Abnormality of pituitary gonadal axis among Nigerian males with infertility: study of patterns and possible etiologic interrelationships

OFN Ozoemena1, JO Ezugworie2, AU Mbah3, EA Esom4, BO Ayogu5, FE Ejezie61Department of Anatomy and Surgery, 2Department of Obstetrics and Gynecology, 3Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Teaching Hospital, 4Department of Anatomy, College of Medicine, University of Nigeria Enugu Campus; 5Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital, Ituku/Ozalla; 6Department of Medical Biochemistry, College of Medicine, University of Nigeria, Enugu Campus, Enugu, NigeriaBackground: Hormonal derangements potentially contribute to the diagnosis of infertility in over 60%–70% of couples investigated. Use of hormonal and antihormonal agents has achieved great success in the treatment of male infertility. Our aim was to investigate the prevalence of hormonal abnormalities in males diagnosed with infertility.Methods: Males diagnosed clinically with infertility and referred from the gynecologic clinics of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State University Teaching Hospital, and some private hospitals in and around Enugu metropolis were recruited for the study. They were grouped according to whether they had primary or secondary infertility on the basis of the World Health Organization definition. Routine fertility test profiles for the subjects were evaluated, and detailed hormonal assays were analyzed.Results: Of 216 men, 173 (80.1%) were found to have a hormonal imbalance. The mean age was 47.7 ± 3.5 (range 30–55) years for primary infertility and 47.2 ± 6.8 (range 33–61) years for secondary infertility. Patterns of hormonal abnormalities diagnosed amongst the 62 (35.80%) primary infertility subjects included hypergonadotrophic hypogonadism in 39 (62.90%), hypogonadotrophic hypogonadism in 18 (29.03%), and hyperprolactinemia in five (8.07%). Among the 111 (64.2%) cases of secondary infertility, there were 55 (49.55%) cases of hypergonadotrophic hypogonadism, 52 (46.85%) of hypogonadotrophic hypogonadism, and four (3.60%) of hyperprolactinemia. There was no statistically significant difference in the mean values between the two groups (χ2 < 1.414; P > 0.05) for hormonal indices.Conclusion: The hormonal profile should be considered as the gold standard for diagnosis and management of male infertility.Keywords: infertility, hormonal indices, males