Pulsatile GnRH or human chorionic gonadotropin human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism:: a review of 42 cases
Pulsatile GnRH or human chorionic gonadotropin human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism:: a review of 42 cases
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DOI：
10.1530/eje.0.1390298
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发表时间：
1998-09-01
影响因子：
5.8
通讯作者：
Nieschlag, E
中科院分区：
文献类型：
--
作者：
Büchter, D;Behre, HM;Nieschlag, E
促性腺激素释放激素或促性腺激素的刺激治疗是一种有效的治疗方法，以诱导精子发生，并实现父权的男性继发性性腺功能减退症。然而，仍有不确定性的最佳治疗方式和时间表，治疗所需的持续时间和干扰因素的影响，如睾丸发育不良，我们已经扩大了我们以前的一系列男子治疗继发性性腺功能减退症，现在我们的治疗经验与42例。21例下丘脑疾病患者（特发性低促性腺激素性性腺功能减退症（IHH）11例，Kallmann综合征（KalS）10例）分别用GnRH（Ia组）或人绒毛膜促性腺激素（hCG）/人绝经期促性腺激素（hMG）（Ib组）治疗，21例垂体功能减退症（II组）用hCG/hMG治疗。共启动了57个疗程以诱导精子生成，其中36个疗程用于诱导女性伴侣妊娠。双侧睾丸体积在治疗后5-12个月内翻了一番。在54/57个疗程中诱导了精子发生，这一点通过射精中精子的出现来证明。36个疗程中有26个发生妊娠，单侧睾丸发育不良并不妨碍IHH或KalS患者在治疗下获得生育能力，即使在一些双侧睾丸发育不良的个体中，精子发生也可以成功启动。一般来说，有双侧隐睾病史的患者在诱导精子发生之前的治疗时间倾向于更长。然而，这并未达到统计学显著性。在接受hCG/hMG或GnRH治疗的IHH或KalS患者中，精子出现时间或妊娠率无统计学显著差异。即使在年龄高达43岁的KalS患者中，也可以诱导精子发生。在重复治疗的患者中，精子发生的刺激往往更快，而在第二个疗程中，诱导妊娠的时间显著缩短。总之，GnRH或hCG/hMG是MH或KalS患者的有效治疗方式，尚待确定是否高纯度尿促性腺激素制剂或重组LH和FSH将提供治疗优势。
Stimulatory therapy with either GnRH or gonadotropins is an effective treatment to induce spermatogenesis and achieve paternity in men with secondary hypogonadism. However, there is still uncertainty about the optimal treatment modality and schedule, the duration of treatment necessary and the influence of interfering factors such as maldescended testes, We have extended our previous series of men treated for secondary hypogonadism and now present our therapeutic experience with 42 cases. Twenty-one patients with hypothalamic disorders (11 with idiopathic hypogonadotropic hypogonadism (IHH) and 10 with Kallmann syndrome (KalS)) were treated with GnRH (group Ia) or human chorionic gonadotropin (hCG)/human menopausal gonadotropin (hMG) (group Ib), and 21 patients with hypopituitarism (group II) were treated with hCG/hMG. A total of 57 treatment courses were initiated for induction of spermatogenesis, 36 of these for the purpose of induction of pregnancy in the female partner. Bilateral testicular volumes doubled within 5-12 months of therapy. Spermatogenesis as evidenced by the appearance of sperm in the ejaculate was induced in 54/57 courses. Pregnancies occurred in 26/36 courses, Unilaterally maldescended testes did not preclude patients with IHH or KalS from gaining fertility under therapy and spermatogenesis could be successfully initiated even in some individuals with bilateral maldescended testes. In general there was a tendency for a longer duration of therapy until induction of spermatogenesis in patients with a history of bilateral cryptorchidism. However this did not reach statistical significance. In patients with IHH or KalS treated with either hCG/hMG or GnRH there were no statistically significant differences in terms of duration to appearance of sperm or pregnancy rates. Even in KalS patients as old as 43 years spermatogenesis could be induced. In repeatedly treated patients stimulation of spermatogenesis tended to be faster while time until induction of pregnancy was significantly shorter in the second treatment course. In conclusion, GnRH or hCG/hMG are effective therapeutic modalities for patients with MH or KalS, It remains to be determined whether highly purified urinary gonadotropin preparations or recombinant LH and FSH will provide therapeutic advantages.