Ventimiglia E, Ippolito S, Capogrosso P, Pederzoli F, Cazzaniga W, Boeri L, Cavarretta I, Alfano M, Viganò P, Montorsi F, Salonia A
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Università Vita-Salute San Raffaele, Milan, Italy.
Andrology. 2017 May;5(3):505-510. doi: 10.1111/andr.12335.
Recently, the cohort of men from the European Male Ageing Study has been stratified into different categories distinguishing primary, secondary and compensated hypogonadism. A similar classification has not yet been applied to the infertile population. We performed a cross-sectional study enrolling 786 consecutive Caucasian-European infertile men segregated into eugonadal [normal serum total testosterone (≥3.03 ng/mL) and normal luteinizing hormone (≤9.4 mU/mL)], secondary (low total testosterone, low/normal luteinizing hormone), primary (low total testosterone, elevated luteinizing hormone) and compensated hypogonadism (normal total testosterone; elevated luteinizing hormone). In this cross-sectional study, logistic regression models tested the association between semen parameters, clinical characteristics and the defined gonadal status. Eugonadism, secondary, primary and compensated hypogonadism were found in 80, 15, 2, and 3% of men respectively. Secondary hypogonadal men were at highest risk for obesity [OR (95% CI): 3.48 (1.98-6.01)]. Primary hypogonadal men were those at highest risk for azoospermia [24.54 (6.39-161.39)] and testicular volume <15 mL [12.80 (3.40-83.26)]. Compensated had a similar profile to primary hypogonadal men, while their risk of azoospermia [5.31 (2.25-13.10)] and small testicular volume [8.04 (3.17-24.66)] was lower. The risk of small testicular volume [1.52 (1.01-2.33)] and azoospermia [1.76 (1.09-2.82)] was increased, although in a milder fashion, in secondary hypogonadal men as well. Overall, primary and compensated hypogonadism depicted the worst clinical picture in terms of impaired fertility. Although not specifically designed for infertile men, European Male Ageing Study categories might serve as a clinical stratification tool even in this setting.
最近，欧洲男性衰老研究中的男性队列已被分为不同类别，以区分原发性、继发性和代偿性性腺功能减退。类似的分类尚未应用于不育人群。我们进行了一项横断面研究，纳入了786名连续的白种欧洲不育男性，分为性腺功能正常组[血清总睾酮正常(≥3.03 ng/mL)且促黄体生成素正常(≤9.4 mU/mL)]、继发性组(总睾酮低、促黄体生成素低/正常)、原发性组(总睾酮低、促黄体生成素升高)和代偿性性腺功能减退组(总睾酮正常；促黄体生成素升高)。在这项横断面研究中，逻辑回归模型测试了精液参数、临床特征与定义的性腺状态之间的关联。分别在80%、15%、2%和3%的男性中发现性腺功能正常、继发性、原发性和代偿性性腺功能减退。继发性性腺功能减退男性肥胖风险最高[比值比(95%可信区间)：3.48(1.98 - 6.01)]。原发性性腺功能减退男性无精子症风险最高[24.54(6.39 - 161.39)]且睾丸体积<15 mL风险最高[12.80(3.40 - 83.26)]。代偿性性腺功能减退组与原发性性腺功能减退男性情况相似，但其无精子症风险[5.31(2.25 - 13.10)]和睾丸体积小的风险[8.04(3.17 - 24.66)]较低。继发性性腺功能减退男性睾丸体积小[1.52(1.01 - 2.33)]和无精子症[1.76(1.09 - 2.82)]的风险也增加，尽管程度较轻。总体而言，就生育能力受损而言，原发性和代偿性性腺功能减退呈现出最糟糕的临床情况。尽管并非专门为不育男性设计，但欧洲男性衰老研究类别即使在这种情况下也可作为一种临床分层工具。
