April 10, 2015
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Sequential therapy for male infertility may produce same result as continual injections

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A sequential treatment regimen to increase sperm concentration in men with idiopathic hypogonadotropic hypogonadism may be just as effective as continual therapy with the same drugs, according to research in The Journal of Clinical Endocrinology & Metabolism.

The randomized, open-label, noninferiority trial demonstrated that the less-invasive treatment can yield similar results, thereby benefiting patients in several ways, according to researchers.

Manna Zhang, MD, of Jiao Tong University in Shanghai, and colleagues at other institutions analyzed data collected between October 2009 and December 2012 from 67 Chinese men aged 18 to 45 years with idiopathic hypogonadotropic hypogonadism (IHH). Participants were randomly assigned to one of two groups.

Patients in groups A and B both received injections of 2,000 U human chorionic gonadotropin (hCG) twice a week for 18 months. In group A, participants also received injections of 75 U urinary follicle-stimulating hormone (uFSH) three times a week from months 6 through 18, whereas group B received the same dose three times a week every other 3 months during the same time period. Researchers conducted a physical examination, semen analysis and hormone measurements at 3, 6, 9, 12, 15 and 18 months after treatment initiation.

After 6 months of hCG monotherapy and 12 months of combination therapy, 51.5% of men in group A achieved a sperm density of at least 1 x 106/mL, as did 55.9% of men in group B (P = .008 for noninferiority). No significant differences between the two groups were observed in time to initial spermatogenesis and achievement of the primary outcome, according to researchers.

Although 80% of those in the study reported no intention for an immediate pregnancy because they were unmarried, one man in group A and five men in group B reported pregnancies with a partner 6 months after the end of the trial.  

The estimated medication cost was $4,800 for group A and $2,490 for group B during the 18-month treatment regimen, indicating an opportunity for cost savings and, possibly, improved compliance for the therapy, according to researchers.

“The sequential uFSH regimen in group B reduced cost by $2,310 for each patient to achieve the noninferior efficacy in spermatogenesis, which could be a tremendous savings for ordinary families with IHH patients in China,” the researchers wrote. – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.