Taylor P Kohn1, Matthew R Louis1, Stephen M Pickett2, Mark C Lindgren3, Jaden R Kohn1, Alexander W Pastuszak4, Larry I Lipshultz5. 1. Baylor College of Medicine, Houston, Texas. 2. Department of Economics, Rice University, Houston, Texas. 3. University of Oklahoma College of Medicine, Department of Urology, Oklahoma City, Oklahoma. 4. Center for Reproductive Medicine, Houston, Texas; Scott Department of Urology, Baylor College of Medicine, Houston, Texas. 5. Center for Reproductive Medicine, Houston, Texas; Scott Department of Urology, Baylor College of Medicine, Houston, Texas. Electronic address: larryl@bcm.edu.
Abstract
OBJECTIVE: To determine factors that influence sperm recovery after T-associated infertility. DESIGN: Clinical retrospective study. SETTING: Academic male-infertility urology clinic. PATIENT(S): Sixty-six men who presented with infertility after T use. INTERVENTION(S): T cessation and combination high-dose hCG and selective estrogen modulator (SERM) therapy. MAIN OUTCOME MEASURE(S): Whether patients successfully achieved or failed to achieve a total motile count (TMC) of greater than 5 million sperm within 12 months of T cessation and initiation of therapy. RESULT(S): A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of T use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of T use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery. CONCLUSION(S): Increasing age and duration of T use significantly reduce the likelihood of recovery of sperm in the ejaculate, based on a criterion of a TMC of 5 million sperm, at 6 and 12 months. Physicians should be cautious in pursuing long-term T therapy, particularly in men who still desire fertility. Using these findings, physicians can counsel men regarding the likelihood of recovery of sperm at 6 and 12 months.
OBJECTIVE: To determine factors that influence sperm recovery after T-associated infertility. DESIGN: Clinical retrospective study. SETTING: Academic male-infertility urology clinic. PATIENT(S): Sixty-six men who presented with infertility after T use. INTERVENTION(S): T cessation and combination high-dose hCG and selective estrogen modulator (SERM) therapy. MAIN OUTCOME MEASURE(S): Whether patients successfully achieved or failed to achieve a total motile count (TMC) of greater than 5 million sperm within 12 months of T cessation and initiation of therapy. RESULT(S): A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of T use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of T use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery. CONCLUSION(S): Increasing age and duration of T use significantly reduce the likelihood of recovery of sperm in the ejaculate, based on a criterion of a TMC of 5 million sperm, at 6 and 12 months. Physicians should be cautious in pursuing long-term T therapy, particularly in men who still desire fertility. Using these findings, physicians can counsel men regarding the likelihood of recovery of sperm at 6 and 12 months.
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