HCG、FSH联合治疗低促性腺激素性性腺功能减退症29例报告

目的 探讨人绒毛膜促性腺激素(HCG)和促卵泡激素(FSH)联合治疗男性低促性腺激素性性腺功能减退症的有效性和安全性.方法 29例男性低促性腺激素性性腺功能减退症23例,Kallmann综合征6例.治疗方案:采用联合HCG 2000 IU,2次/周;FSH 75 IU,3次/周,肌肉注射,连续用药至少3个月. 结果治疗后所有患者体力改善,体质增强;22例患者出现胡须、阴毛和(或)腋毛.睾丸体积治疗前(2.68±1.44)ml,治疗后(8.93±3.24)ml(P<0.01);促卵泡激素(FSH)、促黄体激素(LH)和睾酮(T)水平有所提高(P<0.05);12例患者出现遗精现象,8例有精子生成.结论 对男性低促性腺激素性性腺功能减退症,用HCG和FSH治疗能促进青春期第二性征发育,并可使部分睾丸恢复产生雄激素和生成精子功能.     

高促性腺激素型男性性腺功能低下症的第二性征外科重塑(附光盘)

男性高促性腺激素型性腺功能低下症是各种原因导致的睾丸病变引起的性腺功能低下,其病因为各种先天或者后天因素导致睾丸功能低下,负反馈引起垂体分泌的卵泡刺激素(FSH)和黄体生成素(LH)水平显著增高。目前对于男性高促性腺激素型性腺功能低下症的患者常予以雄激素替代治疗,但雄激素替代治疗对部分成年男性阴茎大小及乳房发育症作用并不明显。本文将介绍男性高促性腺激素型性腺功能低下症相关病因及治疗,重点介绍高促性腺激素型性腺功能低下症的第二性征外科重塑方案。     

误诊为隐睾的低促性腺激素性性腺功能减退一例分析及文献复习

低促性腺激素性性腺功能减退(IHH)与隐睾在临床诊断中容易混淆,应该做好鉴别诊断,以免误诊误治。我们报道一例22岁男性,因发育不良伴肥胖(BMI 30.61kg/m~2)求治,经过查体双侧阴囊内空虚,并经B超诊断为双侧隐睾,拟进行睾丸牵引固定术收入院,经过系统查体和生殖激素分析获得完整资料。嘱患者增加腹压并仔细查体,可在阴囊内高位触及发育极差的睾丸(容积约0.5ml),结合FSH、LH及睾酮均显著低下,初诊为IHH。采用HCG(2 000U肌肉注射,每周2次)联合十一酸睾酮胶丸(80mg,每天2次口服)治疗2个月,患者自觉睾丸增大且已下降,检查阴囊内可触及明确的睾丸,容积约2.0ml。诊断性治疗结果表明,HCG联合睾酮能够有效治疗IHH患者的睾丸发育不良,并进一步明确了诊断。通过对本例误诊为隐睾的IHH病例诊治过程的分析并复习文献,探索了误诊原因及其危害,并制定出有效的治疗方案。     

精原细胞期精子生成受阻不能单用hCG治疗

人类精子生成需要高浓度男性激素。男性激素的生物合成受LH控制。间质细胞内甾体激素缺乏及促性腺激素有效刺激不足,均可导致精子生成障碍。在一些病例,通过外源性hCG治疗,产生内源性男性激素,以增加精子生成。一例26岁男性患者,一年前性欲低下,精子数下降并发展为无精症,婚后两年不育。血清FSH和T降低,LH和Pra(催乳素)正常。LHRH(促黄体生成素释放激素刺激试验)显示FSH低而LH增加。睾丸活检     

男性不育的遗传学评估

无精子症或严重少精子症男性(5×10 6/ml)在接受治疗之前应通过遗传学检测确定其不育的真正原因。正确区分梗阻性无精子症(obstructive azoospermia,OA)与非梗阻性无精子症(non-obstructive azoospermia,NOA)至关重要,因为相比于NOA(睾丸体积小、质地柔软、FSH水平升高),OA(正常的睾丸功能、睾丸体积以及FSH水平)的遗传学检测有所不同。在NOA患者人群中,病史回顾、体格检查和实验室检测对于遗传学检测方法的选择是必须的,尤其针对原发性睾丸衰竭或先天性低促性腺激素型性腺功能低下症的NOA患者。遗传学检测包括由于先天性输精管缺如所致OA的囊性纤维化跨膜传导调节因子的检测,和针对严重少精子症或NOA患者的染色体核型分析、Y染色体微缺失等其他特殊检测方法。这些遗传学检测能够帮助判定哪些患者适合药物和/或手术治疗。最新的遗传学分析技术将有助于男性不育的诊断和掌控。     

