Treatment of Severe Oligospermia with Human Chorionic Gonadotropin/Human Menopausal Gonadotropin: A Placebo-Controlled, Double Blind Trial

Abstract

In an effort to evaluate the effect of hCG/human menopausal gonadotropin (hMG) treatment on semen parameters in normogonadotropic men suffering from oligospermia, a double blind, placebo-controlled study was conducted. After 2 basal examinations of seminal parameters and reproductive hormones, 39 men were recruited for the trial. Nineteen men, allocated randomly to the active drug group, received im injections of 2500 IU hCG twice a week in combination with 150 IU hMG three times a week for 13 weeks, while 20 men were treated, following the same injection schedule, with NaCl only. After the 13-week treatment period, follow-up examination was performed, followed by 3 additional examinations at 4-week intervals. Of those men receiving hCG-hMG, 2 induced pregnancies in their wives, while no pregnancies were reported in the placebo group. Sperm concentrations, the percentages of motile sperm, and the proportions of normally formed spermatozoa, however, were similar in the 2 groups at all times. It was not possible to predict the outcome of treatment based on results of GnRH and hCG tests performed before the treatment phase.

Macrophage activation enhances the human chorionic gonadotrophin-induced disruption of spermatogenesis in the rat

“…Resident macrophages in the rat testis are known to phago¬ cytose degenerating Leydig cells after a single EDS treatment Kerr, Bartlett & Donachie, 1986) and although macrophages are out¬ numbered four to one by Leydig cells (Bergh, 1985;Kerr et al 1987), infiltration of circulating monocytes into the testis assists in the complete removal of Leydig cells after EDS. Clearly this episode of intense phagocytic activity displayed by the macrophages is functionally distinct from the present observations, because germ cell degeneration is first noted 3 days after EDS whereas, after hCG treatment, significant germ cell disruption is seen after 12 h. In clinical studies of the efficacy of hCG compared with placebo treatment of idiopathic oligospermia, it was shown that 2500 IU hCG given twice weeky for over 3 months failed to improve sperm production (Knuth, Honigl, Bals-Pratsch et al 1987). Chronic hCG treat¬ ment is capable of suppressing spermatogenesis in normal men (Matsumoto, Karpas & Bremner, 1986), an effect believed to be related to the simultaneous decline in serum FSH levels which are insufficient to support quantitatively normal sperm production.…”

Diagnostic value of bioactive FSH in male infertility

“…Thus, the infertility in these men is not due to primary testicular failure but is caused by secretion of 'faulty' FSH by the pi¬ tuitary. This hypothesis would explain why in a few men with idiopathic oligozoospermia gonado¬ tropin treatment is helpful, whereas it does not benefit most patients (20,21). Further investiga¬ tions to characterize the circulating FSH in men with elevated immunoFSH are necessary to clarify this point.…”

Superovulation and Intrauterine Insemination in the Treatment of Male Factor Infertility

“…The mean number of treated cycles of CC, HCG and IUI per patient was 4.4 (range [3][4][5][6]. The mean number of treated cycles of HMG, HCG and IUI per patient was 2.7 (range 1-6).…”

“…These modes of treatment, in many cases, have not yielded better results than expectant management [1][2][3]. Recent studies [4][5][6] report that superovulation combined with intrauter ine insemination (IUI) using washed sperm is more suc cessful than superovulation alone, IUI alone, or superovu…”