Does hormonal stimulation therapy have a role in inducing sperm production in azoospermic men with hypogonadotropic and hypergonadotropic hypogonadism?
BAUS ePoster online library. Foran D. 11/10/20; 304189; P6-14
Daniel Foran
Daniel Foran
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Abstract
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Does hormonal stimulation therapy have a role in inducing sperm production in azoospermic men with hypogonadotropic and hypergonadotropic hypogonadism?

Tharakan T1, Foran D1, Maynard W1, Vyas L1, Ramsay J1, Jayasena C1, Minhas S1
1Imperial College London, United Kingdom

Introduction:
Selective oestrogen receptor modulators (SERMs) and aromatase inhibitors (Ais) are often used in men to treat hypergonadotropic hypogonadism (HyperH) empirically, whilst, gonadotropin therapy is used in hypogonadotropic hypogonadism (HypoH) to induce spermatogenesis. This study aimed to evaluate the clinical efficacy of hormone stimulation therapy (HST) in HypoH and HyperH patients through analysis of changes in serum gonadotropins and testosterone; and semen parameters.
Materials and Methods: 79 azoospermic men, (HypoH: n=24, HyperH: n=55) underwent baseline hormone and semen analyses. At 3, 6 and 12 months of treatment, analyses were repeated. Mann-Whitney U tests compared baseline characteristics between both pathological groups. Wilcoxon signed rank matched pair tests determined the significance of the change from baseline of each parameter.

Results:
In HypoH patients, gonadotropin therapy significantly increased serum testosterone from baseline to 3, 6 and 12 months and sperm concentration significantly increased from baseline to 3, 6 and 12 months. In HyperH patients, Clomiphene significantly increased serum gonadotropins from baseline to 3 months and both Clomiphene and Tamoxifen significantly increased serum testosterone from baseline to 3 months. There was no increase in sperm concentration, however. Ais had no significant effects. 2 patients with Klinefelter's syndrome had venous thromboembolic events (VTEs) on HST.

Conclusions:
Whilst, gonadotropins demonstrate clinical efficacy in treating HypoH, empirical HST (CC, tamoxifen and AI) does not induce spermatogenesis in HyperH. Patients with Klinefelter's syndrome may be at increased risk of VTE on HST. Randomised control trials are urgently needed to evaluate the clinical safety and efficacy of these drugs.
Does hormonal stimulation therapy have a role in inducing sperm production in azoospermic men with hypogonadotropic and hypergonadotropic hypogonadism?

Tharakan T1, Foran D1, Maynard W1, Vyas L1, Ramsay J1, Jayasena C1, Minhas S1
1Imperial College London, United Kingdom

Introduction:
Selective oestrogen receptor modulators (SERMs) and aromatase inhibitors (Ais) are often used in men to treat hypergonadotropic hypogonadism (HyperH) empirically, whilst, gonadotropin therapy is used in hypogonadotropic hypogonadism (HypoH) to induce spermatogenesis. This study aimed to evaluate the clinical efficacy of hormone stimulation therapy (HST) in HypoH and HyperH patients through analysis of changes in serum gonadotropins and testosterone; and semen parameters.
Materials and Methods: 79 azoospermic men, (HypoH: n=24, HyperH: n=55) underwent baseline hormone and semen analyses. At 3, 6 and 12 months of treatment, analyses were repeated. Mann-Whitney U tests compared baseline characteristics between both pathological groups. Wilcoxon signed rank matched pair tests determined the significance of the change from baseline of each parameter.

Results:
In HypoH patients, gonadotropin therapy significantly increased serum testosterone from baseline to 3, 6 and 12 months and sperm concentration significantly increased from baseline to 3, 6 and 12 months. In HyperH patients, Clomiphene significantly increased serum gonadotropins from baseline to 3 months and both Clomiphene and Tamoxifen significantly increased serum testosterone from baseline to 3 months. There was no increase in sperm concentration, however. Ais had no significant effects. 2 patients with Klinefelter's syndrome had venous thromboembolic events (VTEs) on HST.

Conclusions:
Whilst, gonadotropins demonstrate clinical efficacy in treating HypoH, empirical HST (CC, tamoxifen and AI) does not induce spermatogenesis in HyperH. Patients with Klinefelter's syndrome may be at increased risk of VTE on HST. Randomised control trials are urgently needed to evaluate the clinical safety and efficacy of these drugs.
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