不育男性双侧Ⅰ度精索静脉曲张对睾丸体积和生殖激素水平的影响

目的 评价不育男性双侧I度精索静脉曲张对睾丸体积和生殖激素水平的影响.方法 185例不育男性双侧I度精索静脉曲张(A组)和149例正常生育男性(B组),比较其睾丸体积、卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)水平.结果 A组患者两侧睾丸体积均小于B组,但睾丸体积绝对差异和睾丸体积相对差异与B组比较,无统计学意义.A组患者血清FSH水平高于B组,而LH、T与B组相比,差异无统计学意义.结论 不育男性双侧I度精索静脉曲张可导致患者双侧睾丸体积减小,血清FSH水平升高.     

微刺激方案中克罗米芬促排卵5天后内源性FSH的变化及结局分析

目的探讨克罗米芬(CC)联合人绝经期促性腺激素(HMG)微刺激方案中应用CC促排卵5d后内源性FSH变化情况及其与促排卵结局的相关性。方法回顾性分析2015年1~5月在南京大学医学院附属鼓楼医院生殖医学中心行CC+HMG微刺激促排卵的156例患者的临床资料,以CC促排卵5d[即月经周期第7天(D7)]内源性FSH的变化分为FSH上升组与FSH下降组;同时将基础D2FSH≥10U/L的患者根据FSH水平变化分为FSH上升组(A组)与FSH下降组(B组),将D2FSH10U/L的患者根据FSH水平变化分为FSH上升组(C组)与FSH下降组(D组),比较各组患者的促排卵结局。结果 156例患者中CC促排卵5d后FSH上升者占53.2%,下降者占46.8%。FSH下降组的D2FSH、D2LH水平、D7E2水平显著高于FSH上升组,FSH下降组的D7FSH、HCG日FSH水平显著低于FSH上升组(P0.05);FSH下降组的促排卵天数及Gn用量亦显著少于FSH上升组(P0.05)。B组的基础窦卵泡数(AFC)、D7E2显著高于A组,D7FSH、HCG日FSH、HCG日LH、促排天数显著低于A组(P0.05);B组的获卵数及冷冻胚胎数显著高于A组(P0.05)。C、D两组除D2FSH、D7FSH有显著性差异外(P0.05),其余指标均无显著性差异(P0.05)。结论 CC+HMG微刺激方案中应用CC促排卵5d后内源性FSH上升与降低都是常见的卵巢反应,对于D2FSH≥10U/L的患者,D7内源性FSH水平变化可用于评价卵巢的储备功能。     

单精子卵母细胞显微注射治疗无精子症(附16例报告)

目的：总结无精子症的诊断和治疗经验。方法：16例无精子症患者，常规行血促卵泡激素（FSH），促黄体生成激素（LH），睾酮（T）检测并行染色体分析，治疗用睾丸取精行单精子卵母细胞显微注射（TESE）辅助受精。结果：16例行TESE，有6例妊娠，妊娠率为37.5%/周期。结论：行TESE前应常规行血FSH，LH，T检测，睾丸活检和染色体分析，TESE是治疗无精子症一种有效的方法。     

GnRH脉冲泵治疗难治性低促性腺激素性男性不育4例报道

本文报道GnRH脉冲泵输注戈那瑞林治疗经双促性腺激素诱导精子失败后的低促性腺激素性男性不育患者的临床效果并文献回顾。4例患者均以低促性腺激素性性腺功能减退性不育为主要表现,均曾经过双促性腺激素(HCG+HMG)治疗7~18个月,未成功诱导出精子,改用GnRH脉冲泵输注戈那瑞林治疗2~7个月,促性腺激素和性激素水平明显上升,雄激素缺乏症状显著改善,4例患者均有精子生成,1例患者配偶自然妊娠,1例患者人工授精妊娠,2例期待自然妊娠或人工助孕。通过本文病例分析和复习文献资料发现,GnRH脉冲泵输注戈那瑞林不仅是低促性腺激素性性腺功能减退男性不育的有效治疗方法,还可以作为促性腺激素诱导精子失败后的补充疗法。     

