Assessment of hormonal status in male infertility. An update

https://doi.org/10.1016/j.dsx.2022.102447Get rights and content

Highlights

  • Male infertility is an underdiagnosed health problem.

  • Male factor in infertility should be studied in a comprehensive manner.

  • Hormonal evaluation of male infertility should include determination of testosterone and gonadotropins hormone levels.

  • The spermatogram is the cornerstone in male infertility evaluation.

Abstract

Background and aims

The prevalence and incidence of infertility are increasing worldwide; they are associated with a significant economic and social impact. Infertility is defined as the inability to achieve pregnancy after 12 months or more of regular unprotected sex. In recent times, the male factor has gained importance and currently it contributes to approximately 50% of infertility cases. Multiple etiologies are stated, such as metabolic, anatomical, genetic or even idiopathic causes; however, the main cause is semen abnormalities. The aim of this manuscript is to provide a complete review of hormonal assessment of male infertility, as well as to review the physiology and pathophysiology related to the male gonadal axis.

Methods

This study is a narrative abstract carried out on basis of systematic bibliographic review, using articles indexed in PubMed/Medline, Scopus, Embase and Scielo, which were published during the last 20 years.

Results

The cornerstone of the evaluation of the hormonal status is semen analysis. Clinicians must rule out hypogonadism in those patients who present oligospermia and azoospermia, by determining levels of testosterone and gonadotropins, which provide the functionality status of the hypothalamic-pituitary-testicular axis. Evaluation of the adrenal, thyroid, and lactotroph axis are indicated in those patients with central hypogonadism.

Conclusions

Despite advances in the diagnosis of male infertility, some causes are not fully understood, therefore, it is crucial to perform a timely hormonal evaluation of the male factor in infertile couples, in order to provide adequate treatment and improve fertility rates.

Introduction

Infertility is defined as the inability to achieve conception after 12 months of frequent sexual intercourse [1]. It is recognized that the male component contributes 50% to infertility cases [2,3]. The World Health Organization (WHO) suggests considering infertility as a global public health problem. Approximately 15% of reproductive age couples are infertile worldwide [4], while the prevalence of infertility is approximately 10% [1]. Male infertility is a prevalent medical condition related to the dysfunction of organs such as the pituitary gland and the male gonads. Testicular functions include testosterone production and spermatogenesis; both regulated by the hypothalamic-pituitary-gonadal (HPG) axis [5]. Spermatogenesis is a complex process involving genetic, hormonal, and environmental factors; the failure of any of these can result in infertility [6].

The etiology of male infertility is idiopathic in 40–50% of cases; the remainder are due to hormonal or anatomical alterations which in some cases are reversible [4,7]. Male infertility has multiple etiologies including genetic, congenital, and acquired [5] (Table 1); each requires a thorough study to reach a diagnosis. However, 15%–30% of male infertility cases will remain without a specific etiology [8]. In these cases, a comprehensive evaluation can unmask the genetic and epigenetic factors contributing to its pathogenesis. It has been shown that the interrelationship between specific genes, epigenetic control of gene expression, environmental factors, and lifestyle will determine the male infertility phenotype [9].

Section snippets

Materials and methods

This study is a narrative review that aimed to identify all currently and relevant information related to the hormonal assessment of male infertility.

Physiology of the hypothalamus-pituitary-gonadal axis

The male reproductive axis is composed of the hypothalamus, the pituitary gland, and the testes. The latter is responsible for the testosterone production necessary for developing and maintaining sperm function, which is directly involved in male fertility. Furthermore, this axis is influenced by other endocrine organs such as the adrenal gland and adipose tissue [11,12]. Fig. 1.

Hormonal status assessment

Among male infertility etiologies endocrine causes represent 2–5%, mainly associated with alterations in the hypothalamic-pituitary. Primary defects in spermatogenesis represent 65–80% of the cases [5]. Sexual dysfunction is an uncommon cause of male infertility. It has been demonstrated that there is an interconnection between virility and fertility in the infertile population [21]. Infertility affects the sexuality of an infertile couple negatively; directly proven by a high percentage of

Conclusions

  • -

    Male infertility is an underdiagnosed health problem with an increasing rate. Therefore, it is essential to timely evaluate the male factor and thus improve the fertility rate.

  • -

    Semen analysis constitutes the fundamental pillar in evaluating male infertility, requiring the obtention of testosterone and gonadotropin samples according to the result.

  • -

    Endocrine disorders play a determining role in the etiology of male infertility.

  • -

    The hormonal study of male infertility is a field of reproductive

Clinical relevance

Recent advances in the diagnosis of male infertility have increased our understanding and ability to find the etiology5. This review presents an update of the hormonal evaluation from the clinical and paraclinical aspects available in the majority of infertility and reproduction centers (determination of testosterone and spermatogram); Furthermore, information related to new tests has been included, which could be useful in providing more information on the hypothalamic and intratesticular

Limitations

Our research team recognizes as the main limitation of this narrative review, that despite describing the methodology used, a research question is not answered; therefore, the scientific evidence is less than a systematic review. Additionally, a minor limitation is the absence of epidemiological studies that describe the current prevalence of male infertility worldwide.

Funding statement

This manuscript was funded by Concepciòn-Zavaleta, Coronado-Arroyo, Concepciòn-Urteaga. This manuscript did not received grants.

Declaration of competing interest

The authors declare no conflict of interest.

Acknowledgement

Mark Stable. English Language Center. North London University United Kingdom.Cesar Campos-Cuellar San Martin de Porres University, School of Medicine, Lima Perú.We appreciate their support for the English translation.

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