Semen analysis is the major test for evaluating male infertility. This test provides important information about the quality and quantity of the sperm. The semen sample is analyzed for volume, viscosity (thickness), pH and color of the ejaculate, sperm concentration, motility, morphology, and forward progression of the sperm. The sample is also examined for the presence of white or red blood cells which may indicate infection or inflammation.
In patients who desire fertility, the options to induce spermatogenesis include exogenous gonadotropins or pulsatile GnRH. In hypogonadotropic hypogonadism, the origin of the disease influences the choice of treatment to achieve fertility. GnRH substitution is more effective for hypothalamic than pituitary disorders. However, depending on the number of functioning gonadotropes remaining, GnRH may also be an effective therapy for patients with hypopituitarism.
Administration of exogenous gonadotropins is suitable for patients with both pituitary and hypothalamic disorders. Conventional therapy uses hCG as an LH substitute in conjunction with FSH in the form of either human menopausal gonadotropins (HMG) or recombinant FSH formulations (rFSH).
The alternative to gonadotropin therapy is pulsatile administration of GnRH, which may be administered by a programmable, portable mini-infusion pump. While intravenous administration produces the most physiologic GnRH pulse contour and ensuing LH response, the subcutaneous route is clearly more practical for the longterm treatment required to stimulate spermatogenesis. The frequency of GnRH administration is normally employed is every 2 hours. The dose of GnRH is titrated for each individual to ensure normalization of testosterone, LH and FSH and varies from 25 to 600 ng/kg per bolus. Patients on longterm therapy are monitored with serum testosterone and gonadotropin levels at monthly intervals. Once testicular volume reaches 8 mL, regular semen analyses are obtained. The majority of patients require treatment for at least 2 years to maximize testicular growth and achieve spermatogenesis, although the time taken to reach these endpoints tends to be shorter in those with a larger initial gonadal size.
Both exogenous gonadotropins and pulsatile GnRH are very effective in stimulating spermatogenesis. Most studies have no shown no advantage of either therapy in terms of testicular growth, onset of spermatogenesis, final sperm counts or pregnancy rates. However, there are some data to suggest that testicular growth is greater and the time taken to achieve spermatogenesis is shorter in patients treated with GnRH
Jenetic
In patients who desire fertility, the options to induce spermatogenesis include exogenous gonadotropins or pulsatile GnRH. In hypogonadotropic hypogonadism, the origin of the disease influences the choice of treatment to achieve fertility. GnRH substitution is more effective for hypothalamic than pituitary disorders. However, depending on the number of functioning gonadotropes remaining, GnRH may also be an effective therapy for patients with hypopituitarism.
Administration of exogenous gonadotropins is suitable for patients with both pituitary and hypothalamic disorders. Conventional therapy uses hCG as an LH substitute in conjunction with FSH in the form of either human menopausal gonadotropins (HMG) or recombinant FSH formulations (rFSH).
The alternative to gonadotropin therapy is pulsatile administration of GnRH, which may be administered by a programmable, portable mini-infusion pump. While intravenous administration produces the most physiologic GnRH pulse contour and ensuing LH response, the subcutaneous route is clearly more practical for the longterm treatment required to stimulate spermatogenesis. The frequency of GnRH administration is normally employed is every 2 hours. The dose of GnRH is titrated for each individual to ensure normalization of testosterone, LH and FSH and varies from 25 to 600 ng/kg per bolus. Patients on longterm therapy are monitored with serum testosterone and gonadotropin levels at monthly intervals. Once testicular volume reaches 8 mL, regular semen analyses are obtained. The majority of patients require treatment for at least 2 years to maximize testicular growth and achieve spermatogenesis, although the time taken to reach these endpoints tends to be shorter in those with a larger initial gonadal size.
Both exogenous gonadotropins and pulsatile GnRH are very effective in stimulating spermatogenesis. Most studies have no shown no advantage of either therapy in terms of testicular growth, onset of spermatogenesis, final sperm counts or pregnancy rates. However, there are some data to suggest that testicular growth is greater and the time taken to achieve spermatogenesis is shorter in patients treated with GnRH
Jenetic