Can inhibin-B predict the outcome of microsurgical epididymal sperm aspiration in patients with suspected primary obstructive azoospermia?

Smit, Marij; Dohle, Gert R.; Wildhagen, Mark F.; Weber, R. F. A.

doi:10.1111/j.1745-7262.2007.00209.x

Cited by 9 publications

(9 citation statements)

References 32 publications

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“…The histological classification of the testis parenchyma was previously associated with the severity of clinical diagnosis in infertile men, but the score was not associated with testicular volume, and serum levels of inhB, FSH, LH and tT [32][33][34] . In agreement, both serum AMH levels and AMH/tT ratio values were not associated with the histological findings.…”

Section: Discussionmentioning

confidence: 94%

Anti-Mullerian hormone-to-testosterone ratio is predictive of positive sperm retrieval in men with idiopathic non-obstructive azoospermia

Alfano¹,

Ventimiglia²,

Locatelli³

et al. 2018

European Urology Supplements

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The lack of clinically-reliable biomarkers makes impossible to predict sperm retrieval outcomes at testicular sperm extraction (TESE) in men with non-obstructive azoospermia (NOA), resulting in up to 50% of unnecessary surgical interventions. Clinical data, hormonal profile and histological classification of testis parenchyma from 47 white-Caucasian idiopathic NOA (iNOA) men submitted to microdissection TESE (microTESE) were analyzed. Logistic regression analyses tested potential clinical predictors of positive sperm retrieval. The predictive accuracy of all variables was evaluated using the receiver operating characteristic-derived area under the curve, and the clinical net benefit estimated by a decision-curve analysis (DCA). Overall, 23 (49%) and 24 (51%) patients were classified as positive and negative sperm retrievals at microTESE. While circulating hormones associated to a condition of primary hypogonadism did not predict sperm retrieval, levels of anti-Mullerian hormone (AMH) and the ratio AMH-to-total Testosterone (AMH/tT) achieved independent predictor status for sperm retrieval at microTESE, with a predictive accuracy of 93% and 95%. Using cutoff values of <4.62 ng/ml for AMH and <1.02 for AMH/tT, positive sperm retrieval was predicted in all individuals, with 19 men out of 47 potentially spared from surgery. DCA findings demonstrated clinical net benefit using AMH and AMH/tT for patient selection at microTESE.The relevance of male infertility has progressively grown in Western societies, with significant medical, psychological, and socio-economic implications. Seven out of 100 men are infertile, with up to 40% of infertile conditions still of unexplained or idiopathic origin [1][2][3] . Azoospermia affects about 1% among all men and 10-15% of infertile men 4,5 . With no sperm found at multiple semen analyses, non-obstructive azoospermia (NOA) is the most severe form of infertility 1,5 . Despite genetic causes have been associated with male infertility 3,6,7 , genetic defects are found only in 17-20% of NOA individuals [7][8][9][10] . Except for a portion of patients with central endocrine disorders, the remaining 80% of NOA men having negative results on genetic testing are classified as idiopathic NOA (iNOA) 11 .In patients with clinical evidence of NOA, testicular sperm extraction (TESE) is the technique of choice, which rationally has to be planned as a part of in vitro fertilization programs; in this context, microdissection TESE (microTESE) has been advocated as the gold-standard technique to improve sperm yield with minimal

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Section: Discussionmentioning

confidence: 94%

Anti-Mullerian hormone-to-testosterone ratio is predictive of positive sperm retrieval in men with idiopathic non-obstructive azoospermia

Alfano¹,

Ventimiglia²,

Locatelli³

et al. 2018

European Urology Supplements

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“…Miller et al [28] also reported no differences in androgen levels taken from the seminal vesicle after vasectomy. Moreover, Smith et al [29] reported that there was no correlation between micro epidydimal sperm aspiration (MESA) success rates and serum FSH, LH, testosterone and inhibin B levels in patients with primary obstructive azoospermia. Sinha Hikim [30] claimed that gonadotropin releasing hormone analog deprivation caused an increase in apoptosis.…”

Section: Apoptotic Indexmentioning

confidence: 99%

Apoptosis in testicular tissue of rats after vasectomy: evaluation of eNOS, iNOS immunoreactivities and the effects of ozone therapy

