Zheng Yi, Bai Heng-Zhou, Zhao Gui-Cheng, Tian Kun, Yue Jun-Tao, Li Ding-Ming, Jiang Xiao-Hui
Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Reprod Biol Endocrinol. 2025 Mar 21;23(1):46. doi: 10.1186/s12958-025-01370-7.
To evaluate whether there was a difference in outcome between pulsatile gonadotropin releasing hormone (GnRH) therapy and human chorionic gonadotropin/human menopausal gonadotropin (hCG/HMG) therapy for induction of spermatogenesis in post-pubertal male patients with congenital hypogonadotropic hypogonadism (CHH).
This was a single-center retrospective cohort study conducted at the Andrology Center of a university hospital. A total of 155 postpubertal CHH patients who met the inclusion criteria underwent spermatogenic induction at the same andrology center. All patients used pulsatile GnRH therapy or hCG/HMG therapy for at least 6 months. The effects of spermatogenic induction therapy and testicular growth were evaluated. Logistic regression analysis was used to identify statistically significant factors which could predict the outcome of treatment.
There was no difference in the efficiency of successfully inducing spermatogenesis between pulsatile GnRH therapy and hCG/HMG therapy (82.1% vs. 75.8%, P: 0.356), nor was there a difference in sperm concentration category (SCC) (P: 0.284). However, the mean time required for pulsatile GnRH therapy was shorter (12.34 vs. 14.74 months, P: 0.038). At the treatment endpoint, total testicular volume (TTV) was greater with pulsatile GnRH therapy compared with hCG/HMG therapy (15 vs. 12 ml, P: 0.010), and there was still no difference in SCC (P: 0.310). Multivariate logistic regression analysis showed that only baseline TTV was statistically significant predictor of induced spermatogenic success (odds ratio, OR: 1.156, 95% confidence interval, CI: 1.013, 1.319). The area under receiver operating characteristic curve was 0.635, a sensitivity of 0.661, and a specificity of 0.588. In addition, multiple linear regression analysis demonstrated that younger age at treatment initiation and higher baseline TTV were significantly associated with increased sperm concentration at the end of treatment.
Pulsatile GnRH therapy was similar to hCG/HMG therapy in inducing spermatogenesis in post-pubertal CHH patients, but it took less time and was more beneficial to testicular development. Larger baseline TTV may mean a better spermatogenic outcome. It was necessary for patients to have more information about spermatogenesis therapy in order to make reasonable medical decisions.
Chinese Clinical Trial Registry. ChiCTR2400086876. Retrospectively registered on July 5, 2024.
评估在青春期后先天性低促性腺激素性性腺功能减退（CHH）男性患者中，脉冲式促性腺激素释放激素（GnRH）疗法与人类绒毛膜促性腺激素/人绝经期促性腺激素（hCG/HMG）疗法在诱导精子发生方面的结局是否存在差异。
这是一项在大学医院男科中心进行的单中心回顾性队列研究。共有155例符合纳入标准的青春期后CHH患者在同一男科中心接受精子发生诱导治疗。所有患者使用脉冲式GnRH疗法或hCG/HMG疗法至少6个月。评估精子发生诱导治疗的效果和睾丸生长情况。采用逻辑回归分析确定可预测治疗结局的统计学显著因素。
脉冲式GnRH疗法与hCG/HMG疗法在成功诱导精子发生的效率上无差异（82.1%对75.8%，P：0.356），精子浓度类别（SCC）也无差异（P：0.284）。然而，脉冲式GnRH疗法所需的平均时间更短（12.34对14.74个月，P：0.038）。在治疗终点，与hCG/HMG疗法相比，脉冲式GnRH疗法的总睾丸体积（TTV）更大（15对12 ml，P：0.010），且SCC仍无差异（P：0.310）。多因素逻辑回归分析显示，只有基线TTV是诱导精子发生成功的统计学显著预测因素（优势比，OR：1.156，95%置信区间，CI：1.013，1.319）。受试者工作特征曲线下面积为0.635，灵敏度为0.661，特异度为0.588。此外，多元线性回归分析表明，治疗开始时年龄较小和基线TTV较高与治疗结束时精子浓度增加显著相关。
在青春期后CHH患者中，脉冲式GnRH疗法在诱导精子发生方面与hCG/HMG疗法相似，但所需时间更短，对睾丸发育更有益。较大的基线TTV可能意味着更好的精子发生结局。患者有必要了解更多关于精子发生治疗的信息，以便做出合理的医疗决策。
中国临床试验注册中心。ChiCTR2400086876。于2024年7月5日进行回顾性注册。
