clinical use of fsh in male infertility hermann m. behre资料.pdf

该【clinical use of fsh in male infertility hermann m. behre资料 】是由【dt83088549】上传分享，文档一共【8】页，该文档可以免费在线阅读，需要了解更多关于【clinical use of fsh in male infertility hermann m. behre资料 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。REVIEWpublished:24May2019doi:.*CenterforReproductiveMedicineandAndrology,UniversityHospitalHalle,MartinLutherUniversityHalle-Wittenberg,Halle,GermanyTheestablishedclinicalindicationforFSHuseinmaleinfertilityisthetreatmentofpatientswithhypogonadotropichypogonadismforstimulationofspermatogenesisthatallowstheinductionofaclinicalpregnancyinthefemalepartnerand?,puri?ed,binantFSHbinationwithhCGhavedemonstratedthehightreatmentef?,sometimeslongerthan2years,,:-analysesManuelaSimoni,haveshownthatFSHcansigni?cantlyincreasepregnancyratesinthefemalepartnersUniversityofModenaandReggioEmilia,Italyofthesepatients,buttheeffect-,predictivefactorsforReviewedby:esshavetobeidenti?ed,ics,toselecttheAlbertoFerlin,,,Keywords:FSH,hMG,hCG,maleinfertiltiy,hypogonadotropichypogonadism,idiopathicmaleinfertilityAndrofert,AndrologyandHumanReproductionClinic,Brazil*Correspondence:.******@-,theindicationfortreatmentwithfolliclestimulatinghormone(FSH)istheinductionandmaintenanceofspermatogenesisinpatientswithhypogonadotropichypogonadismSpecialtysection:(1).Asthesepatientsarenormallyazoospermicwithoutgonadotropinstimulationandduringherapy,thepresenceofsu?cientlyhighnumbersofprogressivelymotileandnormallyReproduction,,andinsomeplacesalreadyinclinicalroutine,FSHpreparationsarealsousedfortreatmentofnormogonadotropicinfertileReceived:18March2019menwithidiopathicimpairmentofspermatogenesis(2,3).Accepted:02May2019Published:24May2019TheprimarygoalofFSHtherapyinthehypogonadotropicornormogonadotropicpatientsisnotthestimulationoftesticulargrowthorspermatogenesisperse,buttheinductionofapregnancyCitation:BehreHM(2019)ClinicalUseofFSHinthefemalepartneroftheinfertilecouple,and?::.|2019|Volume10|Article322BehreClinicalUseofFSHinMaleInfertilityFSHTHERAPYFORMALEINFERTILITYINdoesnotallow?rmconclusionsonthebesttherapyforinfertilityPATIENTSWITHHYPOGONADOTROPICinthesepatients(8,9).HYPOGONADISMbinationInpatientswithhypogonadotropichypogonadism,maleWithhCGTherapyessfullyforinfertilitytreatmentofbythegonadotropinsFSHandluteinizinghormone(LH).patientswithhypogonadotropichypogonadismformorethan50Inso-calledidiopathic/isolated/congenitalhypogonadotropicyears,initiallywithurinarymenopausalgonadotropinshavinghypogonadism(IHHorCHH)andKallmannsyndrome,-essfultherapywithurinarymenopausal(GnRH)(4).ThisleadstodiminishedorabsentLHandFSHgonadotropinsofa37-year-pletesynthesisorsecretionbytheunstimulatedpituitaryglandandhypophysectomyin1963(10,11).Thepatienthadprovideda?,theejaculatequalitydecreasedincludingsecondaryGnRHde?ciencyleadtothesamesigni?cantlyand,followingseveralweeksafterhypophysectomy,pathophysiology(4).,abilateralpituitaryinsu?ciencyduetotumors(especiallymakro-testicularbiopsywasperformedwhichshowedinvolutionofprolactinomas),metastasesofthepituitaryandthehypophysealspermatogenesistothelevelofspermatogoniaandonlyfewareasstalk,post-operativestates,radiotherapyofthepituitaryregion,?rsttesticulartraumata,infections,hemochromatosis,vasculardisorders,biopsy,treatmentwithhMG(humanmenopausalgonadotropinandothers(4).HypogonadotropichypogonadismiscausedoriginatingfromhumanurinewithmainlyFSHandsomeLHbytheinsu?ciencyofthepituitaryglandtosecretsigni?cantactivity)wasinitiatedinthepatient,?uencedbypossibledisturbancesoftheotherAfter64daysofmenopausalgonadotropintreatment,,,therestorationmentionedaboveis—formostofthetimeofthelife-span—ofspermatogenesisappearedonlyqualitativelynormal,-?cientlowLHactivityintheoverdecades,relativelyconvenientforthemalepatientsandhMGpreparationandthereforelowtestosteroneserumlevels,comparablyinexpensive(5).,,butlongersu?