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 1 to 10 microM. 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.