High dosage gonadotropic treatment in testicular spermatogenic arrest

Effective intratesticular follicle-stimulating hormone (FSH) and androgen concentrations are needed for initiation, completion and adequate maintenance of spermatogenesis. We have previously reported a positive correlation between free testosterone levels in plasma and the various spermatogenic maturation stages in the testes. Based on these results and with the compelling evidence that FSH is crucially important for the regulation of spermatogenesis, we treated 37 infertile, non-obstructive, azoospermic patients with 75-150 IU of FSH and 500-1000 IU of luteinizing hormone (LH) daily for at least 6-8 months. Prior to treatment all patients underwent bilateral multifocal testicular fine needle aspiration or biopsy. Cytological evaluation revealed spermatogenic maturation arrest at the spermatocyte stage or beyond it. Treatment was evaluated by the appearance of mature sperm cells in either the centrifuged semen analyzed by high-power light microscopy and by the micro-SEM (scanning electron microscopy) technique or, by the appearance of mature sperm cells in testicular aspirates on routine cytological evaluation or evaluation by the cyto-SEM technique. After treatment, in 8 patients (21.6%) there was completion of spermatogenesis with appearance of spermatozoa. It is therefore suggested that some patients with testicular spermatogenic maturation arrest may benefit from prolonged, high dosage gonadotropin therapy. The use of current sophisticated techniques for detection of sperm cells in the semen, or retrieval directly from the testes and the new method of assisted reproduction in which fertilization results from injection of a single isolated sperm into an oocyte, may justify the approach suggested in this report.