Title:Hypergonadotropic Hypogonadism: Management of Infertility
Volume: 27
Issue: 24
Author(s): Arif Kalkanli, Hakan Akdere, Gökhan Cevik, Emre Salabas, Nusret Can Cilesiz and Ateş Kadioglu*
Affiliation:
- Section of Andrology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,Turkey
Keywords:
Hypergonadotropic hypogonadism, male infertility, empirical medical treatment, gonadotropins, aromatase inhibitors, selective
estrogen receptor modulators.
Abstract:
Background: Medical treatments are used either alone or in combination with assisted reproductive
techniques for the treatment of infertile patients with hypergonadotropic hypogonadism. A wide range of treatment
options such as gonadotropins, aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs)
and their combination are available as options.
Objective: The aim of this review was to evaluate treatment options for infertile men with hypergonadotropic
hypogonadism.
Methods: A literature search of MEDLINE (1980-2019) was conducted using the terms ‘hypogonadism’, ‘male
infertility’, ‘gonadotropins’, ‘SERMs’ and ‘AIs’. Pathologies leading to hypergonadotropic hypogonadism and
treatment modalities such as gonadotropins, SERMs, AIs and surgical treatment were discussed.
Results: FSH increases spontaneous pregnancy rates but the level of evidence was proven to be low for live birth
rates. AIs are valid treatment options for patients with low T/E2 ratio as they significantly increase sperm concentrations.
SERMs are recommended for infertile males with a sperm concentration between 10-20 million.
Varicocele was reported to increase testosterone levels of hypogonadic infertile males.
Conclusion: Medical treatment modalities such as gonadotropins, SERMs, AIs and a combination of these therapies
has been showed to have some effect in improvement of fertility but is not mainstream of the treatment.
