Effects of Human Chorionic Gonadotropin Therapy on Gonadal Function in Men Clinically Confirmed with Subfertility: An Interventional Study at a Teaching Hospital, Ghana — Oak Academic Publishing
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Effects of Human Chorionic Gonadotropin Therapy on Gonadal Function in Men Clinically Confirmed with Subfertility: An Interventional Study at a Teaching Hospital, Ghana
Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana
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Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Department of Biomedical Laboratory Science, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Department of Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
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Department of Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
The study aimed at assessing the effect of beta-human chorionic gonadotropin ( β hCG) therapy on gonadal function in men with subfertility. This was an interventional study conducted at a teaching hospital in Ghana. A total of 57 clinically confirmed men with subfertility were recruited for the study. In addition to the demographic data, venous blood samples were collected, and baseline serum testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were measured. Duplicate semen samples (mean values adopted) were collected and assayed following World Health Organization (2010) protocol. A dosage range of 1500 - 2000 IU β hCG was administered subcutaneously to each participant determined by the patients’ weight and medical history. The frequency of injection was 4 shots every 7 (±1) days for a period of 30 days. Repeated measurements of serum testosterone, FSH, LH, and semen analysis were done 90 days after intervention. The data were analyzed using GraphPad Prism (v8.0) at an alpha value of 0.05. The participants were aged between 23 and 55 years. The mean ± SD serum total testosterone, FSH and LH at baseline were 12.6 ± 3.7; 7.8 ± 2.7; and 4.1 ± 1.5 respectively with testosterone (18.0 ± 4.0) and FSH (5.5 ± 2.7) improving significantly (p < 0001) after 90 days follow-up. At baseline, the mean ± SD of semen parameters; pH, semen volume, total sperm count, sperm concentration were 7.90 ± 0.267, 3.1 ± 0.91 mL, 36.1 ± 19.7 × 10 6 /ejaculate and 11.5 ± 4.97 × 10 6 /mL respectively with total sperm count (p < 0.0001), sperm concentration (p < 0.0001), Active Forward Linear Progressive motility (p = 0.0005) and normal morphology (p = 0.0005) improving significantly after 90 days of follow-up. Beta-human chorionic gonadotropin ( β hCG) therapy for subfertility is recommended since it improved gonadal function among men clinically diagnosed with subfertility, however, a multi-institutional study should be conducted to provide more evidence for this choice.
Vander Borght, M. and Wyns, C. (2018) Fertility and Infertility: Definition and Epidemiology. Clinical Biochemistry , 62, 2-10. https://doi.org/10.1016/j.clinbiochem.2018.03.012
Thurston, L., Abbara, A. and Dhillo, W.S. (2019) Investigation and Management of Subfertility. Journal of Clinical Pathology , 72, 579-587. https://doi.org/10.1136/jclinpath-2018-205579
Manu Maison, P., Gyasi-Sarpong, C. and Koranteng, A. (2017) The Pattern of Male Infertility in Kumasi, Ghana. African Journal for Infertility and Assisted Conception , 2, 3-5. https://doi.org/10.4103/ajiac.ajiac_3_18
Ombelet, W., Cooke, I., Dyer, S., Serour, G. and Devroey, P. (2008) Infertility and the Provision of Infertility Medical Services in Developing Countries. Human Reproduction Update , 14, 605-621. https://doi.org/10.1093/humupd/dmn042
Dyer, S.J. (2007) The Value of Children in African Countries—Insights from Studies on Infertility. Journal of Psychosomatic Obstetrics & Gynecology , 28, 69-77. https://doi.org/10.1080/01674820701409959
Dyer, S.J. (2004) ‘You Are a Man Because You Have Children’: Experiences, Reproductive Health Knowledge and Treatment-Seeking Behaviour among Men Suffering from Couple Infertility in South Africa. Human Reproduction , 19, 960-967. https://doi.org/10.1093/humrep/deh195