Kallmann综合征的诊断和治疗

目的 探讨Kallmann综合征的诊断与治疗特点.方法 Kallmann综合征患者12例,平均年龄24岁.临床表现以外生殖器发育不良和嗅觉障碍为主,体格检查均有性器官幼稚及第二性征缺陷,呈类无睾体型.超声测量睾丸总容积(TV)为(3.47±1.36)ml;血清卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)及游离睾酮(FT)分别为(1.46±0.72)U/L(2.12±1.09)U/L、(1.94±0.69)nmol/L和(4.59±1.99)pmol/L;染色体核型均为46,XY.采用促性腺激素治疗和雄激素替代疗法,绒毛膜促性腺激素(hCG)2000 U肌内注射,每周2次,尿促性腺激素(hMG)75 U肌内注射,每周3次,持续6个月;口服十一酸睾酮,160 mg/d,3个月后减为120 mg/d,维持至6个月.观察停药1年后TV、血清促性腺激素和雄激素水平、性器官和第二性征的发育情况、性功能状况及精液中有无精子出现.结果 治疗结束1年后患者TV增至(6.76±2.12)ml,与治疗前相比差异有统计学意义(P＜0.01);性器官及第二性征明显发育;7例性功能改善;精液常规检查3例有精子产生.治疗后FSH、LH、T及FT分别为(3.24±0.87)U/L、(4.67±1.13)U/L(9.28±2.43)nmol/L和(19.55±4.09)pmol/L,与治疗前比较差异有统计学意义(P＜0.05).结论 促性腺激素治疗和雄激素替代疗法是促进Kallmann综合征患者性发育和维持男性特征及性功能的有效治疗手段.     

Full-term delivery following intracytoplasmic sperm injection in a case of male hypogonadotropic hypogonadism after 8-year treatment with HCG and HMG

A 19-year-old male, who had undergone bilateral orchiopexy at 5 years of age in the Department of Pediatric Surgery, was referred to our clinic presenting with bilateral small testes. Bilateral testis volume was 4 ml involving a small penis and scant pubic hair per Tanner Stage 2. Serum luteinizing hormone, follicle stimulating hormone and testosterone levels were low. Results of hormonal loading tests, including luteinizing hormone-releasing hormone (LH-RH) and human chorionic gonadotropin (HCG), were positive. Brain computed tomographic scan revealed no abnormal findings. The diagnosis of male hypogonadotropic hypogonadism was rendered based on these data. Administration of LH-RH for 1 year was ineffective. Subsequently, HCG and human menopausal gonadotropin (HMG) treatments were initiated. The symptoms of male insufficiency improved; moreover, sperm formation was apparent following HCG and HMG treatments. The patient has received HCG and HMG injections for eight years; furthermore, his wife delivered a boy consequent to the first intracytoplasmic sperm injection.     

Gonadotropin therapy in males with hypogonadotropic hypogonadism: Factors affecting induction of spermatogenesis after gonadotropin replacement

Sixteen patients with hypogonadotropic hypogonadism received gonadotropin replacement therapy. Two patients treated with HCG alone showed induction of spermatogenesis 2 and 12 months after the start of treatment. Three subjects receiving combination therapy showed sperm appearance 6–28 months after treatment. The patients showing sperm appearance, whose testicular volume was ≥4 ml, showed a higher sperm count and impregnated their partners, although no relationship was found between pretreatment testicular volume and sperm appearance. The response to HCG test correlated with sperm appearance after gonadotropin therapy. Sperm appearance was not observed in any subject except for one who showed no response to luteinizing hormone-releasing hormone (LH-RH) test and none of the patients without response of FSH to LH-RH demonstrated any induction of spermatogenesis. In conclusion, the responses to LH-RH test and possibly to HCG test could predict the induction of spermatogenesis after gonadotropin replacement therapy, and a large testicular volume is associated with post-treatment fertility.     

