG (5000 IU, IM3 times /week) for three months. After that, treatment was continued combined with hMG (75 IU, IM 3 times/week). Semen analysis was performed every 3 months. After 15 months, fine needle aspiration was performed if the patients were azoospermic. Treatment continued if mature spermatozoa were present in FNA, otherwise treatment was discontinued. In the former cases, semen analysis was requested 24months after thebeginning of treatment. Results: In this study, spermatozoa were present in the ejaculate in 50 out of 56 patients (89.2%) after combined treatment. Average time of sperm appearance was 9.2 months. Mean sperm concentration was 9.12 x 106/ml. FNA carried out after 15 months of treatment in 23(41%) of patients with persistent azoospermia, 91.3% of these latter patients had mature spermatozoa on fine needle aspiration. Pregnancy occurred in 23 (41%) cases. The mean sperm concentration in patients whose spouses became pregnant was 15.56x 10.6 Conclusion: hCG/ hMG combination therapy is effective treatment for fertility in patients with IHH. FNA can be used as a safe and suitable tool to evaluate patients that remains azoospermic after 15 month of treatment.