원일불명의 남성불임 환자에서 Pure Follicle Stimulating Hormone과 Human Chorionic Gonadotropin 을 이용한 전신적 치료에 관한 연구 = Systemic Treatment Using Pure Follicle Stimulating Hormone and Human Chorionic Gonadotropin in Patients with Idiopathic Male Infertility

다국어 초록 (Multilingual Abstract)

This study was designed to determine if hormonal treatment using pure follicle stimulating hormone(pFSH) and human chorionic gonadotropin(hCG) would improve the fertilizing ability of sperm in patients with idiopathic male infertility. In this study, two groups of patients with severe male factor were evaluated. The group I included 9 patients with a history of failed fertilization in one or more previous IVF attempts when normal oocytes were retrieved, and group II included 12 patients with poor sperm parameters below the level considered critical for fertilization to occur. The critical level of sperm parameters is defined as characterized by sperm concentration of less than 5x106/ml; progressive motility less than 10%; normal sperm morphology less than 2.5% using strict criteria; sperm morphology index(summation of normal and slightly amorphous forms) less than 5.5% using strict criteria. All patients included in this study had normal hormonal state(luteinizing hormone [LH], FSH, testosterone, prolactin) and no structural abnormalities in testis. PFSH, 75 IU, was administered three times a week and hCG, 5,000 IU, was added once a week intramuscularly for three months. Conventional semen analysis and sperm morphology evaluation using strict criteria were performed in all patients(n=21) after pFSH/hCG treatment. The sperm concentration was significantly increased after treatment, with 44.8±26.0x106/ml compared with 27.5±25.0x106/ml before treatment. The sperm motility was also significantly increased after treatment, with 53.9±19.8% compared with 28.1±16.8% before treatment. The normal sperm morphology and morphology index by strict criteria were significantly increased after treatment, with 3.7±1.5% and 6.8±2.3% compared with 2.2±0.8% and 4.0±1.4% before treatment. In the group I, the fertilization and cleavage rates per oocyte were significantly increased after treatment, with 37.2%(35/94) and 29.8%(28/94) compared 5.5%(5/91) and 2.2%(2/91) before treatment. Clinical pregnancy rate after treatment(22.2%=2/9) was higher than before treatment(0%), without statistical significance. In the group II, pregnancies occurred spontaneously in 25%(3/12) of couples after course of hFSH/hCG treatment. There was one spontaneous abortion in these three pregnancies. IVFs were attempted in 6 couples of 12 included in the group II. The fertilization and cleavage rages per oocyte were 44.4%(28/63) and 31.7%(20/63). In these 6 patients, a clinical pregnancy(16.7%) was achieved. In conclusion, systemic hormonal therapy sing pFSH and hCG could improve the fertilization capacity of sperm and it may be reasonable to offer this treatment to the patients with severe male factor as previously defined and for those cases of failed fertilization of IVF.