Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy.
Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy.
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DOI：
10.1016/j.fertnstert.2016.10.004
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发表时间：
2017-02
影响因子：
6.7
通讯作者：
Lipshultz LI
中科院分区：
文献类型：
--
作者：
Kohn TP;Louis MR;Pickett SM;Lindgren MC;Kohn JR;Pastuszak AW;Lipshultz LI
目的：探讨睾丸激素相关性不育患者精子恢复的影响因素。临床回顾性研究。学术男性不育泌尿科诊所。66名男性在使用睾酮后出现不育。停用睾酮（T），联合高剂量人绒毛膜促性腺激素（hCG）和选择性雌激素调节剂（SERM）治疗。患者在T停止和开始治疗的12个月内是否成功实现或未能实现总活动精子计数（TMC）大于500万个精子。46名男性（70%）达到了超过500万个精子的TMC。年龄的增加和睾酮使用的持续时间与hCG/SERM治疗6个月和12个月时精子恢复的时间直接相关。年龄更一致地限制精子的恢复，而睾酮使用的持续时间在12个月时的影响小于6个月时的影响。只有64.8%的无精子症男性在12个月时达到TMC超过500万个精子，而隐精子症男性为91.7%，但这并不能预测精子回收失败。根据6个月和12个月时TMC为500万个精子的标准，增加年龄和使用睾酮的持续时间显著降低了射精中精子回收的可能性。医生在进行长期睾酮治疗时应谨慎，特别是对于仍希望生育的男性。利用这些发现，医生可以建议男性在6个月和12个月时恢复精子的可能性。在对66例睾酮相关性不育男性的回顾性分析中，我们发现睾酮治疗的持续时间和就诊时的年龄与精子恢复时间直接相关。
To determine factors that influence sperm recovery after testosterone-associated infertility. Clinical retrospective study. Academic male-infertility urology clinic. Sixty-six men who presented with infertility after testosterone use. Testosterone (T) cessation and combination high-dose human chorionic gonadotropin (hCG) and selective estrogen modulator (SERM) therapy. Whether patients successfully achieved or failed to achieve a total motile count (TMC) of greater than 5 million sperm within 12 months of T cessation and initiation of therapy. A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of testosterone use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of testosterone use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery. Increasing age and duration of testosterone use significantly reduce the likelihood of recovery of sperm in the ejaculate, based on a criterion of a TMC of 5 million sperm, at 6 and 12 months. Physicians should be cautious in pursuing long-term testosterone therapy, particularly in men who still desire fertility. Using these findings, physicians can counsel men regarding the likelihood of recovery of sperm at 6 and 12 months. In this retrospective analysis of 66 men with testosterone-associated infertility, we found that duration of testosterone therapy and age at presentation are directly correlated with time to sperm recovery.