Alpcan

Başar

Aydos

et al. 2014

Turkish Journal of Urology

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Objective: We aimed to investigate the changes in endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expression and apoptotic index in rat testicular tissue, as well as serum and seminal plasma sex hormone levels after vasectomy, and the effect of ozone therapy (OT). Material and methods:Adult male Wistar rats were used (n=6 per group). Control (G1), sham for 4 weeks (G2) or 6 weeks (G3), orchiectomy at the 4 th (G4) or 6 th (G5) week after left vasectomy, orchiectomy at the 4 th (G6) or 6 th (G7) week after bilateral vasectomy, orchiectomy after 6 weeks OT following left (G8) or bilateral (G9) vasectomy, orchiectomy after 6 weeks OT (G10). Results:In the left testes, while there were increases in eNOS and iNOS immunoreactivity and apoptotic indexes in G4 and G5, no changes were observed in contralateral testis. These values increased in G6 and G7, while OT inhibited these parameters in the left testis of G8 and both testes of G9. Sex hormone levels did not show any changes after vasectomy and ozone therapy. Conclusion:While OT was found to be protective against some parameters mentioned above under stress conditions, it seemed to cause some harmful effects when used in healthy conditions.

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“…The same study did not find significant difference in seminal Inh-B levels between successful and unsuccessful TESE procedure. Smit et al (2007) concluded that serum Inh-B could not replace diagnostic testicular biopsy prior to sperm retrieval by MESA in men with primary OA. When dealt with men with NOA or Figure 1.…”

Section: Discussionmentioning

confidence: 99%

“…Serum Inh-B could not predict the outcome of MESA in a study with primary OA (Smit, Dohle, Wildhagen, & Weber, 2007). One study found neither age nor vasectomy-surgical sperm retrieval interval (V-SSRI) to have any impact on the SSR outcome (Bromage, Douglas, Falconer, Lieberman, & Payne, 2007), whereas another reported V-SSRI to influence negatively on the outcome of Trucut testicular biopsy (McVicar et al, 2005).…”

Section: Introductionmentioning

confidence: 98%

Can we predict the chance of successful epididymal or testicular sperm aspiration following vasectomy?

Datta¹,

Nayini²,

Eapen³

et al. 2016

Human Fertility

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Purpose of this retrospective study was to investigate if serum markers, men's age, interval since vasectomy, BMI, testicular size and smoking could predict the success of epididymal or testicular sperm aspiration (PESA/TESA) in vasectomized men. Forty-four consecutively performed PESA/TESA procedures were reviewed retrospectively. Motile sperm was retrieved from 77.3% of PESA/TESA procedures. Mean serum Inhibin-B (Inh-B) level tended to be higher in men who had motile sperm retrieved compared to those who had not (180.3 versus 126.2 pg/ml, p = 0.05). Univariate analysis identified serum Inh-B to be the only predictor of PESA/TESA success (r = 0.32, CI: 0.006-0.584, p = 0.046). Serum FSH, LH, T levels, age, BMI, smoking status and interval since vasectomy did not correlate with the PESA/TESA outcome. Inh-B could modestly discriminate between successful and unsuccessful PESA/TESA (AUC= 0.70) with high positive (89.5%) but low negative prediction (36.8%); 58.6% sensitivity and 77.7% specificity at the optimum cut-off level of 166 pg/ml. Positive outcome was only 50% when the Inh-B level was below 100 pg/ml. It is concluded that a high serum Inh-B might reliably predict successful PESA/TESA in vasectomized men. More invasive sperm retrieval procedures could be reserved for men with very low Inh-B or failed PESA/TESA. Future studies with adequate power may confirm our findings.

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Can inhibin-B predict the outcome of microsurgical epididymal sperm aspiration in patients with suspected primary obstructive azoospermia?

Abstract: Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.

Cited by 9 publications

References 32 publications

Anti-Mullerian hormone-to-testosterone ratio is predictive of positive sperm retrieval in men with idiopathic non-obstructive azoospermia

Anti-Mullerian hormone-to-testosterone ratio is predictive of positive sperm retrieval in men with idiopathic non-obstructive azoospermia

Apoptosis in testicular tissue of rats after vasectomy: evaluation of eNOS, iNOS immunoreactivities and the effects of ozone therapy

Can we predict the chance of successful epididymal or testicular sperm aspiration following vasectomy?

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