Open Access

ARTICLE

Defining hypogonadism in male partners of couples with unexplained infertility

J.C. Trussell¹, Ava Delu¹, Robert J. Kiltz², Vladimir A. Kuznetsov¹

1 Department of Urology, Upstate University Hospital, Syracuse, New York, USA
2 CNY Fertility Center, Intrepid Lane, Syracuse, New York, USA
Address correspondence to Dr. Vladimir A. Kuznetsov, Department of Urology, SUNY Upstate Medical University, Weiskotten Hall, Room 1271, 750 East Adams Street, Syracuse, NY 13210 USA

Canadian Journal of Urology 2020, 27(4), 10306-10311.

Abstract

Introduction: Men with unexplained infertility (UI) should undergo an initial hormonal evaluation including serum FSH and total testosterone (TT). Unfortunately, there is no consensus regarding which TT cut point should be used to define hypogonadism in such men. To determine the best definition for hypogonadism, three different, literature-based TT cut points were used to assess associations between TT and semen parameters. The hypothesis was that the lowest TT cut point would associate with poorest sperm parameters.
Materials and methods: We performed an IRB-approved retrospective chart review of 247 consecutive males presenting for evaluation of male factor infertility. After exclusions, basic statistics and correlation analysis of semen analysis parameters, TT, age, and body mass index (BMI) were evaluated on 128 men (age 34 +/- 33.5) categorized by three different TT cut points: 65 males were hypogonadal according to a TT cutoff of < 264; 16 with a cutoff of 264-300; 44 with a cutoff of 301-400; and 42 with a TT over 400 ng/dL. Basic statistics, one-way ANOVA, and Levene comparative analysis were performed. Besides a negative correlation between TT and BMI, there was no significant association between the three TT literature-based cut points and the other studied parameters. These findings were further supported by multiple comparison analyses.
Results: For men with UI, regardless of how hypogonadism was defined, no relationship between semen parameters and TT was found.
Conclusion: Conventional, TT-based definitions of male hypogonadism in the setting of UI need to be clarified. Clinically relevant, accurate, and reproducible multivariable biomarkers need to be investigated to further advance best practices for treating men with UI.

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