I-3: Hypogonadotropic Hypogonadism

Hypogonadotropic hypogonadism (HH) is an uncommon cause of male infertility and a congenital or secondary disorder characterized by delayed or absent sexual maturation. Congenital abnormalities leading to HH are usually the consequence of deficient GnRH secretion occurring either in isolation (idiopathic hypogonadotropic hypogonadism (IHH)), or in association with anosmia (Kallmann syndrome; KS). Acquired causes of HH can be due to any disorder that affects the hypothalamicpituitary axis. The induction of spermatogenesis in men with HH can be successfully achieved using gonadotropin therapy. In spite of low sperm count, motility and normal morphology, some of gonadotropin treated patients with HH have fertile sperm and can fertilize ovum naturally or by IUI and ART. We are studied sperm DNA fragmentation index (DFI), testicular volume, semen parameters and hormone profile in hCG and hMG treated hypogonadotropic hypogonadism (HH) patients with and without a successful pregnancy. The study initially included 81 patients with HH and azoospermia at the Infertility Unit of Royan Institute between 2010 and 2012. 58 of 81 (71.6%) patients achieved > 1 × 106 sperm per ml during hCG and hMG therapy. These 58 patients were divided into two groups: 20 HH patients who achieved pregnancy in response to hCG/hMG (responders, 16 naturally and 4 by IUI) and 38 gonadotropin treated HH patients with failed pregnancy (non-responders, 29 naturally, 5 by IUI, 1 by IVF and 3 by ICSI). It was shown that DFI in responders is significantly lower than DFI in non-responders and duration of hCG and hMG therapy in responders is significantly higher than those of non-responders. DFI could be predictive of conception. It can be concluded that despite of low sperm quality, especially sperm concentration in these patients, decreasing sperm DNA damage may be resulted in successful fertilization.