A Modern Approach to the Gonadotropin Treatment in Oligozoospermia

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Abstract
A critical review of the gonadotropin therapy in male infertility or hypofertility is presented. In the author's opinion, the poor and conflicting results so far obtained wih this kind of treatment are mainly due to inadequate selection of the patients admitted to the treatment itself. The author stresses some points concerning the modern knowledge on the physiology of gonadotropin secretion in males; points that must be borne in mind in approaching this type of treatment, and which in some way revolutionize the old concept of "low" or "high" plasma gonadotropin levels. In this concern, the gonadotropin therapy can be applied not only to the hypogonadotropic hypogonadism, as for the past, but also to the spermatogenic arrests and to the idiopathic oligospermiogenesis wtih "normal" gonadotropin levels. The author then exposes the rigid criteria adopted in the Andrologic Center of the 5th Medical Clinic of the University of Rome for the selection of the patients to be admitted to the treatment; criteria which are based on hormonal, morphological and seminal parameters. In the final part the results are reported obtained in the selected patients with a treatment schedule with associated HMG + MCG (150--300 I.U. as FSH per week and 2000--6000 I.U. as LH per week for 12--16 weeks). The results seem very encouraging: in 85% of the patients a quantitative and qualitative amelioration of the spermatogenesis was obtained; in 30% of these cases an outcome of pregnancies in the partner has been documented so far.