Lunenfeld, B. (2004) Infertility in the Third Millennium: Implications for the Individual, Family and Society: Condensed Meeting Report from the Bertarelli Foundation’s Second Global Conference. Human Reproduction Update , 10, 317-326. https://doi.org/10.1093/humupd/dmh028
Bobjer, J., Bogefors, K., Isaksson, S., Leijonhufvud, I., Åkesson, K., Giwercman, Y.L., et al . (2016) High Prevalence of Hypogonadism and Associated Impaired Metabolic and Bone Mineral Status in Subfertile Men. Clinical Endocrinology , 85, 189-195. https://doi.org/10.1111/cen.13038
Mulligan, T., Frick, M.F., Zuraw, Q.C., Stemhagen, A. and Mcwhirter, C. (2008) Prevalence of Hypogonadism in Males Aged at Least 45 Years: The HIM Study. International Journal of Clinical Practice , 60, 762-769. https://doi.org/10.1111/j.1742-1241.2006.00992.x
Spitzer, M., Huang, G., Basaria, S., Travison, T.G. and Bhasin, S. (2013) Risks and Benefits of Testosterone Therapy in Older Men. Nature Reviews Endocrinology , 9, 414-424. https://doi.org/10.1038/nrendo.2013.73
Hackett, G., Cole, N., Bhartia, M., Kennedy, D., Raju, J. and Wilkinson, P. (2013) Testosterone Replacement Therapy with Long-Acting Testosterone Undecanoate Improves Sexual Function and Quality-of-Life Parameters Vs. Placebo in a Population of Men with Type 2 Diabetes. The Journal of Sexual Medicine , 10, 1612-1627. https://doi.org/10.1111/jsm.12146
Fink, J.E., Hackney, A.C., Matsumoto, M., Maekawa, T. and Horie, S. (2020) Mobility and Biomechanical Functions in the Aging Male: Testosterone and the Locomotive Syndrome. The Aging Male , 23, 403-410.
Rhoden, E.L. and Morgentaler, A. (2004) Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring. New England Journal of Medicine , 350, 482-492. https://doi.org/10.1056/nejmra022251
Coward, R. and McBride, J. (2016) Recovery of Spermatogenesis Following Testosterone Replacement Therapy or Anabolic-Androgenic Steroid Use. Asian Journal of Andrology , 18, 373-380. https://doi.org/10.4103/1008-682x.173938
Mulhall, J.P., Giraldi, A., Hackett, G., Hellstrom, W.J.G., Jannini, E.A., Rubio-Aurioles, E., et al . (2018) The 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction. The Journal of Sexual Medicine , 15, 1280-1292. https://doi.org/10.1016/j.jsxm.2018.06.005
Raheem, O.A., Chen, T., Akula, K.P., Greenberg, J., Le, T.V., Chernobylsky, D., et al . (2021) Efficacy of Non-Testosterone-Based Treatment in Hypogonadal Men: A Review. Sexual Medicine Reviews , 9, 381-392. https://doi.org/10.1016/j.sxmr.2020.08.003
Wenker, E.P., Dupree, J.M., Langille, G.M., Kovac, J., Ramasamy, R., Lamb, D., et al . (2015) The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use. The Journal of Sexual Medicine , 12, 1334-1337. https://doi.org/10.1111/jsm.12890
Clavijo, R.I. and Hsiao, W. (2018) Update on Male Reproductive Endocrinology. Translational Andrology and Urology , 7, S367-S372. https://doi.org/10.21037/tau.2018.03.25
La Vignera, S., Condorelli, R.A., Cimino, L., Russo, G.I., Morgia, G. and Calogero, A.E. (2015) Late-Onset Hypogonadism: The Advantages of Treatment with Human Chorionic Gonadotropin Rather than Testosterone. The Aging Male , 19, 34-39. https://doi.org/10.3109/13685538.2015.1092021
Lee, J.A. and Ramasamy, R. (2018) Indications for the Use of Human Chorionic Gonadotropic Hormone for the Management of Infertility in Hypogonadal Men. Translational Andrology and Urology , 7, S348-S352. https://doi.org/10.21037/tau.2018.04.11
Adams, Y., Afoko, A.A., Amidu, N., Quaye, L., Bani, S.B., Dapare, P.P.M., et al . (2022) Effect of Varicocelectomy on Gonadal Function among Patients Reporting with Sexual Dysfunction in Ghana. Open Journal of Urology , 12, 305-330. https://doi.org/10.4236/oju.2022.126031
Mittal, B.V. and Singh, A.K. (2010) Hypertension in the Developing World: Challenges and Opportunities. American Journal of Kidney Diseases , 55, 590-598. https://doi.org/10.1053/j.ajkd.2009.06.044
Agarwal, A., Mulgund, A., Hamada, A. and Chyatte, M.R. (2015) A Unique View on Male Infertility around the Globe. Reproductive Biology and Endocrinology , 13, Article No. 37. https://doi.org/10.1186/s12958-015-0032-1
Masoumi, S.Z., Parsa, P., Darvish, N., Mokhtari, S., Yavangi, M. and Roshanaei, G. (2015) An Epidemiologic Survey on the Causes of Infertility in Patients Referred to Infertility Center in Fatemieh Hospital in Hamadan. Iranian Journal of Reproductive Medicine , 13, 513-516.
