Q. What does gondotropin levels with moderate testicular failure indicate?

Answered by Dr. Sameer Kumar and medically reviewed by Dr. Nithila A

 

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Hello doctor,

He is 30 years old, and his height is 6ft. Gondotropin levels show moderate testicular failure, but no treatment was given. We had a micro TESE done for him, and no abnormalities were found. What does it mean? Should he have received medication to support this?


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Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity). The sperm analysis shows azoospermia (complete absence of sperm from the fluid ejaculated during orgasm) and testicular failure. If even after Micro TESE (testicular sperm extraction) testicular biopsy, there has been no sperm seen, and there is no blockage disorder either, then his chances of contributing to natural or assisted conception are grim which means that testis is not producing any sperms and have gone in failure.

The next chance would be to opt for donor sperm, and IVF (in vitro fertilization) followed by embryo transfer to conceive.

 

Thank you doctor,

Please tell me what does gonadotropin levels show moderate testicular failure mean?

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

Gonadotrophin testicular failure in his case is hypogonadotropic hypogonadism where the hypothalamus is producing FSH (follicle-stimulating hormone) or LH (luteinizing hormone) gonadotropins, but not been utilized for sperm production or maturation at the level of the testis. This is also called primary testicular failure.

The testicular (hypogonadotropic hypogonadism or primary testicular failure) causes of azoospermia are primary defects of the testis. Primary testicular failure is classified into four distinct subtypes they are,

  1. Sertoli cell-only syndrome (SCOS),
  2. Germ cell aplasia or maturation arrest (GCA or MA),
  3. Hypospermatogenesis (HS) and
  4. Tubular fibrosis (TF) according to histopathology or cytology findings.

Although accurate categorization is only possible by multiple testicular biopsies or fine needle aspiration cytology (FNAC).

 

Thank you doctor,

What is the treatment for this?

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

There are gonadotrophin injections of FSH and LH available which are known to potentiate spermatogenesis, but the response depends entirely upon the distinct subtype of failure as would be detected by testicular biopsy which should have been reported by cytology study in his case. They can help in cases of Sertoli cell only syndrome, germ cell maturation arrest and even to an extent in hypospermatogenesis but not in cases of tubular fibrosis.

His treatment would have to be decided based on the subtype. You have to discuss with your treating infertility specialist and weigh your options, thereby taking an informed decision.

 

Thank you doctor,

Shall I ask the fertility specialist whether he can have this treatment to check if he would produce sperm?

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

Yes, you can ask your doctor, and he would have to answer and explain the various options in detail.

 

Thank you doctor,

With the details you have seen, can injections be an option?

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

It is difficult to answer without a biopsy cytology report and a diagnosis established. So I suggest be straight with your queries, and I am sure your doctor would be happy to put your questions to rest.

 

Thank you doctor,

His testes were 12 to 14cc's. The gonadotropin profile shows moderate testicular failure. Could you advise if this means that hormone therapy would not be beneficial? I may be asking the same questions because we are really confused. And the clinic we attended has not been supportive and not been able to answer anything before the operation. Even when we met the surgeon for the first time, he could not explain anything as he did not have our notes.

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

Firstly the report is inadequate and does not mention the gonadotropin levels, which are important. And the biopsy does not comment on the structure and the exact pathology of the testis. He may require a repeat consultation with an andrologist, and you would need the gonadotropin levels. With the present information, the prognosis for conception appears grim according to me.

 
 
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