Evaluation of a serum 17-hydroxyprogesterone as predictor of semen parameter(s) improvement in men undergoing medical treatment for infertility

Abstract

Introduction: The goal of medical therapy for infertile men with testosterone deficiency (TD) is to improve intratesticular testosterone (ITT). There is a gap in knowledge to identify those who will respond with semen parameter(s) improvement. We hypothesized that serum 17-hydroxyprogesterone (17-OHP) — a marker of ITT — can be used to predict improvement of semen parameter(s).
 Methods: Between July 2018 and January 2020, we conducted a prospective study of 31 men with primary infertility, TD, and secondary hypogonadism receiving clomiphene citrate (CC) and/or human chorionic gonadotropin (hCG) for three months. We assessed baseline and followup hormones, including testosterone, 17-OHP, semen parameter(s), and demographics. Semen quality upgrading was based on assisted reproduction eligibility: in-vitro fertilization (<5 million), intrauterine insemination (IUI) (5–9 million), and natural pregnancy (>9 million). Variables were compared using the Mann-Whitney U or Wilcoxon rank test.
 Results: Twenty-one men received CC and 10 received CC/hCG. Median followup was 3.7 (3.3–5.1) months. Sixteen men upgraded semen quality. Six of 10 men with baseline total motile sperm count (TMSC) of 0 had motile sperm after treatment, and 11/20 men with TMSC<5 upgraded semen quality into TMSC>5 range. Low 17-OHP was the only factor that predicted semen quality upgrading. Men with 17-OHP ≤55 ng/dL upgraded semen quality and improved hormones, whereas men with 17-OHP >55 ng/dL did not upgrade semen quality.
 Conclusions: Medical therapy for infertile men with TD resulted in the improvement of sperm concentration, TMSC, testosterone, and 17-OHP. Semen quality upgrading appears to be more significant in patients with low 17-OHP, suggesting that ITT can be used as a biomarker to predict semen parameter(s) improvement.

Effect of oestrogen modulation on semen parameters in men with secondary hypogonadism: Systematic review and meta‐analysis

“…We identified five NRSIs including 105 participants reporting semen parameters with SERMs 27–31 . Four studies were uncontrolled retrospective observational, while the study by Lima et al.…”

“…was uncontrolled prospective. Although details of patients treated with human chorionic gonadotropin (hCG) are also reported in two studies 29,31 the authors did not consider this a comparator group. There were no eligible studies reporting data on AIs.…”

“…29 In one study, patients who had been on TRT were given a washout period of 8 weeks. 31 Except in the study by Patel et al, 28 mean/median sperm concentration at baseline was low or close to the lower limit of the normal. The approximate follow-up duration was 3 months for all the studies.…”

“…We identified five NRSIs including 105 participants reporting semen parameters with SERMs. [27][28][29][30][31] Four studies were uncontrolled retrospective observational, while the study by Lima et al was uncontrolled prospective. Although details of patients treated with human chorionic gonadotropin (hCG) are also reported in two studies 29,31 the authors did not consider this a comparator group.…”

“…The mean/median BMI of participants in all four studies reporting BMI was >28 kg/m 2 . 27,28,30,31 In two studies, previous TRT was an exclusion criterion, 27,28 whereas in one study, previous TRT was not reported, 30 and in the other, one patient had been on TRT. 29 In one study, patients who had been on TRT were given a washout period of 8 weeks.…”