(alternatingwithhCGinjections).,paredtothehypogonadism,patientsareusuallytreatedwithhumanlevelsanalyzedbeforehypophysectomy(11).Laterthepatientchorionicgonadotropin(hCG)preparationswithsimilar,butnotdecidednottocontinuewithhMGtherapyand,unfortunately,identicalbioactivity(6).hCGhasalongereliminationhalf-,prehensivethanLHandpatientscanbetreatede?ectivelybytwoinjectionscasereportdemonstratedclearlytheprincipleofFSHtherapyperweek(4).,exogenouspulsatileGnRHcanalsobeusedfortreatment,asthiswillstimulatetheFSHandLHsecretionfromthepituitarygland(4,7).binationcomplexandtime-consumingpulsatiletherapy,todayonlyfewWithhCGTherapypatientswithhypogonadotropichypogonadismaretreatedwithSincethen,,,?cientwell-designed,prehensivestudiesonthetreatmente?cacyinpatientswithFrontiersinEndocrinology|2019|Volume10|Article322BehreClinicalUseofFSHinMaleInfertilitydi?erentetiologiesforhypogonadotropichypogonadismwasInanrecentstudyon51adultpatientswithhypogonadotropicpublishedbyBü(8).reatmentcyclewithFSHmightberegardedasonereferencestudyforhMGtreatment(binantFSH)plushCG,thosepatientswhohadofthesepatients,asatthattimehMGhasbeenreplacedmorehypogonadotropichypogonadismacquiredafterpubertyorhadeintheandrologyclinic(12,13).InthisstudybyBüchterand(15).Thesepatientsachievedhigher?nalbilateraltesticularcolleagues,,thepregnancywasperformed,30treatmentcoursescouldbeincludedintherateof62%washigherinpatientswithpost--pubertallyacquiredhypogonadism(42%).Inaddition,syndromeorcongenitalhypogonadotropichypogonadismwereaconceptioninthefemalepartnersofpatientswithpost-treatedwithhMGplushCG(18cases,20treatmentcourses).urredAltogether,31ofthe50treatmentcourseswithhMGplussigni?cantlyearlier(±)thaninthefemalehCGwereinitiatedfortheinductionofpregnancyinthepartnersofpatientswithpre-pubertallyacquiredhypogonadismfemalepartnerand19of50coursesonlyfortheinduction(±).(100%)inpatientspreviouslyundescendedtestes,inpatientswithhigherbaselinewithapituitarydisorder,(15).Theidenti?cationofthesepredictivepatientswithahypothalamicdisorder,gonadotropintherapyfactorsisinlinewithvariousclinicalstudiesbyotherstudyinducedspermatogenesisin18of20treatmentcourses(90%).groups(16–21).Thedurationoftherapyuntilthe?,theaveragetreatmenttimewas4months(range2–binationWith16months).Inthepatientswithahypothalamicdisorder,thehCGTherapyaveragetreatmentdurationwas6months(1–18months).TheNoadequatelarge,randomizedcontrolledtrials(RCTs)havedurationoftimeuntilinductionofpregnancyofthefemalebinantorhighlypartnerinpatientswithpituitarydisorderswas10months(2–puri?edFSHwiththeurinaryhMGpreparationsinmales—46months),and8months(1–15months),,itseemsthatonpregnancieswasincludedthatwasaddedinproofofthethee?cacyofthevariousFSHpreparationsinmalepatientspublicationbyBüchteretal.(8).Anadditionalpregnancyinparable,urredaftergonadotropintreatmentofregardingstimulationofspermatogenesisandinducingtheonepatientwithpituitarydisorderfor42monthsaswellasdesiredpregnancyinthefemalepartner(13,18,20–25).Today,,(86%)and6pregnanciesin10treatmentcourses(60%)CommonDosingSchemesinpatientswithahypothalamicdisorder(8).Comparedtoothermondosingschemesofgonadotropinsincurrenttreatmentsofinfertilityincludingapplicationofassistedmalehypogonadotropichypogonadismistheadministrationofreproductivetechniques(ART),this“causal”therapyofmale150––(4).Severalprovedtobehighlye?ective(14).FactorsIn?uencingtheEf?cacyofTreatmentBox1|?nallyclinicaltreatment(15)pregnancyinductioninthefemalepartner,thetreatmentmight??Nohistoryofcryptorchidismtherapymightlastforseveralmonthsandevenyearsbeforethe?,itisrelevantto?HigherbaselineserumlevelsofinhibinBidentifypred