Pulsatile Gonadotropin-Releasing Hormone Therapy Is Associated With Better Spermatogenic Outcomes than Gonadotropin Therapy in Patients With Pituitary Stalk Interruption Syndrome
Authors' conclusion
Pulsatile GnRH therapy was superior to hMG/hCG therapy for spermatogenesis in patients with PSIS. Earlier spermatogenesis and higher concentrations of sperm could be obtained in the GnRH group if patients received therapy over 6 months.
Study context
- Population
- Male patients with pituitary stalk interruption syndrome (PSIS)retrospective
- Participants
- 119 patients
- Exposure
- Pulsatile gonadotropin-releasing hormone (GnRH) therapy vs gonadotropin therapy
- Human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG)n = 60reference
- Pulsatile GnRHn = 59
- Outcome
- Success of spermatogenesis
Main finding
Overall spermatogenesis success rate
HR for achieving spermatogenesis
1.97
95% CI 1.08–3.57
P = 0.026
Events by group
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | hMG/hCG | P value |
|---|---|---|
| Total testosteronehMG/hCG vs GnRH · higher with hMG/hCG | median 2.16 (IQR 1.06–4.89) ng/mL | P = 0.004 |
| Pulsatile GnRH subgroup: successful spermatogenesis rate, response vs poor-response (LH cutoff 1 IU/L after 1 month)Higher with response | P = 0.002 | |
| Pulsatile GnRH subgroup: basal total testosterone, response vs poor-response (LH cutoff 1 IU/L)Higher with response | P = 0.026 |
- Time to induce spermatogenesis · GnRH vs hMG/hCG · shorter period with GnRH
- P = 0.019
- Total testosterone: GnRH median 1.31 (IQR 0.21–2.26) ng/mL
- Pulsatile GnRH subgroup: successful spermatogenesis rate, response vs poor-response (luteinizing hormone (LH) cutoff 1 IU/L after 1 month): Poor-response 5.00%
- Pulsatile GnRH subgroup: successful spermatogenesis rate, response vs poor-response (LH cutoff 1 IU/L after 1 month): Response 48.72%
- Pulsatile GnRH subgroup: basal total testosterone, response vs poor-response (LH cutoff 1 IU/L): Poor-response median 0.00 (IQR 0.00–0.03) ng/mL
- Pulsatile GnRH subgroup: basal total testosterone, response vs poor-response (LH cutoff 1 IU/L): Response median 0.04 (IQR 0.00–0.16) ng/mL
Time to induce spermatogenesis
- GnRH required a shorter period to induce spermatogenesis
Original publication
Pulsatile Gonadotropin-Releasing Hormone Therapy Is Associated With Better Spermatogenic Outcomes than Gonadotropin Therapy in Patients With Pituitary Stalk Interruption Syndrome. Endocr Pract. Published 28 November 2023. doi:10.
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