KMID : 1033620190460040173
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Clinical and Experimental Reproductive Medicine 2019 Volume.46 No. 4 p.173 ~ p.177
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Misuse of testosterone replacement therapy in men in infertile couples and its influence on infertility treatment
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Song Seung-Hun
Sung Su-Ye Her Young-Sun Oh Mi-Hee Shin Dong-Hyuk Lee Jin-Il Baek Jeong-Won Lee Woo-Sik Kim Dong-Suk
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Abstract
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Objective: We investigated the clinical characteristics of men with testosterone replacement therapy (TRT)-induced hypogonadism and its effect on assisted reproductive technology (ART) in infertile couples.
Methods: This study examined the records of 20 consecutive male patients diagnosed with azoospermia or severe oligozoospermia (<5¡¿106/mL) who visited a single infertility center from January 2008 to July 2018. All patients were treated at a primary clinic for erectile dysfunction or androgen deficiency symptoms combined with low serum testosterone. All men received a phosphodiesterase 5 inhibitor and TRT with testosterone undecanoate (Nebido¢ç) or testosterone enanthate (Jenasteron¢ç). Patients older than 50 years or with a chronic medical disease such as diabetes were excluded.
Results: The mean age of patients was 37 years and the mean duration of infertility was 16.3¡¾11.6 months. At the initial presentation, eight patients had azoospermia, nine had cryptozoospermia, and three had severe oligozoospermia. Serum follicle-stimulating hormone levels were below 1.0 mIU/mL in most patients. Three ongoing ART programs with female factor infertility were cancelled due to male spermatogenic dysfunction; two of these men had normal semen parameters in the previous cycle. After withholding TRT, serum hormone levels and sperm concentrations returned to normal range after a median duration of 8 months.
Conclusion: TRT with high-dose testosterone can cause spermatogenic dysfunction due to suppression of the hypothalamic-pituitary-testicular axis, with adverse effects on infertility treatment programs. TRT is therefore contraindicated for infertile couples attempting to conceive, and the patient¡¯s desire for fertility must be considered before initiation of TRT in a hypogonadal man.
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KEYWORD
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Azoospermia, Hypogonadism, Male infertility, Testosterone
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