Low Serum Inhibin B/Follicle-Stimulating Hormones and Anti-Müllerian Hormone/Follicle-Stimulating Hormones Ratios as Markers of Decreased Germ Cells in Infants with Bilateral Cryptorchidism

Abstract

Purpose:In cryptorchidism, germ cell development failure presents from infancy and may be reflected by altered hormonal levels produced by Sertoli cells. Our object was to assess for associations between serum hormone levels and testicular histopathology in cryptorchidism with an infertility risk according to the pretreatment undescended testicular positions. Materials and Methods: Prepubertal cryptorchid boys aged 7-91 (median 20) months who underwent orchidopexy between 2014 and 2019 were included (122 unilateral [median 19 (range 7-91) months], 23 bilateral [24 (11-81) months]). We evaluated the pretreatment testicular position and size; serum hormone levels; and the mean number of germ cells per tubule transverse section (G/T). We also performed a subgroup analysis of boys aged ≤24 months at orchidopexy. Results: Serum inhibin B levels and G/T were significantly lower in bilateral than in unilateral cryptorchid boys (median 96 [range 46-197] pg/mL vs. 125 [21-354] pg/mL, p=0.026; 0.20 [0-2.59] vs. 0.65 [0-4.55], p<0.001, respectively). Inhibin B/follicle-stimulating hormones (FSH) and AMH/FSH ratios were positively correlated with G/T in bilateral cryptorchid boys aged ≤24 months (n=12, p=0.008 and p=0.019,

Cryptorchidism: What Are the Risks of Infertility? What Do We Tell the Parents? How Do We Manage the Child?

“…These patients predominantly have bilateral undescended testis, suggesting the presence of an underlying genetic disorder causing a global testicular defect that is not reversed by early orchiopexydin essence, infertility occurring in the absence of elevated testicular temperatures. 5,6…”

“…7 Given these facts, the article by Dr. Kato and colleagues is of considerable value. 5 Their paper suggests we can now reliably identify the subset of patients with bilateral cryptorchidism who are at high risk for infertility by the findings of high serum follicular stimulating hormone (FSH) and low inhibin B/FSH and anti-m€ ullerian hormone/FSH ratios, thereby saving the risk of a testicular biopsy. 5,7…”

“…In this regard, Dr. Kato and associates have identified a select group of patients by a minimally invasive and low-risk method at high risk for infertility. 5 Rather than blindly pursuing possible harmful hormonal stimulation to abate infertility, why not identify the genetic abnormality and attack at the heart of the defect?…”

Undetectable anti‐Mullerian hormone and inhibin B do not preclude the presence of germ cell tumours in 45,X/46,XY or 46,XY gonadal dysgenesis

“…Such pathologically confirmed streak gonads cannot develop germ cell cancer so prophylactic gonadectomy would not be necessary. Sertoli cells secrete inhibin B and anti‐Müllerian hormone (AMH) and serum levels of these hormones have been shown to correlate with Sertoli cell number and germ cell number in boys with cryptorchidism 13–15 . It has been proposed that in boys with bilateral non‐palpable testes, a diagnosis of testicular regression syndrome can be made based on inhibin B being undetectable or close to the lower limit of detection, in combination with clearly elevated gonadotropins, without the need for laparoscopy 16 .…”

“…Sertoli cells secrete inhibin B and anti-Müllerian hormone (AMH) and serum levels of these hormones have been shown to correlate with Sertoli cell number and germ cell number in boys with cryptorchidism. [13][14][15] It has been proposed that in boys with bilateral non-palpable testes, a diagnosis of testicular regression syndrome can be made based on inhibin B being undetectable or close to the lower limit of detection, in combination with clearly elevated gonadotropins, without the need for laparoscopy. 16 The (nearly) undetectable level of inhibin B is thought to indicate an absence of Sertoli cells and thus an absence of germ cells.…”