Asthenospermia and Its Treatment with HCG

F. MISURALE, M.D., G. CAGNAZZO, M.D., and A. STORACE, M.D.

IN RECENT YEARS a committee of the International Fertility Association

has begun revision of the evaluation criteria of fertility in the male. These
new concepts have markedly decreased the importance given, up to now,
to sperm density: the lower limit of the fertile range has been dropped
from 60 to 20 millionjml.
It is therefore evident that motility has become more important in the
evaluation of semen fertility. According to the research of MacLeod and
Gold, it is not true that fecundating ability increases directly with the num-
ber of spermatozoa; on the contrary, this ability seems to be related to the
percentage of spermatozoa with good motility. It is obvious that by good
motility we mean that characterized by rectilinear motion, since the oscilla-
tory and the rotating spermatozoa must be regarded as completely ineffec-
tive for the purpose of fecundation.
On the basis of the earlier parameters, a large number of the patients
today classifiable as asthenospermic, would have fallen within the group of
oligoasthenospermia. Present therapy in such cases is generally HMG, with
or without HCG. The identification of asthenospermia as a .specific cause
of sterility and the well-known Leydig cell action induced by the chorionic
gonadotropin, suggested to us its specific use in the therapy of this form
of sterility. Moreover, we believe that the results obtained by MacLeod
et al. in the restoration of spermatogenesis confirm the value of our orienta-
tion.
In fact, while the administration of HMG (Pergonal 500) caused the
maturation of the seminal line up to the exfoliation of spermatozoa into the
lumen of seminiferous tubules, only its association with HCG caused the
appearance of an ejaculate containing mobile spermatozoa and consequent-
ly a full restoration of fertility. That motility becomes normal only after the
administration of chorionic gonadotropin might indicate an action of the
hormone on the epithelium of the epididymis, seminal vessels, and seminal
capsules. The functionality and integrity of these structures should be
From the Department of Obstetric and Gynecology, University of Genoa, Italy.
650
VoL. 20, No.4, 1969 HCG AND SPERM MoTILITY 651

essential for the spermatozoa's motility and should depend on the Leydig
cell incretion caused by an ICSH type of activity. 5 These interesting re-
marks of MacLeod et al. on the determinative effect of HCG on the motility
of spermatozoa, suggested to us a specific use of chorionic gonadotropin in
the therapy of pure forms of asthenospermia.

METHOD

Twenty-five men with variable degrees of asthenospermia were selected

for the therapeutic trial; 17 had adequate fol1ow-up and are reported here.
The therapy consisted of the administration of 2500 I.U. of HCG (Pro-
fasi*) every 5 days for 75-90 days.
RESULTS

Figure 1 shows the results obtained in the 17 patients with adequate

follow-up.
DISCUSSION
Effect on Sperm Count
We often found a reduction, sometimes a particularly significant one, in
the number of spermatozoa per milliliter during the early stages of the
treatment. As Fig. 1 shows, at the end of the therapy, the number of
spermatozoa ranged again within the basal values; in certain cases it ex-
ceeded them, and in other cases it was still below the starting values. We
believe that this behavior does not support the suggestion of HCG stimu-
lating spermatogenesis.

Effect on Sperm Motility

Motility improved in all but one patient (Patient 17). Figure 1 shows
the percentage values of rectilinear motility before and after HCG ad-
ministration. Upon completion of the therapy, the percentage of mean
effective motility increased from 22% to 60%, thus largely exceeding the
minimum limit of 40% which is believed to be essential for semen fertility.
This HCG action proved to be independent or even in contrast with the
effects on the spermic density. In fact, sometimes an improvement in mo-
tility corresponded to a decrease in the number of spermatozoa. That this
resulted in a greater fertility of the semen is proved by some pregnancies
achieved in these particular cases.
*lstituto Serono, Italy.
652 MISURALE ET AL, FERTILITY & STERILITY

The positive modification of motility was generally associated with an

improvement in the semen quality, proved by a remarkable decrease in
degenerative forms. It is likely, therefore, that one of the reasons for the
HCG effect on the semen motility may depend on the effect of the hormone

Nt:G IJIUI J.V.

IDI/"'OTII.ITY BEFO.RI T.RIATIVEHT

~ HOT/t.ITY AFTI.R T.RIATHEHT WIT/I Nt'li

D II'I.RI'f t'OVHT 1"11.1.1/IJHJ/IIfl..

0 He'll ODJI J. U.
Fig. 1. Results of treatment of asthenospermia with HCG.

on the conditions of the epithelium of the epididymis, the seminal vessel,

and the seminal capsules, as reported by MacLeod et al.

Effect on Ejaculate Volume

The ejaculate volume, which was already within the physiologic limits
even before treatment in most cases, did not undergo any remarkable
quantitative changes upon completion of the treatment. Such a finding
might mean that in our patients the Leydig cell function was integral.
However, the existence of asthenospermia and the effectiveness of the HCG
therapy contradict such hypotheses. It would seem more logical to think
that the damage caused to the seminal pathways by Leydig cell deficit
might be manifested, according to its importance, through various degrees
ranging from the simple motor and qualitative damage of spermatozoa to
the quantitative reduction of seminal plasma and its disappearance.
VoL. 20, No.4, 1969 HCG AND SPERM MoTILITY 653

Pregnancies
There were 8 pregnancies in 6 of our patients' partners. These couples
had been under observation for primary sterility dating back 3 years at
least, and the examination we carried out had shown that asthenospermia
alone was the probable cause of their sterility. Five of these pregnancies
went to term; 3 were interrupted by abortion during the first 3 months.
Two of the abortive pregnancies refer to the same couple (Case 8, Fig. 1).
Of the patients in whom an improvement of the spermatic motility not
followed by any pregnancies was obtained, 2 were single and 4 married to
women suffering from anovulation (and being treated with HMG plus
HCG). Therefore, the percentage of pregnancies on this revised number
of cases is 54.5%.
The results of our studies, therefore, seem to indicate asthenospermia as
a specific cause of sterility, and chorionic gonadotropin as an elective means
to correct it.
SUMMARY

HCG ( 45,000 I.U. for 75-90 days) was given to 17 infertile men suffering
from asthenospermia. After the therapy, a constant improvement of the
spermatozoa rectilinear motility was noted, followed by 8 pregnancies in
the partners of 6 patients.
The results obtained seem to indicate that asthenospermia is a specific
cause of sterility, and that the chorionic gonadotropin is an elective means
to correct it.
Department of Obstetrics and Gynecology
University of Genoa, Italy
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