Verlaufskontrolle bei andrologischen Patienten unter HCG/HMG-Therapie unter besonderer Berücksichtigung des Spermiogramms und der somatischen Entwicklung

Between 1971 and 1976, 47 patients were treated in the department for andrology with daily alternating HCG/HMG injections. This treatment provides an attempt for examination of effects of a combined HCG/HMG therapy with a larger group of patients. As a condition for the HCG/HMG treatment a testicular biopsy was performed. It could be shown that in 70% of the cases there was no normal tabulus diameter, that the germinal epithelium was mostly low, and that in the germinal epithelium in 53,8% of the cases a spermiogenesis was demonstrable, but only in 3% of the cases sufficient spermatozoa existed. Most of the patients presented a disorganisation and desquamation of the germinal epithelium. During treatment no further testicular biopsies were made so that no statements can be given on the change of the tubules. Concerning the observation of the patients' sperm count it could be proved that, as a result of the HCG/HMG treatment, 33,3% of the patients showed an increase of motility and in 37,5% of the patients the number of spermatozoa increased. The paper describes two patients showing normal sperm count already after 8 to 12 weeks. Furthermore de Kretsers' observations on large decrease of spermatozoal number after the 150th day of treatment, and Paulsens' observations on hot flushes in some patients due to interruption of treatment, could be confirmed. The somatic development during HCG/HMG treatment showed an increase of volume of the testicles and an increase of the secondary hair. These changes also appeared already within 12 weeks after the beginning of treatment. In 38,5% of studied cases erections and ejaculations appeared already after 8 to 12 weeks as far as this didn't occur before treatment. In four cases pregnancy resulted from treatment. There was one early abortion. In all other cases gravidity and birth were normal. Only in one case negative side effects as a lack of concentration resulted. This study provides evidence that an alternating HCG/HMG treatment can be quite successful. Gonadotropin levels and the result of testicular biopsy have to be considered for clinical evaluation of treatment and therapeutic results.     

Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study

PURPOSE: Hypogonadotropic hypogonadism (HH) is an uncommon cause of male infertility. Even specialized centers see small numbers of patients and have little experience in restoring fertility in these patients. To explore the phenotypic heterogeneity and treatment outcome of HH, we summarized our 30-year experience. MATERIALS AND METHODS: Medical charts of 36 male patients (age range 11 to 42 years) with HH (81% primary, 19% secondary) treated at university affiliated male infertility centers were reviewed. Pubic hair stage, genital stage, testicular volume (TV), sexual function and sperm production were determined before and after human chorionic gonadotropin/human menopausal gonadotropin (hCG/hMG) treatment. Differences were analyzed statistically. RESULTS: The population was stratified according to initial TV into a small testis subset (TV less than 4 ml in 23) and a large testis subset (TV 4 ml or greater in 13). Comparison of these 2 subsets revealed significant differences in the incidence of cryptorchidism (39% vs 8%) and Kallmann's syndrome (22% vs 0%), pubic hair stage (1.3 +/- 0.5 vs 3.5 +/- 1.4), genital stage (1.2 +/- 0.4 vs 3.9 +/- 0.9) and TV (1.6 +/- 0.9 vs 7.5 +/- 3.5 ml). Long-term administration of hCG/hMG for 12 to 240 months (average 56 +/- 11) resulted in sperm production in only 36% of the small testis subjects but in 71% of the large testis subjects. CONCLUSIONS: Initial TV values provide insight into phenotypic variables such as time of onset and severity in patients with primary or secondary HH, and may predict sperm output in response to hCG/hMG therapy.     

Successful GnRH Treatment in a Patient with Kallmann''s Syndrome, who previously failed HMG/HCG Treatment/Erfolgreiche GnRH-Behandlung bei einem Mann mit Kallmann-Syndrom bei vorher erfolgloser HMG-HCG-Behandlung

A successful GnRH treatment for hypogonadotropic hypogonadism is described. A 40 year old infertile patient due to Kallmann's syndrome, associated with obesity and NIDDM, was treated with HCG (5,000 IU/week) for 8 years. In an attempt to induce spermatogenesis HMG (75 IU/daily) was added for 2 years. During the combined gonadotropin treatment semen analysis indicated an improvement from azoospermia to 2 x 10(6) sperm/ml. Since semen quality remained poor and obviously no pregnancy was achieved, the last regime was replaced by a pulsatile GnRH treatment (5 mcg/90 minutes). Following 6 months sperm count increased up to 15 x 10(6) associated with normal motility and morphology. Patient's wife conceived after the second intrauterine insemination and delivered a full term healthy baby.     

Hypogonadotropic hypogonadism treated with HCG monotherapy: report of 3 cases]

We report 3 cases of hypogonadotropic hypogonadism and the effects of human chorionic gonadotropin (HCG) monotherapy on plasma testosterone levels, which were related to clinical results. The patients were males 29, 21 and 14 years old. Each received 5,000 units of HCG subcutaneously or intramuscularly twice or three times a week for 16 to 40 months. Genital effects, including an increase in testicular volume were seen in all patients after 2 or 3 months. The increase in plasma testosterone level after HCG therapy was significantly correlated with the genital effects similarly to other treatments. Moreover, spermatozoa appeared in one case.     