Krausz, C. (2011) Male Infertility: Pathogenesis and Clinical Diagnosis. Best Practice & Research Clinical Endocrinology & Metabolism , 25, 271-285. https://doi.org/10.1016/j.beem.2010.08.006
Jockenhövel, F., Minnemann, T., Schubert, M., Freude, S., Hübler, D., Schumann, C., et al . (2009) Comparison of Long-Acting Testosterone Undecanoate Formulation versus Testosterone Enanthate on Sexual Function and Mood in Hypogonadal Men. European Journal of Endocrinology , 160, 815-819. https://doi.org/10.1530/eje-08-0830
Ulloa-Aguirre, A. and Lira-Albarrán, S. (2016) Clinical Applications of Gonadotropins in the Male. Progress in Molecular Biology and Translational Science , 143, 121-174. https://doi.org/10.1016/bs.pmbts.2016.08.003
Rahnema, C.D., Lipshultz, L.I., Crosnoe, L.E., Kovac, J.R. and Kim, E.D. (2014) Anabolic Steroid-Induced Hypogonadism: Diagnosis and Treatment. Fertility and Sterility , 101, 1271-1279. https://doi.org/10.1016/j.fertnstert.2014.02.002
Tsujimura, A., Matsumiya, K., Takao, T., Miyagawa, Y., Takada, S., Koga, M., et al . (2005) Treatment with Human Chorionic Gonadotropin for PADAM: A Preliminary Report. The Aging Male , 8, 175-179. https://doi.org/10.1080/13685530500282794
Ishikawa, T., Ooba, T., Kondo, Y., Yamaguchi, K. and Fujisawa, M. (2007) Assessment of Gonadotropin Therapy in Male Hypogonadotropic Hypogonadism. Fertility and Sterility , 88, 1697-1699. https://doi.org/10.1016/j.fertnstert.2006.11.022
Kirk, J.M.W., Savage, M.O., Grant, D.B., Bouloux, P.G. and Besser, G.M. (1994) Gonadal Function and Response to Human Chorionic and Menopausal Gonadotrophin Therapy in Male Patients with Idiopathic Hypogonadotrophic Hypogonadism. Clinical Endocrinology , 41, 57-63. https://doi.org/10.1111/j.1365-2265.1994.tb03785.x
Ley, S.B. and Leonard, J.M. (1985) Male Hypogonadotropic Hypogonadism: Factors Influencing Response to Humanchorionic Gonadotropin and Human Menopausal Gonadotropin, Including Prior Exogenous Androgens. The Journal of Clinical Endocrinology & Metabolism , 61, 746-752. https://doi.org/10.1210/jcem-61-4-746
Shoshany, O., Abhyankar, N., Mufarreh, N., Daniel, G. and Niederberger, C. (2017) Outcomes of Anastrozole in Oligozoospermic Hypoandrogenic Subfertile Men. Fertility and Sterility , 107, 589-594. https://doi.org/10.1016/j.fertnstert.2016.11.021
Joseph, (2022) Are SERMs Safe and Effective for the Treatment of Hypogonadism in Men? The Journal of Family Practice , 71, E18-E21. https://doi.org/10.12788/jfp.0342
Rainer, Q., Pai, R. and Masterson, T. (2022) 9 Safety of Human Chorionic Gonadotropin Monotherapy for Men with Hypogonadal Symptoms and Testosterone > 300 ng/dl. The Journal of Sexual Medicine , 19, S5-S5. https://doi.org/10.1016/j.jsxm.2022.01.020
Depenbusch, M., von Eckardstein, S., Simoni, M. and Nieschlag, E. (2002) Maintenance of Spermatogenesis in Hypogonadotropic Hypogonadal Men with Human Chorionic Gonadotropin Alone. European Journal of Endocrinology , 147, 617-624. https://doi.org/10.1530/eje.0.1470617
Hsieh, T., Pastuszak, A.W., Hwang, K. and Lipshultz, L.I. (2013) Concomitant Intramuscular Human Chorionic Gonadotropin Preserves Spermatogenesis in Men Undergoing Testosterone Replacement Therapy. Journal of Urology , 189, 647-650. https://doi.org/10.1016/j.juro.2012.09.043
Lipshultz, L., Ramasamy, R. and Armstrong, J. (2015) Preserving Fertility in the Hypogonadal Patient: An Update. Asian Journal of Andrology , 17, 197-200. https://doi.org/10.4103/1008-682x.142772
