Clinical and Experimental Reproductive Medicine

  • 제49권1호
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  • Pages.62-69
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  • 2022
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  • 2233-8233(pISSN)
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  • 2233-8241(eISSN)
대한생식의학회 (The Korean Society for Reproductive Medicine)
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Azoospermic men with isolated elevation of follicle-stimulating hormone represent a specific subpopulation of patients with poor reproductive outcomes

  • Gamidov, Safar (Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology) ;
  • Shatylko, Taras (Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology) ;
  • Popova, Alina (Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology) ;
  • Gasanov, Natig (Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology) ;
  • Sukhikh, Gennadiy (Department of Andrology and Urology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology)
  • 투고 : 2021.04.30
  • 심사 : 2021.08.27
  • 발행 : 2022.03.31
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초록

Objective: This study aimed to describe a distinct subpopulation of azoospermic patients with isolated elevation of follicle-stimulating hormone (iFSH) and poor outcomes of microdissection testicular sperm extraction (microTESE). Methods: A retrospective analysis of microTESE outcomes was conducted among 565 patients with non-obstructive azoospermia (NOA). Testicular pathology was assessed by the dominant histological pattern and Bergmann-Kliesch score (BKS). Descriptive statistics were presented for the iFSH subgroup. Inhibin B levels, the sperm retrieval rate (SRR), and BKS were compared in iFSH patients and other NOA patients. Results: The overall SRR was 33.3% per microTESE attempt. The median BKS was 0.6 (interquartile range, 0-2). Of all NOA patients, 132 had iFSH, and microTESE was successful only in 11 of those cases, with an SRR of 8.3%, while the total SRR in other NOA patients was 38.1% (p<0.001). iFSH had a sensitivity of 32.1% (95% confidence interval [CI], 27.4%-36.8%) and specificity of 94.1% (95% CI, 90.8-97.5%) as a predictor of negative microTESE outcomes. Conclusion: Patients with iFSH may harbor a distinct testicular phenotype with total loss of the germ cell population and poor outcomes of surgical sperm retrieval.

