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VOLUME 2 - NUMBER 3 - 2025

Gonadotropins: reversing azoospermia in hypo-hypo

  • Virginia Zamponi, Manuela Macera, Antongiulio Faggiano, Rossella Mazzilli
  • Original Article, 19-24
  • Full text PDF

  • PurposePurpose: This study evaluates the effectiveness of gonadotropin therapy in inducing spermatogenesis and improving semen parameters in azoospermic males with hypogonadotropic hypogonadism (HH), distinguishing between pre-pubertal and post-pubertal onset forms. Additionally, it compares responses in congenital versus acquired HH within the pre-pubertal group.

    Materials and methods: Seventeen azoospermic males with HH (FSH <2 IU/L) were included. Nine had pre-pubertal onset HH, and eight had post-pubertal onset HH. Semen analysis was conducted at baseline and after 3, 6, and 9 months of gonadotropin therapy (FSH 150 IU, three times/week; hCG 2000 IU, once/week).

    Results: After gonadotropin therapy, 88.9% of patients in the pre-pubertal group resumed spermatogenesis, with response rates of 22.2% at 3, 55.5% at 6, and 11.1% at 9 months. In the post-pubertal group, 87.5% achieved spermatogenesis, with 62.5% responding at 3 months, 12.5% at 6 and 9 months. Post-pubertal patients showed greater semen parameter improvements, with lower atypical forms (p = 0.032) and higher sperm concentration (p = 0.012), total count (p = 0.004), and motility (p = 0.013). Among pre-pubertal patients, acquired HH cases had a better response (100% vs. 75% in congenital HH).

    Conclusion: Gonadotropin therapy effectively induces spermatogenesis in HH patients, with high response rates. Post-pubertal onset cases respond faster and exhibit superior semen quality. Acquired HH cases in the pre-pubertal group show better outcomes than congenital cases, underscoring the need for individualized treatment based on HH etiology and onset timing.

  • KEY WORDS: Hypogonadotropic hypogonadism, gonadotropin therapy, male infertility, spermatogenesis, male reproductive health.