Introduction

Recently, the cohort of men from the European Male Ageing Study (EMAS) has been stratified into different categories distinguishing primary, secondary and compensated hypogonadism. A similar classification has not yet been applied to infertile men, traditionally younger than those usually considered for population studies. We aimed to investigate the prevalence of different forms of hypogonadism and the eventual association of clinical, semen and hormonal parameters in a homogeneous cohort of white-European men presenting for primary couple’s infertility.

Methods

We performed a cross-sectional study enrolling 786 consecutive Caucasian-European primary infertile men segregated into: eugonadal [normal serum total testosterone (tT >= 3.03 ng/mL) and normal LH (=<9.4 mU/mL)]; secondary (low tT; low/normal LH); primary (low tT; elevated LH); and, compensated hypogonadism (normal tT; elevated LH). Logistic regression models tested the association between semen parameters, clinical characteristics and the defined gonadal status.

Results

Eugonadism, secondary, primary, and compensated hypogonadism were found in 80%, 15%, 2%, and 3% of men, respectively. Secondary hypogonadal men were at highest risk for obesity (OR [95% CI] 3.56 [2.03-6.13]). Primary hypogonadal men were those at highest risk for non-obstructive azoospermia (NOA) (23.5 [6.25-152.96]) and testicular volume <15ml (12.78 [3.42-82.91]). Compensated had a similar profile to primary hypogonadal men, though their risk of NOA (6.27 [2.79-14.81]) and small testicular volume (8.94 [3.57-27.19]) was lower. The risk of small testicular volume (1.6 [1.05-2.44]) and NOA (1.83 [1.15-2.89]) was increased, though in a milder fashion, in secondary hypogonadal men as well.

Conclusions

Overall, primary and compensated hypogonadism depicted the worst clinical picture in terms of impaired fertility. Though not specifically designed for infertile men, EMAS’ categories might serve as a clinical stratification tool even in this setting.

Funding

none