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참고문헌

  1. Schlegel PN, Li PS. Microdissection TESE: sperm retrieval in non-obstructive azoospermia. Hum Reprod Update 1998;4:439. https://doi.org/10.1093/humupd/4.4.439
  2. Berookhim BM, Palermo GD, Zaninovic N, Rosenwaks Z, Schlegel PN. Microdissection testicular sperm extraction in men with Sertoli cell-only testicular histology. Fertil Steril 2014;102:1282-6. https://doi.org/10.1016/j.fertnstert.2014.08.007
  3. Li H, Chen LP, Yang J, Li MC, Chen RB, Lan RZ, et al. Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian J Androl 2018;20:30-6. https://doi.org/10.4103/aja.aja_5_17
  4. Ramasamy R, Lin K, Gosden LV, Rosenwaks Z, Palermo GD, Schlegel PN. High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction. Fertil Steril 2009;92:590-3. https://doi.org/10.1016/j.fertnstert.2008.07.1703
  5. Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male [corrected]. Clinics (Sao Paulo) 2011;66:691-700. https://doi.org/10.1590/s1807-59322011000400026
  6. Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod 2009;24:2683-7. https://doi.org/10.1093/humrep/dep343
  7. Cooper TG, Aitken J, Auger J, Baker HW, Barratt CL, Behre HM, et al. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: WHO Press; 2010.
  8. Bergmann MN, Kliesch S. Hodenbiopsie. In: Krause W, Weidner W, editors. Andrologie. Stuttgart: Enke Verlag; 1998. p. 66-71.
  9. Meduri G, Bachelot A, Cocca MP, Vasseur C, Rodien P, Kuttenn F, et al. Molecular pathology of the FSH receptor: new insights into FSH physiology. Mol Cell Endocrinol 2008;282:130-42. https://doi.org/10.1016/j.mce.2007.11.027
  10. Simoni M, Gromoll J, Nieschlag E. The follicle-stimulating hormone receptor: biochemistry, molecular biology, physiology, and pathophysiology. Endocr Rev 1997;18:739-73. https://doi.org/10.1210/er.18.6.739
  11. Themmen AP, Huhtaniemi IT. Mutations of gonadotropins and gonadotropin receptors: elucidating the physiology and pathophysiology of pituitary-gonadal function. Endocr Rev 2000;21:551-83. https://doi.org/10.1210/er.21.5.551
  12. Yang Q, Huang YP, Wang HX, Hu K, Wang YX, Huang YR, et al. Follicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia: a systematic review and meta-analysis. Asian J Androl 2015;17:281-4. https://doi.org/10.4103/1008-682X.139259
  13. Zeadna A, Khateeb N, Rokach L, Lior Y, Har-Vardi I, Harlev A, et al. Prediction of sperm extraction in non-obstructive azoospermia patients: a machine-learning perspective. Hum Reprod 2020;35:1505-14. https://doi.org/10.1093/humrep/deaa109
  14. Kelsey TW, McConville L, Edgar AB, Ungurianu AI, Mitchell RT, Anderson RA, et al. Follicle stimulating hormone is an accurate predictor of azoospermia in childhood cancer survivors. PLoS One 2017;12:e0181377. https://doi.org/10.1371/journal.pone.0181377
  15. Amer MK, Ahmed AR, Abdel Hamid AA, GamalEl Din SF. Can spermatozoa be retrieved in non-obstructive azoospermic patients with high FSH level? A retrospective cohort study. Andrologia 2019;51:e13176. https://doi.org/10.1111/and.13176
  16. Marques P, Skorupskaite K, George JT, Anderson RA. Physiology of GnRH and gonadotropin secretion [Internet]. Endotext, MDText.com; 2018 [cited 2021 Apr 29]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279070/.
  17. Namwanje M, Brown CW. Activins and inhibins: roles in development, physiology, and disease. Cold Spring Harb Perspect Biol 2016;8:a021881. https://doi.org/10.1101/cshperspect.a021881
  18. Yu Y, Xi Q, Wang R, Zhang H, Li L, Zhu H, et al. Intraoperative assessment of tubules in predicting microdissection testicular sperm extraction outcome in men with Sertoli cell-only syndrome. J Int Med Res 2019;47:722-9. https://doi.org/10.1177/0300060518809257
  19. Gnessi L, Scarselli F, Minasi MG, Mariani S, Lubrano C, Basciani S, et al. Testicular histopathology, semen analysis and FSH, predictive value of sperm retrieval: supportive counseling in case of reoperation after testicular sperm extraction (TESE). BMC Urol 2018;18:63. https://doi.org/10.1186/s12894-018-0379-7
  20. Liu YP, Qi L, Zhang NN, Shi H, Su YC. Follicle-stimulating hormone may predict sperm retrieval rate and guide surgical approach in patients with non-obstructive azoospermia. Reprod Biol 2020;20:573-9. https://doi.org/10.1016/j.repbio.2020.10.006
  21. Zhu ZG, Zhao ZG, Pang QY, Chen T, Zhang JM, Zhang TJ, et al. Predictive significance of serum inhibin B on testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men. Asian J Androl 2019;21:137-42. https://doi.org/10.4103/aja.aja_94_18
  22. Zhang H, Xi Q, Zhang X, Zhang H, Jiang Y, Liu R, et al. Prediction of microdissection testicular sperm extraction outcome in men with idiopathic nonobstruction azoospermia. Medicine (Baltimore) 2020;99:e19934. https://doi.org/10.1097/MD.0000000000019934
  23. Chen SC, Hsieh JT, Yu HJ, Chang HC. Appropriate cut-off value for follicle-stimulating hormone in azoospermia to predict spermatogenesis. Reprod Biol Endocrinol 2010;8:108. https://doi.org/10.1186/1477-7827-8-108
  24. Das A, Halpern JA, Darves-Bornoz AL, Patel M, Wren J, Keeter MK, et al. Sperm retrieval success and testicular histopathology in idiopathic nonobstructive azoospermia. Asian J Androl 2020;22:555-9. https://doi.org/10.4103/aja.aja_137_19
  25. Kiserud CE, Fossa A, Bjoro T, Holte H, Cvancarova M, Fossa SD. Gonadal function in male patients after treatment for malignant lymphomas, with emphasis on chemotherapy. Br J Cancer 2009;100:455-63. https://doi.org/10.1038/sj.bjc.6604892
  26. Veldhuis JD, Iranmanesh A, Demers LM, Mulligan T. Joint basal and pulsatile hypersecretory mechanisms drive the monotropic follicle-stimulating hormone (FSH) elevation in healthy older men: concurrent preservation of the orderliness of the FSH release process: a general clinical research center study. J Clin Endocrinol Metab 1999;84:3506-14. https://doi.org/10.1210/jc.84.10.3506