Babak, J., Behruz, F., Mohammadreza, Y. and Morteza, F. (2018) The Effect of Human Chorionic Gonadotropin Therapy on Semen Parameters and Pregnancy Rate after Varicocelectomy. Current Urology , 11, 92-96. https://doi.org/10.1159/000447200
Lindheim, S.R., Barad, D.H., Zinger, M., Witt, B., Amin, H., Cohen, B., et al . (1996) Abnormal Sperm Morphology Is Highly Predictive of Pregnancy Outcome during Controlled Ovarian Hyperstimulation and Intrauterine Insemination. Journal of Assisted Reproduction and Genetics , 13, 569-572. https://doi.org/10.1007/bf02066610
Zinaman, M.J., Brown, C.C., Selevan, S.G. and Clegg, E.D. (2000) Semen Quality and Human Fertility: A Prospective Study with Healthy Couples. Journal of Andrology , 21, 145-153. https://doi.org/10.1002/j.1939-4640.2000.tb03284.x
Slama, R. (2002) Time to Pregnancy and Semen Parameters: A Cross-Sectional Study among Fertile Couples from Four European Cities. Human Reproduction , 17, 503-515. https://doi.org/10.1093/humrep/17.2.503
van der Merwe, F.H., Kruger, T.F., Oehninger, S.C. and Lombard, C.J. (2005) The Use of Semen Parameters to Identify the Subfertile Male in the General Population. Gynecologic and Obstetric Investigation , 59, 86-91. https://doi.org/10.1159/000082368
Nallella, K.P., Sharma, R.K., Aziz, N. and Agarwal, A. (2006) Significance of Sperm Characteristics in the Evaluation of Male Infertility. Fertility and Sterility , 85, 629-634. https://doi.org/10.1016/j.fertnstert.2005.08.024
Kolettis, P.N., Ross, J.H., Kay, R. and Thomas, A.J. (1999) Sperm Retrieval and Intracytoplasmic Sperm Injection in Patients with Prune-Belly Syndrome. Fertility and Sterility , 72, 948-949. https://doi.org/10.1016/s0015-0282(99)00388-x
Gunalp, S., Onculoglu, C., Gurgan, T., Kruger, T.F. and Lombard, C.J. (2001) A Study of Semen Parameters with Emphasis on Sperm Morphology in a Fertile Population: An Attempt to Develop Clinical Thresholds. Human Reproduction , 16, 110-114. https://doi.org/10.1093/humrep/16.1.110
Kumar, R., Gautam, G. and Gupta, N.P. (2006) Drug Therapy for Idiopathic Male Infertility: Rationale versus Evidence. Journal of Urology , 176, 1307-1312. https://doi.org/10.1016/j.juro.2006.06.006
Andrabi, S.W., Makker, G.C., Makker, R., Mishra, G. and Singh, R. (2022) Human Chorionic Gonadotropin Therapy in Hypogonadic Severe-Oligozoospermic Men and Its Effect on Semen Parameters. Clinical and Experimental Reproductive Medicine , 49, 57-61. https://doi.org/10.5653/cerm.2021.04742
Vicari, E., Mongioì, A., Calogero, A.E., Moncada, M.L., Sidoti, G., Polosa, P., et al . (1992) Therapy with Human Chorionic Gonadotrophin Alone Induces Spermatogenesis in Men with Isolated Hypogonadotrophic Hypogonadism-Long-Term Follow-Up. International Journal of Andrology , 15, 320-329. https://doi.org/10.1111/j.1365-2605.1992.tb01131.x
Corona, G., Rastrelli, G., Reisman, Y., Sforza, A. and Maggi, M. (2018) The Safety of Available Treatments of Male Hypogonadism in Organic and Functional Hypogonadism. Expert Opinion on Drug Safety , 17, 277-292. https://doi.org/10.1080/14740338.2018.1424831
Madhusoodanan, V., Patel, P., Lima, T.F.N., Gondokusumo, J., Lo, E., Thirumavalavan, N., et al . (2019) Human Chorionic Gonadotropin Monotherapy for the Treatment of Hypogonadal Symptoms in Men with Total Testosterone > 300 ng/dl. International Braz ilian Journal of Urol ogy , 45, 1008-1012. https://doi.org/10.1590/s1677-5538.ibju.2019.0132