(299) The Modulating Effects of Follicle Stimulating Hormone and Clomid on Men with Azoospermia or Oligozoospermia Taking Human Chorionic Gonadotropin
Authors: Kassab J , Garcia Keeme-Sayre A , Lindsey Ii J , Torres-Anguiano J , Lipshultz L 
Published: February 2024

Abstract

Introduction
Depression of spermatogenesis is a significant concern for hypogonadal patients on testosterone therapy. Human chorionic gonadotropin (hCG) is commonly prescribed in these men to prevent testicular atrophy and to maintain some degree of spermatogenesis. Furthermore, hCG dosages are significantly increased when a pregnancy is desired. Historically, we have concomitantly used Clomid to stimulate FSH and testosterone production since both are needed for optimal spermatogenesis. However, with the availability of compounded FSH, we have introduced its usage instead of Clomid to evaluate if it yields superior quantitative sperm production.

Objective
To investigate which medication pairings yields the greatest improvement in hormone and semen parameters over time.

Methods
Including men with azoospermia or oligozoospermia who were prescribed hCG, we noted whether the men were additionally taking FSH or Clomid. The patient population of men in the hCG + FSH group had 32, and the hCG + Clomid group totaled 14. Baseline laboratory values were documented for testosterone and total sperm count for each patient prior to being prescribed their combined medications, followed by subsequent values for these variables in the months following this prescription. ANOVAs were employed using SPSS to analyze the change in the two assessed metrics across follow up visits.

Results
By analyzing increase in testosterone over time, the hCG + FSH cohort experienced the greatest improvement after four follow up visits (600.89 ng/dL after four visits, 150.22 (ng/dL)/visit), outperforming the hCG + Clomid group (505.63 ng/dL after four visits, 126.41 (ng/dL)/visit). The ANOVAs across the subsequent visits for each treatment group are as follows: hCG + FSH: f-ratio = 3.226, p-value = 0.0137; hCG + Clomid: f-ratio = 1.456, p-value = 0.219. Regarding total sperm count, the hCG + FSH group surpassed the HCG + Clomid group across the follow-up visits as well: hCG + FSH: 41.47 million after three follow-up visits; hCG + Clomid: 26.20 million after three follow-up visits. The ANOVAs across the subsequent visits for each treatment group are: hCG + FSH: f-ratio = 3.015, p-value = 0.0339; hCG + Clomid: f-ratio = 1.485, p-value = 0.234.

Conclusions
Those taking hCG with FSH experienced a greater improvement in both testosterone and total sperm counts compared to men on hCG and Clomid. It would seem that the use of FSH gives a more rapidly successful outcome for hypogonadal patients, since its combination with hCG acts directly to stimulate spermatogenesis, within the testes rather than requiring, as with Clomid, secondary stimulation through the pituitary gland's secretion of LH and FSH. With the relatively recent introduction of FSH as compounded biologics and its reduction in cost compared to brand FSH, the use of this trophic hormone can now be more widely used. Moreover, these data suggest that hCG with FSH results in a more rapid improvement in both spermatogenesis and serum testosterone than historically alternative therapies.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant).