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.
Volume 107, Issue 2, Pages 351–357
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.
To determine factors that influence sperm recovery after T-associated infertility.
Clinical retrospective study.
Academic male-infertility urology clinic.
Sixty-six men who presented with infertility after T use.
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.
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.
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.