Endocrine Abstracts

Introduction and aim: In the UK, 15% of couples are affected by infertility which is due to primary or secondary male factors in 30%. Induction of spermatogenesis with gonadotrophins is a long established endocrine treatment for gonadotrophin deficiency. However, there are concerns that some patient groups have very low success rates. The aim of our audit was to define success of spermatogenesis and fertility rates amongst these men.

Methods: We retrospectively reviewed records from the male reproductive clinic at UCLH. All men presented with azoospermia or oligospermia (<15 millions/ml) and received human chorionic gonadotropin therapy or combination with recombinant follicle-stimulating hormone.

Results: Fifty five men were included in this audit of whom 58% had hypogonadotrophic hypogonadism, 36% hypopituitarism and 6% partial testicular failure. Eight (15%) achieved sperm cryopreservation, 11 men (20%) stopped attending our clinic for personal reasons and 36 (65%) wanted immediate fertility. Pregnancy was achieved for 26 out of 36 men (72%) who attempted fertility. Spontaneous conception was achieved for 16/36 men (44%), with 15/16 live births (94%) and 1/16 miscarriage (6%). Median conception time was 16 (range 5–36) months. Ten out of 36 (28%) men proceeded to in vitro fertilization (IVF) which resulted in 5/10 live births (50%), 3/10 miscarriages (30%) and 2/10 failed conception (20%). Median conception time for this group was 19.5 (range 6–44) months. Testicular sperm extraction (TESE) with was performed for 10/36 men (28%) resulting in 2/10 live births (20%) whilst 8/10 failed conception (80%). Median time to TESE was 19 (range 5–62) months.

Conclusion: This study reports real life fertility rates in men with secondary subfertility of different aetiologies. Closer assessment of factors predicting successful outcome will allow us to identify good and poor responders in order make the program more effective.