IVF and ICSI in Male Infertility: Update on Outcomes, Risks, and Costs

Assisted reproductive technology with intracytoplasmic sperm injection (ICSI) is becoming an international panacea for couples struggling with infertility. The increasing popularity of these techniques and the data generated has given us a better understanding of the efficacy, consequences and costs of these procedures. There still remain many unanswered questions and controversies surrounding the use of IVF and ICSI. Increased experience, better refinement of these techniques and clearer indications for IVF and ICSI will inevitably minimize the risks associated with this procedure

The role of testosterone replacement therapy following radical prostatectomy.

Hypogonadism is associated with a decreased serum testosterone level and numerous signs and symptoms, such as decreased libido, erectile dysfunction, decreased muscle mass, increased fat deposition, decreased ability to concentrate, and decreased bone mineral density Unlike women, who have a sudden loss of estrogen during menopause, men experience a gradual 1% to 2% decline in testosterone every year starting at age 30. There are several reasons for decreasing testosterone levels with age. As men age, they have a decline in Leydig cell numbers (primary failure), a decrease in gonadotropin-releasing hormone pulse amplitude (secondary failure), and an increase in sex hormone-binding globulin, all of which result in the reduction of available free or total testosterone Testosterone replacement therapy (TRT) is effective in treating the signs and symptoms of hypogonadism. These benefits include improvements in sexual function, muscle mass and strength, fat distribution, bone density, cognition, and mood Hypogonadism occurs frequently among men who have prostate cancer. Yamamoto and colleagues The association between testosterone replacement therapy and the development of prostate cancer In 1941, Huggins and Hodges [14] first demonstrated that a reduction in testosterone by castration caused metastatic prostate cancer to regress and that administration of exogenous testosterone promoted prostate cancer growth; however, current data have demonstrated that low testosterone levels are more likely to be associated with prostate cance

The Use of HCG‐Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use

Introduction and AimAbout 3 million men take testosterone in the United States with many reproductive‐age men unaware of the negative impact of testosterone supplementation on fertility. Addressing this population, we provide an early report on the use of human chorionic gonadotropin (HCG)‐based combination therapy in the treatment of a series of men with likely testosterone‐related azoospermia or severe oligospermia. MethodsWe retrospectively reviewed charts from two tertiary care infertility clinics to identify men presenting with azoospermia or severe oligospermia (<1 million sperm/mL) while taking exogenous testosterone. All were noted to have been placed on combination therapy, which included 3,000 units HCG subcutaneously every other day supplemented with clomiphene citrate, tamoxifen, anastrozole, or recombinant follicle‐stimulating hormone (or combination) according to physician preference.Main Outcome MeasureClinical outcomes, including hormone values, semen analyses, and clinical pregnancies, were tracked. ResultsForty‐nine men were included in this case series. Return of spermatogenesis for azoospermic men or improved counts for men with severe oligospermia was documented in 47 men (95.9%), with one additional man (2.1%) having a documented pregnancy without follow‐up semen analysis. The average time to return of spermatogenesis was 4.6 months with a mean first density of 22.6 million/mL. There was no significant difference in recovery by type of testosterone administered or supplemental therapy. No men stopped HCG or supplemental medications because of adverse events. ConclusionsWe here provide an early report of the feasibility of using combination therapy with HCG and supplemental medications in treating men with testosterone‐related infertility. Future discussion and studies are needed to further characterize this therapeutic approach and document the presumed improved tolerability and speed of recovery compared with unaided withdrawal of exogenous testosterone. Wenker EP, Dupree JM, Langille GM, Kovac J, Ramasamy R, Lamb D, Mills JN, and Lipshultz LI. The use of HCG‐based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med 2015;12:1334–1337.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111925/1/jsm12890.pd