OUTCOME OF FOLLICLE-STIMULATING HORMONE (FSH) THERAPY IN MALE INFERTILITY

Background: Infertility affects 15-25% of couples globally and the male factor accounts for approximately 40-50% of the cases, presenting a significant challenge to reproductive health. Treatment options for male infertility are limited and often inconclusive, highlighting the need for assisted reproductive technologies (ART). Follicle-stimulating hormone (FSH) treatment is commonly used to treat people with hypogonadotropic hypogonadism. Although this application is well recognised and established, a similar approach is empirically recommended for male idiopathic infertility. In such cases, after other causes of infertility and obstruction have been ruled out, FSH therapy is used to improve the quantity and quality of sperm, as well as to increase pregnancy rates, particularly when plasma FSH levels are below 8 IU/L. Objective: This study aims to evaluate the effectiveness of FSH administration to male partners of infertile couples with idiopathic oligozoospermia and/or asthenozoospermia who have plasma FSH levels < 8 IU/L by estimating conventional seminal parameters (i.e., spermatid count, motility and morphology). The secondary objectives of the study are to quantify the magnitude of the improvements in seminal parameters, assessing the clinical relevance of FSH as a therapeutic option in patients with idiopathic male factor infertility and to determine whether a specific FSH molecule is more effective than others in enhancing the semen parameters. Materials and Methods: A retrospective study was conducted in the Complex Operating Unit of Andrology and Reproductive Medicine of the University Hospital of Padua involving male patients from infertile couples who underwent FSH therapy. Semen analyses were performed before and after treatment. Primary outcome measures included sperm concentration and total count, motility, and morphology. Data were collected from medical records and analysed to determine changes in seminal parameters before and after therapy. Results: Analysis revealed a statistically significant improvement in semen quantity and quality after FSH therapy. Notable increases were observed in total sperm count (p < 0.001) and the total number of motile sperm (p < 0.001). Significant improvements in combined progressive and non-progressive motility were also observed (p = 0.018) and a reduction in immotile sperm (p = 0.034). Although positive trends in semen volume and progressive motility were identified, these changes were not statistically significant. Treatment showed a moderate impact on total sperm count and total number of motile sperm, while a smaller effect was observed in the improvement of combined motility and reduction of immotile sperm. No significant differences were found between the different FSH molecules used (hpFSH, rhFSH-β and rhFSH-α). Conclusions: FSH therapy demonstrated its effectiveness in improving sperm production and motility in patients with idiopathic infertility. Furthermore, the choice of FSH formulation did not affect treatment outcomes, confirming the overall efficacy of FSH therapy regardless of the specific molecule administered. These findings highlight a clinically significant impact of FSH therapy on the treatment of idiopathic male factor infertility, although more studies are needed to evaluate pregnancy outcomes and long-term efficacy.