Therapy with human chorionic gonadotrophin alone induces spermatogenesis in men with isolated hypogonadotrophic hypogonadism-long-term follow-up

The effects of long-term (14-120 months) hCG-treatment of 17 male patients affected by isolated hypogonadotrophic hypogonadism (IHH) on testicular volume, plasma testosterone levels, and sperm concentration were assessed. Mean testicular volume increased from 3.8 +/- 0.2 (Mean +/- SEM) ml to a maximal of 14.9 +/- 1.1 ml after 22.2 +/- 2.3 months of hCG treatment. Maximal testicular volume correlated positively with the volume recorded before the patients had undergone any previous treatment. Testicular growth was also analysed by sorting the patients into two sub-groups according to whether their initial testicular volume was less than 4 ml (small testis subset, STS) or greater than or equal to 4 ml (large testis subset, LTS), supposedly indicating complete or partial gonadotrophin deficiency, respectively. Testicular volumes in the LTS group were always greater than those of the STS. Plasma testosterone levels reached adulthood values during hCG treatment and no statistically significant difference was detected between LTS and STS patients with IHH. Thirteen patients (70%) became sperm-positive during treatment with hCG alone; five out of eight (60%) were STS patients and eight out of nine (90%) were LTS. In addition, LTS patients always had a greater sperm output than did STS patients. Sperm concentration correlated positively with maximal testicular volume, but not with patient age, length of treatment, or initial testicular volume. The administration of hMG to eight of these patients caused an increase in testicular volume in two patients but the mean volume was not statistically different from that recorded at the end of treatment with hCG alone. Similarly, sperm concentration improved in three patients but again it did not differ significantly from that achieved in the course of hCG treatment. It is noteworthy that one patient became sperm-positive after the addition of hMG to his therapeutic regimen. Among sperm-positive patients attempting conception, seven out of 10 succeeded, two of whom were from the STS group. In summary, this study indicates that hCG alone is an effective treatment to induce complete spermiogenesis in IHH patients regardless of their initial testicular volume. However, a number of IHH patients may benefit from the addition of hMG in terms of testicular volume, sperm output, and pregnancy outcome.     

Prospective evaluation of human chorionic gonadotropin in the differentiation of undescended testes from retractile testes

PURPOSE: We prospectively evaluated the efficacy of human chorionic gonadotropin (HCG) in the treatment of undescended testis and sought to determine whether HCG assists in the differentiation of undescended testis from retractile testis. MATERIALS AND METHODS: Patients with undescended testes were offered HCG. Testis position, laterality and the presence or absence of a hypoplastic scrotum were noted. The same physician (G. W. K.) recorded physical findings prospectively and stated clinical impression of descent. RESULTS: A total of 67 patients with 90 undescended or retractile testes were treated and evaluated with HCG. Of the 64 undescended testes 13 (20%) descended with HCG therapy, with none requiring subsequent surgery. Of the 26 retractile testes 15 (58%) descended with HCG (p <0.001). Based on physical examination, 100% of retractile testes descended if the testis was in the high scrotal position but only 40% descended if the testis was in the superficial pouch or inguinal area. In the undescended testes group no ectopic or nonpalpable testis descended with HCG. Evaluation of HCG with age demonstrated minimal response (15%) to HCG at less than 24 months, and a peak response between ages 2 and 6 years (75%) with response decreasing thereafter. CONCLUSIONS: HCG may have a limited role in the evaluation of undescended testis in patients younger than 2 years. HCG can serve as an adjunct in the clinical diagnosis of retractile testis in older children.     

中药联合安特尔治疗迟发性睾丸功能减退30例疗效观察

目的探讨中药联合安特尔治疗迟发性睾丸功能减退的有效性。方法将60例迟发性腺功能减退症患者随机分成两组，治疗组30例采用逍遥散合菟丝子丸加减联合安特尔治疗，对照组30例单纯采用安特尔治疗，两组均治疗3个月，观察患者治疗前后PADAM评分、PSA的变化，并对其进行疗效评估。结果治疗组有效率明显高于对照组，两组比较差异有显著性（P〈0．05）。结论中药联合安特尔可能明显改善患者的性腺功能减退症状，较单纯应用安特尔疗效为佳。