Two livebirths achieved in cases of hypergonadotropic hypogonadism nonobstructive azoospermia, treated with GnRH agonist and gonadotrophins: a case series and review of the literature.

IF 1.8 Q3 OBSTETRICS & GYNECOLOGY Jornal Brasileiro de Reproducao Assistida Pub Date : 2024-08-26 DOI:10.5935/1518-0557.20240039
Mauro Bibancos de Rose, Arhon Bizelli Sicard, Natalia Alvarenga Aguiar, Beatriz de Oliveira Onório, Antonio Alberto Rodrigues Almendra, Wagner Eduardo Matheus, Andrea Garolla, Carlo Foresta, Daniela Paes de Almeida Ferreira Braga, Amanda Souza Setti, Edson Borges
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Abstract

Non-obstructive azoospermia (NOA) is the most severe form of male factor infertility. It results form from either primary or secondary testicular failure. Here, we report cases of two patients with NOA due to maturation arrest and increased serum FSH, treated with GnRH agonist and gonadotrophins. The two NOA patients underwent a pharmacological treatment consisting of pituitary desensibilization using a GnRH agonist and testicular stimulation using menotropin. Testicular stimulation started one month after the beginning of GnRH agonist treatment. The female partner underwent controlled ovarian stimulation (COS) followed by intracytoplasmic sperm injection (ICSI). On the third day of the cycle, menotropin daily doses was administered. When at least one follicle ≥14 mm was visualized, pituitary blockage was performed using GnRH antagonist ganirelix. When three or more follicles attained a mean diameter of ≥17 mm, triptorelin acetate was administered to trigger final follicular maturation. Oocyte retrieval was performed 35 hours later. After treatment, male partner blood levels of the FSH, LH, decreased and total testosterone were increased. Spermatozoa was observed after semen collection in both cases. After COS, oocytes were retrieved and ICSI was performed. Embryos were biopsied for preimplantation genetic testing (PGT) and those considered euploidy were transferred resulting in positive implantation, ongoing pregnancy, and livebirth on both cases. In this report we present a successful strategy for hypergonadotropic hypogonadism AOA men, as an alternative approach to the surgical testicular sperm recovery. Nevertheless, prospective randomized trials are needed to confirm our findings.

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用 GnRH 激动剂和促性腺激素治疗高促性腺激素性性腺功能减退症非梗阻性无精子症病例中的两例活产:病例系列和文献综述。
非梗阻性无精子症(NOA)是男性不育症中最严重的一种。它由原发性或继发性睾丸功能衰竭引起。在此,我们报告了两例因成熟停滞和血清前列腺素(FSH)升高而导致的非梗阻性无精子症患者,他们均接受了 GnRH 激动剂和促性腺激素治疗。这两名 NOA 患者接受了药物治疗,包括使用 GnRH 激动剂进行垂体去势和使用促性腺激素进行睾丸刺激。睾丸刺激在 GnRH 激动剂治疗开始一个月后开始。女方接受控制性卵巢刺激(COS),然后进行卵胞浆内单精子显微注射(ICSI)。在周期的第三天,每天注射一次促性腺激素。当观察到至少一个卵泡≥14毫米时,使用GnRH拮抗剂加尼瑞克进行垂体阻断。当三个或更多卵泡的平均直径≥17毫米时,注射醋酸曲普瑞林,以促使卵泡最终成熟。35 小时后进行取卵。治疗后,男方血液中的 FSH、LH 水平下降,总睾酮水平升高。两个病例的精液采集后都观察到了精子。COS 后,取回卵母细胞并进行了卵胞浆内单精子显微注射(ICSI)。胚胎经活检后进行植入前遗传学检测(PGT),被认为是非整倍体的胚胎被移植,结果两个病例均成功植入,持续妊娠并活产。在本报告中,我们介绍了一种针对促性腺激素低下型 AOA 男性的成功策略,作为手术睾丸精子回收的替代方法。不过,还需要进行前瞻性随机试验来证实我们的研究结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.30
自引率
6.70%
发文量
56
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