Infertility

[Michael Scally MD]

[OA] Patient-Reported Outcomes and Biochemical Alterations During Hormonal Therapy in Men with Hypogonadotropic Hypogonadism Who Have Finished Infertility Treatment

Male hypogonadotropic hypogonadism (MHH) is effectively treated by gonadotropins with a high rate of ejaculate sperm and paternity; however, there is no information regarding the appropriate management, including patient-reported outcomes (PROs), of men with MHH who have finished infertility treatment. To compare health-related quality of life, erectile function and biochemical alterations in men with MHH who were treated with testosterone replacement therapy (TRT) or human chorionic gonadotropin (hCG).

Twenty-six MHH patients (mean age: 34 years) who needed to improve their androgen deficiency symptoms underwent either hCG therapy (n = 16, started with self-injection of 2,000-7,500 IU per week) or TRT (n = 10, testosterone enanthate 250 mg every 3 weeks). The 36-item Short Form Health Survey (SF-36) questionnaire, five-item International Index of Erectile Function (IIEF-5) and hormonal and biochemical analyses were assessed every 3 months. Changes and comparison of each treatment regarding these parameters were analyzed.

Both hCG and TRT significantly improved all domains of the SF-36, except for bodily pain and social functioning. hCG significantly improved the general and mental health domains compared with TRT. Significant improvements in IIEF-5 were observed with both treatments, showing significant improvement with hCG compared to TRT. TRT caused progressive testicular atrophy.

There were significant decreases in waist circumference and triglycerides in both treatment groups and significant elevations in prostate-specific antigen and hematocrit. Both hCG and TRT are effective and safe, with preferable PROs by hCG, for treating androgen deficiency in men with MHH who do not need infertility treatment.

Shiraishi K, Ohmi C, Matsuyama H. Patient-reported outcomes and biochemical alterations during hormonal therapy in men with hypogonadotropic hypogonadism who have finished infertility treatment. Endocr J. 2020 Oct 3. doi: 10.1507/endocrj.EJ20-0365. Epub ahead of print. PMID: 33012744. https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ20-0365/_article

 

[Michael Scally MD]

Male Fertility Before and After Androgen Abuse

Purpose: Previous research has found that male users of androgens are diagnosed, approximately, twice as often with infertility. We therefore set out to investigate the fertility in men using androgens.

Methods: The study includes the 545 males who were tested positive for androgens in an anti-doping test program in Danish fitness centers during the period January 3 rd, 2006 to March 1 st, 2018. The confirmed users were matched by birth year with 5,450 male controls. We followed this cohort from ten years prior to testing positive and until the end of follow-up in May 2018.

Results: During the ten-year period prior to testing positive the group of androgen users experienced a 26% lower fertility rate than the controls (rate ratio: 0.74, 95% CI: (0.60-0.90), p=0.0028). However, in the years following the doping sanction, they made a significant catch-up, and at completed follow-up the total fertility rate was only 7% lower than expected (RR 0.93, 95% CI (0.84-1.03). The prevalence of assisted reproduction was 5.69% in the group of androgen users and 5.28% in the control group (p =0.69).

Conclusion: Androgen use was associated with a temporary decline in fertility and most androgen users obtained parenthood without any help from the healthcare system. Overall, the fertility rate and the prevalence of assisted reproduction among androgen users were close to that in the background population.

Windfeld-Mathiasen J, Dalhoff KP, Andersen JT, Klemp M, Horwitz A, Horwitz H. Male fertility before and after androgen abuse. J Clin Endocrinol Metab. 2020 Nov 16:dgaa837. doi: 10.1210/clinem/dgaa837. Epub ahead of print. PMID: 33196845. Male fertility before and after androgen abuse