Introduction: Infertility affects 15% of couples and a male factor accounts for 50% of cases. Adequate history taking, examination of both partners, hormone testing and semen analysis are required to ascertain a cause and treatment strategy. Gonadotropin therapy with Human Chorionic Gonadotropin (HCG) and recombinant Follicle Stimulating Hormone (rFSH) is indicated for use in men with reduced spermatogenesis due to hypogonadotropic hypogonadism (HH). We present a man with hypogonadotropic hypogonadism, azoospermia and previous right orchidectomy who received gonadotropin therapy with subsequent stimulation of spermatogenesis.
Case: A 40 year old man presented to the endocrine department in August 2015 with a 4-year history of tiredness, reduced libido and infertility. He was seen by the urologist in 2011 for right undescended testis and had an orchidectomy in January 2015. In March 2014 he attended the fertility clinic and was found to have HH with azoospermia (repeat tests in 2015 and 2016 confirmed the same). An ultrasound revealed a small, well-perfused left testicle of 13 ml-size. His pituitary gland imaging was normal. We commenced subcutaneous HCG 1500 IU three times a week until serum testosterone levels normalised. At month-3 subcutaneous rFSH 150 IU three times a week was commenced while the HCG dose was reduced to 1500 IU once a week. Semen analysis at month-6 and month-9 has revealed progressive improvement in spermatogenesis (concentration, motility, and progressiveness). Three-monthly assessment of testosterone levels, full blood count, prostate specific antigen and liver function tests have been normal. Combined therapy is being continued until appreciable levels of spermatogenesis have been achieved for non-assisted conception and/or for semen freezing and assisted conception treatment.
Conclusion: In conclusion, we describe a man with hypogonadotropic hypogonadism, azoospermia, previous right orchidectomy and a remaining small left testicle, who is currently receiving gonadotropin therapy with subsequent stimulation of adequate spermatogenesis.