Male infertility and gonadotropin treatment: What can we learn from real-world data?

Gonadotropin therapy to treat specific male infertility disorders associated with hypogonadotropic hypogonadism is evidence-based and effective in restoring spermatogenesis and fertility. In contrast, its use to improve fertility in men with idiopathic oligozoospermia or nonobstructive azoospermia remains controversial, despite being widely practiced. The existence of two major inter-related pathways for spermatogenesis, including FSH and intratesticular testosterone, provides a rationale for empiric hormone stimulation therapy in both eugonadal and hypogonadal males with idiopathic oligozoospermia or nonobstructive azoospermia. Real-world data (RWD) on gonadotropin stimulating for these patient subsets, mainly using human chorionic gonadotropin and follicle-stimulating hormone, accumulated gradually, showing a positive therapeutic effect in some patients, translated by increased sperm production, sperm quality, and sperm retrieval rates. Although more evidence is needed, current insights from RWD research indicate that selected male infertility patients might be managed more effectively using gonadotropin therapy, with potential gains for all parties involved. •The primary role of FSH is to increase sperm quantity in synergy with intratesticular testosterone (ITT).•Adequate ITT levels are required for post-meiotic progression of spermiogenesis.•FSH is the treatment of choice for idiopathic oligozoospermia and may be used with hCG in nonobstructive azoospermia (NOA).•FSH therapy might increase sperm quantity in IO, with an apparent positive effect on natural and ART pregnancy rates.•Gonadotropin therapy in NOA males might help improve sperm retrieval success or the presence of sperm in the ejaculate.