What is the optimal treatment for sperm production in men hypogonadism?

This study investigated the effect of gonadotrophin-releasing hormone (GnRH) pulse therapy (PT) compared to human chorionic gonadotropin and human menopausal gonadotropin (HCG/HMG) combination therapy in men with hypogonadotropic hypogonadism (HH). 

They found that GnRH-PT stimulated sperm production earlier than other treatments. 

Hypogonadotropic hypogonadism (HH) involves a reduced production of hormones called gonadotropins (GDTs). These are normally produced by the pituitary gland. GDTs are important in stimulating other hormones. These include sex hormones. In men, sex hormones are necessary for sperm production (spermatogenesis, SPG) and normal male sexual development. Sex hormones include luteinizing hormone (LH) and follicle stimulating hormone (FSH). They are involved in testosterone (TT) production. Human chorionic gonadotropin (HCG) stimulates LH production. Human menopausal gonadotrophin (HMG) stimulates FSH. HCG and HMG are usually prescribed to treat HH. 

Treatment with synthetic gonadotrophin-releasing hormone (GnRH) may improve SPG. However, these findings are inconsistent. The method of delivery and dose varies in clinical reports. GnRH pulse therapy (GnRH-PT) administers GnRH by infusion under the skin (subcutaneous).  It is unclear if GnRH-PT more effectively stimulates SPG in men with HH than HCG/HMG combination. 

This study included 220 men with HH. Some patients had HH since birth (congenital HH, CHH). The remaining patients had acquired HH (AHH). 117 patients were treated with HCG/HMG. 103 patients were treated with GnRH-PT. HCG/HMG was administered by intramuscular injection. Treatment lasted up to 18 months. LH, FSH, and TT levels were measured. Testicular volume (TV) was also measured.  

The TV and TT levels were significantly increased 6 months after treatment in both groups compared to before the treatment. 

SPG was observed in 52.99% of the GnRH-PT group and in 25.24% of the HCG/HMG-treated patients. The average initial time for SPG was 6.2 months in GnRH- and 10.9 months in HCG/HMG-patients. The average TV at this time was 9.8 ml (GnRH) versus 8.1 ml (HCG/HMG). TT levels were significantly higher in HCG/HMG-treated patients. There was no difference between CHH and AHH patients in any of the findings.

The authors concluded that GnRH-PT stimulated sperm production earlier than other treatments in men with HH.

Genetic mutations are often involved in HH. The effect of GnRH treatment in different types of HH needs more investigation. 

If you have any concerns regarding infertility treatment, please consult with your physician.