Human Reproduction, Vol 12, 1230-1232, Copyright © 1997 by Oxford University Press
EL Yong, KO Lee, SC Ng and SS Ratnam
Idiopathic hypogonadotrophic hypogonadism (IHH) is a potentially
correctable cause of male infertility. However hormonal treatment is
usually a slow process and artificial reproductive techniques such as
intracytoplasmic sperm injection (ICSI) might be resorted to before full
testicular response has been achieved. We report here an unusual variant of
IHH of post-pubertal onset in which early intervention with ICSI was
attempted. Our patient was 37 years old and presented with male infertility
due to azoospermia and undetectable serum gonadotrophin concentrations. He
had an apparently normal pubertal development, a testicular volume of 8 ml,
normal pituitary-thyroid and pituitary-adrenal function, as well as normal
computerized tomographic appearance of the sella region. A combination of
human chorionic gonadotrophin (HCG) and menopausal gonadotrophins (HMG) was
administered. Spermatozoa were first detected in the semen after 3 months
and reached a concentration of approximately 2x10(6)/ml after 9 months.
ICSI was attempted at this point; the spermatozoa had good fertilizing
ability and three embryos were obtained and replaced. Unfortunately no
pregnancy resulted. Treatment with 5000 IU HCG and 150 IU HMG three times
per week was continued and sperm counts rose rapidly thereafter to reach
28.3x10(6)/ml after 16 months of injections. His wife conceived naturally
during this period and the pregnancy is now in the second trimester. This
case illustrates the good prognosis of the rare patient with IHH of
post-pubertal onset when treated with gonadotrophins, and suggests that
ICSI procedures should be delayed until final testicular maturation is
attained.
ARTICLES
Induction of spermatogenesis in isolated hypogonadotrophic hypogonadism with gonadotrophins and early intervention with intracytoplasmic sperm injection
Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
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