This study was designed to determine if hormonal treatment using pure follicle stimulating hormone(pFSH) and human chorionic gonadotropin(hCG) would improve the fertilizing ability of sperm in patients with idiopathic male infertility. In this
study,
two groups of patients with severe male factor were evaluated. The group I included 9 patients with a history of failed fertilization in one or more previous IVF attempts when normal oocytes were retrieved, and group II included 12 patients with
poor
sperm parameters is defined as characterized by sperm concentration of less than 5×10E6/ml ; progressive motility less than 10% ; normal sperm morphology less than 2.5% using strict criteria ; sperm morphology index(summation of normal and
slightly
amorphous forms) less than 5.5% using strict criteria. All patients included in this study had normal hormonal state(luteinizing hormone [LH], FSH testosterone, prolactin) and no structural abnormalities in testis. PFSH, 75 IU, was administered
three
times a week and hCG, 5,000 IU, was added once a week intramuscularly for three months. Conventional semen analysis and sperm morphology evaluation using strict criteria were performed in all patients(n=21) after pFSH/hCG treatment. The sperm
concentration was significantly increased after treatment, with 44.8±26.0×10E6/ml compared with 27.5±25.0×10E6/ml before treatment. The sperm motility was also significantly increased after treatment, with 53.9±19.8% compared with
28.1±16.8%
before treatment. The normal sperm morphology and morphology index by strict criteria were significantly increased after treatment, with 3.7±1.5% and 6.8±2.3% compared with 2.2±0.8% and 4.0±1.4% before treatment. In the group I, the
fertilization
and cleavage rates per oocyle were significantly increased after treatment, with 37.2%(35/94) and 29.8%(28/94) compared 5.5%(5/91) and 2.2%(2/91) before treatment. Clinical pregnancy rate after treatment(22.2%=2/9) was hisgher than before
treatment(0%),
without statistical significance. In the group II, pregnancies occurred spontaneously in 25%(3/12) of couples after course of hFSH/hCG treatment. There was one spontaneous abortion in these three pregnancies. IVFs were attempted in 6 couples of
12
included in the group II. The fertilization and cleavage rates per oocyte were 44.4%(28/63) and 31.7%(20/63). In these 6 patients, a clinical pregnancy(16.7%) was achieved. In conclusion, systemic hormonal therapy using pFSH and hCG could improve
the
fertilization capacity of sperm and it may be reasonable to offer this treatment to the patients with severe male factor as previously defined and for those cases of failed fertilization f IVF.
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