Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study

Area of Science:

• Endocrinology
• Reproductive Medicine
• Men's Health

Background:

• Hypogonadotropic hypogonadism (HHG) with azoospermia presents a significant challenge for male fertility.
• Inducing spermatogenesis is crucial for restoring fertility in affected individuals.

Purpose of the Study:

• To systematically analyze the efficacy of gonadotropin and Gonadotropin-Releasing Hormone (GnRH) therapy in inducing spermatogenesis in men with HHG and azoospermia.
• To compare the success rates and sperm concentrations achieved with both treatment modalities.

Main Methods:

• A meta-analysis of studies retrieved from Medline and Embase databases.
• Keywords included 'gonadotropins', 'GnRH', 'infertility', 'hypogonadotropic', and 'hypogonadism' in male human subjects.
• Data extraction focused on spermatogenesis appearance and sperm concentration.

Main Results:

• Both gonadotropin and GnRH therapies demonstrated an overall 75% success rate in achieving spermatogenesis.
• Mean sperm concentrations were 5.92 million/mL for gonadotropin and 4.27 million/mL for GnRH therapy.
• Therapy was less effective in pre-pubertal onset HHG compared to mixed or post-pubertal onset populations. Higher success rates were observed with lower baseline gonadotropin levels and combined human chorionic gonadotropin (hCG) and FSH use.

Conclusions:

• Gonadotropin therapy, including urinary derivatives, is a viable option for inducing fertility in azoospermic HHG patients.
• Efficacy is enhanced in individuals with secondary hypogonadism (low gonadotropins) and post-pubertal onset.
• Previous testosterone replacement therapy (TRT) did not negatively impact gonadotropin therapy outcomes.