Pharmacological concentrations of follicle-stimulating hormone and testosterone improve the efficacy of in vitro germ cell differentiation in men with maturation arrest

Objective: To examine whether in vitro differentiation of germ cells from men with maturation arrest is improved by augmenting FSH and T concentrations above the values effective in samples from men with normal spermatogenesis. Design: Prospective, controlled in vitro study. Setting: Private assisted reproduction centers and a university department. Patient(s): Men with meiotic or postmeiotic maturation arrest. Intervention(s): Testicular spermatid extraction, in vitro culture of testicular biopsy samples, intraoocyte injection of elongated spermatids, embryo culture and transfer. Main Outcome Measure(s): Progression of in vitro germ cell differentiation, fertilization, and pregnancy outcomes with in vitro cultured germ cells. Result(s): In some cases of meiotic and postmeiotic maturation arrest, more advanced germ cell stages were achieved by in vitro culture in the presence of 500 IU/L FSH as compared with 50 IU/L FSH. The beneficial effect of 500 IU/L FSH was further potentiated by a simultaneous increase of T concentration from I to 10 AM. Fertilizations with germ cells recovered after incubation with these Pharmacological hormone concentrations gave rise to viable embryos and the births of five healthy babies. Conclusion(s): Pharmacological concentrations of FSH and T are beneficial for in vitro maturation of germ cells from some men with in vivo maturation arrest. (Fertil Steril(R) 2002;77:245-51. (C) 2002 by American Society for Reproductive Medicine.).