A man with hypogonadotropic hypogonadism successfully treated with nasal administration of the low-dose gonadotropin-releasing hormone analog buserelin.

Objective To report a patient with hypogonadotropic hypogonadism of hypothalamic origin successfully treated with nasal administration of a low-dose gonadotropin-releasing hormone (GnRH) analogue. Design Case report. Setting A reproductive medical center. Patient(s) A 37-year-old man with anejaculation and infertility. Intervention(s) Nasal administration of a low-dose GnRH analogue, buserelin. Main Outcome Measure(s) Semen analysis and serum levels of gonadotropins and testosterone after nasal buserelin use. Result(s) The patient's laboratory examination showed low serum levels of gonadotropins and testosterone. After being diagnosed with hypogonadotropic hypogonadism, 15 μg of buserelin acetate spray was administrated in each nostril three times a day (total: 90 μg/day). This therapy improved semen parameters and serum gonadotropin and testosterone levels. After approximately 1 year of this treatment, the patient's serum gonadotropin and testosterone levels remained in the normal range and semen analysis showed normozoospermia. The patient and his wife were treated with intracytoplasmic sperm injection, resulting in pregnancy. Conclusion(s) A low-dose buserelin nasal spray appears to be an effective and well-tolerated therapeutic option for patients with hypogonadotropic hypogonadism of hypothalamic origin.