Low inhibin B levels alone are not a reliable marker of dysfunctional spermatogenesis in childhood cancer survivors

Abstract

Hormone and semen analyses were carried out to examine the diagnostic value of hormones and hormone combinations as markers of spermatogenesis in male patients who had received oncological treatment in childhood. Hormone analyses from 73 participants and spermiograms from 42 participants were evaluated. Spearman's correlation coefficients and measures of diagnostic accuracy were calculated for the hormone and semen analysis values. Inhibin B levels of <80 ml/ml, follicle-stimulating hormone (FSH) levels of >10 IU l(-1) and a combination of the two parameters showed positive predictive values for azoospermia of 0.423, 0.6154 and 0.6667 respectively. While 32% of the 73 participants showed a combination of abnormal inhibin B and FSH values, which strongly indicates impaired spermatogenesis, 31% of the 42 spermiogram results revealed azoospermia. The hormone and semen analyses showed that approximately one-third of the participants had fertility impairment. Inhibin B alone thus does not reflect spermatogenesis as well as inhibin B in combination with FSH in patients who have undergone cancer treatment in childhood. Both parameters should therefore be evaluated in paediatric cancer follow-up programmes to allow better identification of treatment regimens that cause persistent azoospermia in male childhood cancer survivors.

Follicle Stimulating Hormone is an accurate predictor of azoospermia in childhood cancer survivors

“…The application of inclusion and exclusion criteria to the studies found in the literature yielded four sources of FSH and semen concentration in CCS (Table 1, S2 Table, Fig 1) [5, 14, 32, 33]. Studies identified for full-text analysis, but excluded are listed in S1 References together with reasons for exclusion.…”

Hypogonadism in Children with a Previous History of Cancer: Endocrine Management and Follow-Up

“…In a study of 25 males, it was found that in prepubertal boys, inhibin B concentration, together with sensitive measurements of FSH concentration, was a potential marker of the gonadotoxic effects of chemotherapy, but not as good as the gold standard (semen analysis) [36]. Two other studies that investigated the diagnostic value of inhibin B concentrations and FSH concentrations for detecting azoospermia and oligospermia showed that measurements of FSH, inhibin B concentrations and using the inhibin-FSH ratio all show fairly diagnostic value for detecting azoospermia [37, 38]. The accuracy of FSH as a predictor of azoospermia in adult survivors of childhood cancer remains controversial, with conflicting results in the published literature.…”

Predictivity of Nonclinical Male Reproductive Findings for Human Effects

“…There is also the question of whether hormones are appropriate or sufficiently sensitive to detect a treatment‐induced effect on spermatogenesis. The hypothesis that FSH and inhibin B are good markers of spermatogenesis (Meachem et al, ; Kumanov et al, ) is not universally supported in the literature, and many acute treatment‐induced changes appear the most problematic for a hormone response (Kolb et al, ; Salenave et al, ; Rendtorff et al, ); Small sample sizes and high variability . The human studies sometimes included fewer than 20 men per dose group, which was likely insufficient to identify statistically significant changes in measures with high variability such as semen analysis endpoints.…”