Treatment of Male Infertility with Human Gonadotrophins: Selection of Cases,Management and Results*

Behandlung infertiler Männer mit HMG/hCG: Auswahl der Fälle, Behandlung und Ergebnisse Um bei der Behandlung infertiler Männer mit Gonadotropinen (HMG/hCG) optimale Ergebnisse zu erzielen, ist eine strenge Auswahl der Patienten von überragender Bedeutung. Die Verwendung algorithmischer Tafeln erlaubt den Ausschluß von Fällen mit primärer Hodenstörung, genetischer oder anderer, vom Endokrinium unabhängiger Gründe der Infertilität. In dieser Arbeit werden im Rahmen einer retrospektiven Studie die Ergebnisse bei 25 Männern mit schwerer Oligozoospermie beschrieben, die mit Gonadotropinen behandelt worden sind. Die Patienten waren nach dem oben angeführten algorithmischen Schema ausgewählt worden, die Serum-Spiegel von FSH, LH und Testosteron wurden vor und während der Stimulation mit GnRH bestimmt. Die vorliegende Studie weist darauf hin, daß das Vorhandensein niedriger basaler FSH-Werte bei gleichzeitigem Ausbleiben oder nur schwachem FSH-Anstieg nach GnRH-Stimulation ein nützlicher Hinweis für die Auswahl derjenigen Patienten ist, die mit einer Gonadotropin-Therapie erfolgreich behandelt werden können.     

HORMONAL PROFILES FOLLOWING CLOMIPHENE CITRATE THERAPY IN CONCEPTION AND NONCONCEPTION CYCLES

The hormonal profiles following clomiphene citrate (CC) administration during a single cycle were compared in infertile women who conceived and in those who did not. Of 41 treated patients, ovulation was assumed to have occurred in 28 and was confirmed by clinical pregnancy in five. In the 28 women who presumably ovulated, two distinct patterns of hormonal secretion were observed. A normal response was exhibited by 17 patients (including the five who became pregnant). The other 11 patients exhibited an abnormal response, characterized by significantly higher luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratios than in the normal response group from day 9 until the occurrence of the LH peak (days 9 and 10, P less than 0.05; days 11 and 12, P less than 0.001), and significantly higher oestradiol (E2) levels throughout the cycle (P less than 0.01). In addition, in comparison with the normal response group their LH levels during the follicular phase were significantly higher (P less than 0.05) but their LH peaks at ovulation were significantly lower (P less than 0.02). Moreover, their progesterone levels, in contrast to those in the normal response group, began to increase prior to the LH peak and remained high during the early and mid-luteal phases. None of the women who exhibited this abnormal gonadotrophin response to CC therapy achieved a clinical pregnancy. Exposure to high LH levels in the follicular phase following CC therapy seems to reduce the rate of fertilization and/or to contribute to early embryonic loss.