Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy

Objective: To determine factors that influence sperm recovery after T-associated infertility. Design: Clinical retrospective study. Setting: Academic male-infertility urology clinic. Patient(s): Sixty-six men who presented with infertility after T use. Intervention(s): T cessation and combination high-dose hCG and selective estrogen modulator (SERM) therapy. Main Outcome Measure(s): Whether patients successfully achieved or failed to achieve a total motile count (TMC) of greater than 5 million sperm within 12 months of T cessation and initiation of therapy. Result(s): A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of T use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of T use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery. Conclusion(s): Increasing age and duration of T use significantly reduce the likelihood of recovery of sperm in the ejaculate, based on a criterion of a TMC of 5 million sperm, at 6 and 12 months. Physicians should be cautious in pursuing long-term T therapy, particularly in men who still desire fertility. Using these findings, physicians can counsel men regarding the likelihood of recovery of sperm at 6 and 12 months. (C) 2016 by American Society for Reproductive Medicine.