Dados do Trabalho

Title

Association with the use of gonadotropins in the treatment of infertility in men with Kallmann Syndrome: a report of 2 cases

Objective

To evaluate the sperm production response in 2 (two) azoospermic patients diagnosed with Kalmann Syndrome (KS) and treated at the Human Reproduction Center - Cenafert.

Methods

Patient 1 (first), 35 years old, started the protocol with human menopausal gonadotropin (HMG) 75 IU daily and, after 60 days, added human chorionic gonadotropin (HCG) 5,000 IU every 5 days. Then, showed a response after 5 months of using the medications, with rare motile spermatozoa in the sample. However, the patient became azoospermic again, being diagnosed with varicocele, that has done a surgery for correction. There was no interruption of the hormonal protocol and at 6 months sperm production returned. An in vitro fertilization (IVF) cycle was performed using fresh and freeze ejaculated semen from all the embryos: 6 inseminated oocytes, 4 frozen embryos. Two months after the first oocyte collection, a second IVF cycle was performed with fresh ejaculated semen: 6 inseminated oocytes, 4 frozen embryos. Performed a transfer of 2 frozen embryos, twin pregnancy and babies at home.
Patient 2 (second), 34 years old, used HMG 75 IU daily for 60 days, then added HCG 5,000 IU every 5 days. One year after the beginning of the hormonal protocol, a spermogram was performed at the clinic and the presence of rare motile spermatozoa was observed and an IVF cycle was performed: 16 oocytes were inseminated, 7 blastocysts were frozen and medication was discontinued. Three transfers of frozen embryos were performed, resulting in a pregnancy that progressed to abortion. Two years later, the patient restarted the same gonadotropin protocol for 80 days, and rare motile spermatozoa were observed, which were used in the second cycle of IVF: 14 oocytes were inseminated, 5 blastocysts were frozen after trophectoderm biopsy, and cellules were sent for preimplantation genetic testing for aneuploidy (PGT-a), resulting in 3 euploid embryos with a single transfer and ongoing clinical pregnancy.

Results

The two patients treated with the hormonal protocol of gonadotropins were successful in the production of spermatozoa; and submitted to IVF techniques they achieved pregnancy.

Conclusion

The protocol using gonadotropins HMG and HCG was effective in the treatment of male infertility caused by KS in both patients in this study, but more controlled studies with a representative sample are needed to confirm this protocol and determine the safety of this treatment.

Keywords

Kallmann Syndrome, Azoospermia, Infertility, Gonadotropins.