Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy

In this retrospective analysis of 66 men with testosterone- associated infertility, we found that duration of testosterone therapy and age at presentation are directly correlated with time to sperm recovery.

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Volume 107, Issue 2, Pages 351–357

Authors:

Taylor P. Kohn, M.Phil., Matthew R. Louis, B.S., Stephen M. Pickett, B.B.A., Mark C. Lindgren, M.D., Jaden R. Kohn, B.S., Alexander W. Pastuszak, M.D. Ph.D., Larry I. Lipshultz, M.D.

Abstract:

Objective

To determine factors that influence sperm recovery after T-associated infertility.

Design

Clinical retrospective study.

Setting

Academic male-infertility urology clinic.

Patient(s)

Sixty-six men who presented with infertility after T use.

Intervention(s)

T cessation and combination high-dose hCG and selective estrogen modulator (SERM) therapy.

Main Outcome Measure(s)

Whether patients successfully achieved or failed to achieve a total motile count (TMC) of greater than 5 million sperm within 12 months of T cessation and initiation of therapy.

Result(s)

A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of T use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of T use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery.

Conclusion(s)

Increasing age and duration of T use significantly reduce the likelihood of recovery of sperm in the ejaculate, based on a criterion of a TMC of 5 million sperm, at 6 and 12 months. Physicians should be cautious in pursuing long-term T therapy, particularly in men who still desire fertility. Using these findings, physicians can counsel men regarding the likelihood of recovery of sperm at 6 and 12 months.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.