(350) EFFICACY AND PREDICTORS OF SPERMATOGENESIS INDUCTION UPON GONADOTROPIN AND GNRH THERAPY IN CONGENITAL HYPOGONADOTROPIC HYPOGONADISM: A META-ANALYSIS

Congenital Hypogonadotropic Hypogonadism (CHH) is among the few causes of male infertility, which could benefit from a rationale treatment. Both gonadotropin and GnRH therapy proved effective in inducing spermatogenesis in patients with CHH. However, due to the small sample size of the studies available and the lack of randomized studies, a precise evaluation of the efficacy and a comparison among different treatments remain difficult. A meta-analysis was conducted to evaluate the efficacy of either gonadotropin or GnRH treatment in inducing spermatogenesis in subjects with CHH and azoospermia and to identify possible treatment response moderators.

An extensive Medline and Embase search was performed, including the following words: “gonadotropins” or “GnRH”, “infertility”, “hypogonadotropic”, “hypogonadism” and limited to studies in male humans.

Overall, 41 and 22 studies were retrieved for gonadotropin and GnRH therapy in CHH patients, respectively. All considered the appearance of at least one spermatozoon in semen, whereas 23 and 9 considered sperm concentration upon gonadotropin and GnRH, respectively. The succes rate in obtaining at least one spermatozoon in the ejaculate and the achived sperm concentration were 0.70 [0.62-0.77] and 7.28 [5.19-9.36] x10^6/mL for gonadotropin therapy and 0.65 [0.52-0.77] and 6.48 [2.48-10.48] x10^6/mL for GnRH therapy. In studies using gonadotropins, worse results were obtained by hCG alone. Non differences were reported from studies using urinary-derived or recombinant FSH or from those enrolling or not patients previously treated with testosterone. Higher testis volume and lower LH and FSH at baseline were associated with a higher success rate upon gonadotropin therapy.

Gonadotropin therapy is a suitable option for inducing fertility in azoospermic CHH subjects. Protocols with combining FSH and hCG showed better results in terms of seminal outcomes than hCG therapy alone. These treatments appear to be more effective in subjects with lower baseline FSH and LH while previous TRT and FSH preparation do not affect the outcome.

The authors declare no conflict of interest.