Endocrine Abstracts

JOINT1361

Introduction: Infertility is the inability to conceive following one year of unprotected intercourse. About 30% of cases are related to male factors alone, and in 30% of these no specific cause for subnormal semen parameters can be found. However, a meticulous diagnostic process is essential before diagnosing the patient as having idiopathic infertility. The use of FSH treatment has been suggested in idiopathic infertile men with FSH plasma levels < 8 IU/lto increase sperm quantity and quality and pregnancy rate.

Methods: Twenty-three males with idiopathic infertility were assessed. Data on specific causes of infertility and genetic, environmental and lifestyle risk factors for infertility were investigated, along with basal hormonal and semen parameters. Patients with FSH plasma levels < 8 IU/l, oligo/asthenozoospermia and no seminal tract obstruction were treated with FSH. New semen analyses were assessed three and six months after treatment in 18 and 6 patients, respectively.

Results: Mean age of the 23 enrolled patients was 37.4±4.8 years. We evaluated risk factors for infertility and found that 5 patients (21.7%) were current smokers, 10 (43.5%) had BMI ≥ 24.9 kg/m², 4 (17.4%) had either impaired fasting glucose or diabetes. 12 patients (52.2%) had sonographic evidence of varicocele (10 ≤ II grade, 2 III grade), furthermore 4 underwent surgical correction. Median testosterone levels were 4.62 ng/ml (IQR 4.0-5.8). Baseline semen analysis showed that 20 patients (86.9%) had oligozoospermia [median spermatozoa concentration: 4.6x10⁶/ml (IQR 1.2-13); median total number: 16.2x10⁶ (IQR 5.1-32.7)]; 21 (91.3%) had asthenozoospermia [median total motility: 26% (IQR 12-37)]; 22 (95.6%) ha teratozoospermia. Patients were treated with FSH 150 UI 3 times per week. After 3 months of treatment there was no statistically significant improvement in semen parameters. Six patients were evaluated after 6 months of treatment and showed an improvement in semen parameters, although not significant probably due to the small sample size [median spermatozoa concentration: 8.1x10⁶/ml (IQR 1.9 – 14.9)(P = 0.46); median total number: 24.6x10⁶ (IQR 6.5-47.5)(P = 0.46); median total motility: 43% (IQR 30.8-60.5)(P = 0.71)].

Conclusion: The careful search for factors related to altered semen parameters could reduce the number of men diagnosed as having idiopathic infertility, allowing better management in the clinical practice. Our data, even though on a limited number of patients, seem to suggest that prescribing FSH therapy for more than 3 months could lead to an improvement in semen parameters. Further studies on larger series are needed.