Gonadotropin Therapy in Men With Isolated Hypogonadotropic Hypogonadism: The Response to Human Chorionic Gonadotropin Is Predicted by Initial Testicular Size

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Abstract
This study was designed to determine whether exogenous hCG alone can complete spermiogenesis in men with isolated hypogonadotropic hypogonadism (IHH). hCG was administered to 22 men with IHH until maximal testicular growth was achieved. Their mean testicular volume increased from 5.5 .+-. 1.1 (.+-. SE) mL (pretreatment) to 10.8 .+-. 1.6 mL (maximum) during treatment (P < 10-6). The maximum mean testicular volume was highly positively correlated with initial volume (r = 0.84; P < 10-6). All men attained normal serum testosterone levels, and 7 of 22 men achieved supraphysiological serum estradiol levels. During hCG treatment, 14 of the 22 men had serum appear in their semen. Six of 11 men with complete gonadotropin deficiency, defined as an initial mean testicular volume less than 4 mL, became sperm positive during hCG treatment. In contrast, 9 of 11 men wiht partial gonadotropin deficiency (initial mean testicular volume of 4 mL or more) produced sperm during treatment (P < 0.001). Sperm concentration was highly positively correlated with both pretreatment (r = 0.65; P < 0.01) and final testicular volume (r = 0.73; P < 0.001). Of 13 men attempting to impregnate their partners, 7 were successful in initiating conception; a total of 8 pregnancies ensued. The sperm concentration at the time of conception was less than 10 million/mL in all but 1 man. Our study demonstrates that hCG, in the absence of exogenous FSH, can complete spermiogenesis in men with partial gonadotropin deficiency. The response to hCG in men with IHH is predicted by the initial testicular volume.

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