This comprehensive review examines the state of fertility treatment for men with congenital hypogonadotropic hypogonadism (CHH). It describes how hormone treatments using either pulsatile GnRH or gonadotropin injections can successfully induce sperm production in 75-80% of men with CHH - although sperm counts typically remain relatively low. The article identifies key predictors of treatment success and discusses how the lack of mini-puberty in infancy impacts adult fertility.
CHH is a treatable cause of male infertility, but success rates vary depending on disease severity, when treatment begins, and the type of treatment. Understanding what predicts a better or worse outcome helps doctors to tailor treatment for individual patients. The article highlights that men who experienced some spontaneous pubertal development typically respond better than those with complete absence of puberty.
The review provides evidence-based guidance for choosing fertility treatment based on individual patient characteristics. Key negative predictors include history of undescended testes, very small testicular volume (<4 mL), and absent mini-puberty. The article emphasizes the potential benefits of early intervention during infancy to "replace" the missed mini-puberty, which could significantly improve future fertility outcomes. Doctors can use this information to counsel patients, set realistic treatment expectations, and optimize treatment strategies to maximize fertility potential.
