Endocrine Abstracts

Background: Exogenous follicle-stimulating hormone (FSH) administration in male idiopathic infertility showed the most convincing rationale in the face of a clinical efficacy below expectations. It was calculated that 10 to 18 men have to be treated to achieve one pregnancy.

Objectives: To assess the effectiveness of FSH administration in male idiopathic infertility in a clinical setting.

Methods: A retrospective real-world study was carried out, including all consecutive male partners of infertile couples attending the Andrology Unit of Modena (Italy) from June 2015 to May 2022. Medical history, physical and andrological examinations, hormonal and seminal parameters, therapeutic management and pregnancy data were collected. Primary endpoints were semen parameters, while pregnancies were the secondary outcome.

Results: 197 on 362 (54.4%) infertile men were treated with FSH (mean age 37.9±6.1 years). After FSH administration (therapy duration 9.1±7.1 months), a significant increase in sperm concentration (9.9±12.2 vs 18.9±38.9 million/mL, P = 0.045) was detected. Also, treatment led to a significant increase in normozoospermia (from 1.0 to 4.8%, P = 0.044) and decrease in azoospermia rate (from 9.6 to 6.5%, P = 0.044). 43 pregnancies were recorded (30.5%), 22 spontaneous and 21 after assisted reproduction. Dividing the cohort in FSH-responders and non-responders, considering obtaining or not a pregnancy, a higher sperm concentration (15.7±26.6 vs 22.2±25.7 million/mL, P = 0.033) and progressive sperm motility (18.0±18.2 vs 27.3±11.3, P = 0.044) were found in pregnancy group.

Conclusion: Our experience suggests that FSH empirically administered to men with idiopathic infertility increases sperm concentration and leads to pregnancy in 1 of 5 patients. Although the expected limits due to a real-world data study, the number of FSH-treated patients required to achieve a pregnancy seems to be lower if compared to previously published data.