# Two livebirths achieved in cases of hypergonadotropic hypogonadism nonobstructive azoospermia, treated with GnRH agonist and gonadotrophins: a case series and review of the literature

## TL;DR

This paper reports two successful live births in men with infertility due to testicular failure, using hormone treatments instead of surgery.

## Contribution

The study presents a successful non-surgical treatment approach for hypergonadotropic hypogonadism with nonobstructive azoospermia.

## Key findings

- Pharmacological treatment with GnRH agonist and gonadotrophins led to sperm production in two NOA patients.
- The treatment resulted in successful fertilization, embryo transfer, and live births in both cases.
- Hormone levels improved, and preimplantation genetic testing confirmed healthy embryos.

## Abstract

Non-obstructive azoospermia (NOA) is the most severe form of male factor infertility. It
results form from either primary or secondary testicular failure. Here, we report cases of
two patients with NOA due to maturation arrest and increased serum FSH, treated with GnRH
agonist and gonadotrophins. The two NOA patients underwent a pharmacological treatment
consisting of pituitary desensibilization using a GnRH agonist and testicular stimulation
using menotropin. Testicular stimulation started one month after the beginning of GnRH
agonist treatment. The female partner underwent controlled ovarian stimulation (COS)
followed by intracytoplasmic sperm injection (ICSI). On the third day of the cycle,
menotropin daily doses was administered. When at least one follicle ≥14 mm was
visualized, pituitary blockage was performed using GnRH antagonist ganirelix. When three
or more follicles attained a mean diameter of ≥17 mm, triptorelin acetate was
administered to trigger final follicular maturation. Oocyte retrieval was performed 35
hours later. After treatment, male partner blood levels of the FSH, LH, decreased and
total testosterone were increased. Spermatozoa was observed after semen collection in both
cases. After COS, oocytes were retrieved and ICSI was performed. Embryos were biopsied for
preimplantation genetic testing (PGT) and those considered euploidy were transferred
resulting in positive implantation, ongoing pregnancy, and livebirth on both cases. In
this report we present a successful strategy for hypergonadotropic hypogonadism AOA men,
as an alternative approach to the surgical testicular sperm recovery. Nevertheless,
prospective randomized trials are needed to confirm our findings.