Abstract
In order to clarify to what extent a hormonal disturbance may cause infertility in men, a study was made of 98 infertile men aged 23–52 years. Their spermatogenesis was defective. Urinary excretion of total gonadotropins, LH, estrogens, 17-ketogenic steroids, 17-ketosteroids and fractionated 17-ketosteroids was determined. The patient material was divided into 4 groups according to the excretion of total gonadotropins and estrogens in the urine. The groups were compared with a control group of 50 healthy males (aged 16–47 years) of proven fertility.
Group I had an elevated excretion of total gonadotropins and estrogens in the urine. No treatment was possible in this group. In group II, the excretion of total gonadotropins was <40 MU/litre, the excretion of LH was slightly elevated and the excretion of estrogens in the urine was higher than in the control group. A faulty testicular response to normal gonadotropin stimulation or an imbalance in the FSH/LH ratio might explain the increased estrogen excretion in the urine. In group III, the excretion of total gonadotropins and estrogens in the urine was normal and the excretion of 17-ketogenic steroids was slightly diminished.
In group IV, there was a decreased excretion of steroids in the urine, which may support the diagnosis of pituitary hypofunction. This group is the only one in which treatment with gonadotropins might prove successful. The excretion of DHA was low in groups I and IV, probably depending on the condition of the germinal epithelium.
The conclusion is reached that the cause of infertility in males may occasionally be a hormonal disturbance depending on hypothalamus-pituitary hypofunction. Only men who have a low excretion of gonadotropins and steroids in the urine may have a chance of becoming fertile after treatment with gonadotropic or releasing hormones.