Recovery of spermatozoa after rFSH/hCG treatment, and subsequent ICSI/IVF, in a male with testicular atrophy due to severe congenital hypogonadotrophic hypogonadism

A 47-year old man attending at an in vitro fertilization clinic for infertility was diagnosed with congenital idiopathic hypogonadotrophic hypogonadism. No palpable testes and no spermatozoa in the ejaculate were found. Endocrinologically serum FSH, LH and testosterone was undetectable. A retroperitoneal magnetic resonance imaging confirmed the testicular absence. rFSH/hCG treatment was initiated. At four months almond-sized testes had developed and puncture with testicular sperm extraction (TESE) showed occasional immobile spermatozoa. Six months after initiation of treatment occasional mobile spermatozoa in semen were successfully used for intracytoplasmic sperm injection (ICSI) and one oocyte was fertilized and transferred. After 12 months sperm count revealed 10(5) mobile spermatozoa and three oocytes were fertilized. The embryo transfers did not result in a clinical pregnancy. As far as we know, this is the first time that objectively diagnosed testes atrophy could be successfully treated with FSH/hCG.