Hypergonadotropic Hypogonadism: Management of Infertility

Area of Science:

• Reproductive Endocrinology
• Male Infertility Research
• Medical Treatment Efficacy

Background:

• Hypergonadotropic hypogonadism affects infertile men, with various medical treatments available, including gonadotropins, aromatase inhibitors (AIs), and selective estrogen receptor modulators (SERMs).
• These treatments are used alone or with assisted reproductive techniques.

Purpose of the Study:

• To review and evaluate the available treatment options for infertile men diagnosed with hypergonadotropic hypogonadism.

Main Methods:

• A comprehensive literature search was performed on MEDLINE from 1980 to 2019.
• Keywords included 'hypogonadism', 'male infertility', 'gonadotropins', 'SERMs', and 'AIs'.
• The review discussed underlying pathologies and treatment modalities like gonadotropins, SERMs, AIs, and surgical interventions.

Main Results:

• Follicle-stimulating hormone (FSH) demonstrated an increase in spontaneous pregnancy rates, but with low evidence for live birth rates.
• Aromatase inhibitors (AIs) are effective for patients with a low testosterone/estradiol ratio, significantly improving sperm concentration.
• Selective estrogen receptor modulators (SERMs) are recommended for males with sperm counts between 10-20 million.
• Varicocele treatment was noted to elevate testosterone levels in hypogonadal infertile males.

Conclusions:

• Medical treatments including gonadotropins, SERMs, AIs, and combination therapies show some potential for improving male fertility.
• However, these medical interventions are not yet considered mainstream treatments for hypergonadotropic hypogonadism.