正常精蟲數量之不孕族群睪固酮低下的盛行率與危險因子

林巧文¹、黃奕燊^1,2、陳昱光¹、黃志賢^1,2

¹臺北榮民總醫院泌尿部

²國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心

Incidence and risk factors of hypogonadism in men with normal sperm concentration

Chyau-Wen Lin¹, I-Shen Huang^1,2, Yu-Kuang Chen¹, William J. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital

²Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center,
National Yang Ming Chiao Tung University, Taipei, Taiwan

Introduction & objectives

Infertile men without quantitative semen alterations, defined as a sperm count above the lower reference limit, 15 million/ml, might not receive a comprehensive evaluation of their endocrine profile through an initial workup. For those with hypogonadism, hormone manipulation can stimulate endogenous testosterone production and sperm counts, thereby increase their chances of spontaneous conception. The objective of this study was to investigate the incidence of hypogonadism in infertile men with a normal sperm count and, in addition, to acknowledge the proportion of such men without endocrine evaluation.   

Materials & methods

Medical records of men who presented with a chief complaint of infertility from January 2013 to December 2020 were reviewed. Only men with normal sperm concentration (>15 million/ml), consulting for infertility for the first time, and without prior evaluation or treatment were studied. Clinical information in the diagnostic workup, including semen analysis, endocrinology profile, testicular size measurement, presence or absence of varicoceles, and whether a gynecologist or urologist provided the infertility workup was retrospectively collected.

Results

A total of 2593 men who visited our out-patient department during the study period due to infertility and had normal sperm concentration were enrolled. Of them, 2351 (90.7%) men assessed by gynecologists as the first healthcare providers had never been tested for serum hormone levels and did not receive physical examination. Overall, 242 men received a hormonal assessment as well as a thorough physical examination. Among them, 138 (57.0%) men had hypogonadism (defined as serum total testosterone < 300 ng/dL). Varicoceles is found in a higher percentage among men having testosterone levels > 300 ng/dL than those with hypogonadism (62.5% vs 49.3%, p < 0.001). Age, body mass index, testis size, sperm motility, sperm morphology, and levels of follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol did not show significant differences when comparing men with and without hypogonadism.