Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot Study
Introduction: Appropriate gonadotropin therapy regimen for the induction of spermatogenesis in congenital Hypogonadotropic Hypogonadism (HH) patients is a matter of debate. Pre-treatment with hCG is discouraged, while the rationale for FSH pre-treatment is that it mimics minipuberty, thereby being e...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-05-01
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| Series: | Indian Journal of Endocrinology and Metabolism |
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| Online Access: | https://journals.lww.com/10.4103/ijem.ijem_307_24 |
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| author | Japleen Kaur Nikhil Singhania Umanath Adhikari Richa Vatsa Ujjwal Gorsi Akash Bansal Sanjay Bhadada Nidhi Gupta Anil Bhansali Naresh Sachdeva Aayushi Kaushal Rama Walia |
| author_facet | Japleen Kaur Nikhil Singhania Umanath Adhikari Richa Vatsa Ujjwal Gorsi Akash Bansal Sanjay Bhadada Nidhi Gupta Anil Bhansali Naresh Sachdeva Aayushi Kaushal Rama Walia |
| author_sort | Japleen Kaur |
| collection | DOAJ |
| description | Introduction:
Appropriate gonadotropin therapy regimen for the induction of spermatogenesis in congenital Hypogonadotropic Hypogonadism (HH) patients is a matter of debate. Pre-treatment with hCG is discouraged, while the rationale for FSH pre-treatment is that it mimics minipuberty, thereby being expected to be better than upfront combined hCG and FSH therapy.
Methods:
A prospective RCT was conducted in the Department of Endocrinology of a tertiary centre. 24 azoospermic males between 17y and 40y of age with congenital HH were randomized into two groups. Group A (n = 12) received upfront combined hCG and FSH, while group B (n = 12) was given pre-treatment with FSH for 3 months, before addition of hCG.
Results:
Patients were followed up for a maximum duration of 18 months. Overall success rate was 91.3% (21/23). In group A, 100% (12/12) responded to treatment compared with 81.8% (9/11) in group B, with significantly lesser median (IQR) time to spermatogenesis of 10.5 (9–12) months in group A, compared to 15 (13.5–16.5) months in group B (P = 0.007). Maximum sperm concentration [median (IQR)] attained in group A and B was 30 (15.5–47) million/mL and 20 (7.5–34.5) million/mL, respectively (P = 0.292). Sonographic bi-testicular volume (median) increased to 8.05 (7.13–10.57) mL in group A and 9.2 (5.45–14) mL in group B.
Conclusion:
Both FSH pre-treatment and upfront combined hCG and FSH have a favourable outcome in initiating spermatogenesis in congenital HH, with the time to initiation of spermatogenesis favouring combined treatment. |
| format | Article |
| id | doaj-art-ac2dd2244d4b4b27a3366dafd16fcb19 |
| institution | DOAJ |
| issn | 2230-8210 2230-9500 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Endocrinology and Metabolism |
| spelling | doaj-art-ac2dd2244d4b4b27a3366dafd16fcb192025-08-20T02:44:52ZengWolters Kluwer Medknow PublicationsIndian Journal of Endocrinology and Metabolism2230-82102230-95002025-05-0129333233610.4103/ijem.ijem_307_24Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot StudyJapleen KaurNikhil SinghaniaUmanath AdhikariRicha VatsaUjjwal GorsiAkash BansalSanjay BhadadaNidhi GuptaAnil BhansaliNaresh SachdevaAayushi KaushalRama WaliaIntroduction: Appropriate gonadotropin therapy regimen for the induction of spermatogenesis in congenital Hypogonadotropic Hypogonadism (HH) patients is a matter of debate. Pre-treatment with hCG is discouraged, while the rationale for FSH pre-treatment is that it mimics minipuberty, thereby being expected to be better than upfront combined hCG and FSH therapy. Methods: A prospective RCT was conducted in the Department of Endocrinology of a tertiary centre. 24 azoospermic males between 17y and 40y of age with congenital HH were randomized into two groups. Group A (n = 12) received upfront combined hCG and FSH, while group B (n = 12) was given pre-treatment with FSH for 3 months, before addition of hCG. Results: Patients were followed up for a maximum duration of 18 months. Overall success rate was 91.3% (21/23). In group A, 100% (12/12) responded to treatment compared with 81.8% (9/11) in group B, with significantly lesser median (IQR) time to spermatogenesis of 10.5 (9–12) months in group A, compared to 15 (13.5–16.5) months in group B (P = 0.007). Maximum sperm concentration [median (IQR)] attained in group A and B was 30 (15.5–47) million/mL and 20 (7.5–34.5) million/mL, respectively (P = 0.292). Sonographic bi-testicular volume (median) increased to 8.05 (7.13–10.57) mL in group A and 9.2 (5.45–14) mL in group B. Conclusion: Both FSH pre-treatment and upfront combined hCG and FSH have a favourable outcome in initiating spermatogenesis in congenital HH, with the time to initiation of spermatogenesis favouring combined treatment.https://journals.lww.com/10.4103/ijem.ijem_307_24congenitalgonadotropinhypogonadotropic hypogonadismspermatogenesis |
| spellingShingle | Japleen Kaur Nikhil Singhania Umanath Adhikari Richa Vatsa Ujjwal Gorsi Akash Bansal Sanjay Bhadada Nidhi Gupta Anil Bhansali Naresh Sachdeva Aayushi Kaushal Rama Walia Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot Study Indian Journal of Endocrinology and Metabolism congenital gonadotropin hypogonadotropic hypogonadism spermatogenesis |
| title | Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot Study |
| title_full | Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot Study |
| title_fullStr | Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot Study |
| title_full_unstemmed | Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot Study |
| title_short | Comparison of FSH Pre-treatment Versus Upfront hCG and FSH Regimens for Inducing Spermatogenesis in Congenital Hypogonadotropic Hypogonadism: A Pilot Study |
| title_sort | comparison of fsh pre treatment versus upfront hcg and fsh regimens for inducing spermatogenesis in congenital hypogonadotropic hypogonadism a pilot study |
| topic | congenital gonadotropin hypogonadotropic hypogonadism spermatogenesis |
| url | https://journals.lww.com/10.4103/ijem.ijem_307_24 |
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