Browse > Article
http://dx.doi.org/10.5653/cerm.2021.04623

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)
Publication Information
Clinical and Experimental Reproductive Medicine / v.49, no.1, 2022 , pp. 62-69 More about this Journal
Abstract
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.
Keywords
Azoospermia; Follicle-stimulating hormone; Male infertility; Sperm retrieval;
Citations & Related Records
연도 인용수 순위
  • Reference
1 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.   DOI
2 Bergmann MN, Kliesch S. Hodenbiopsie. In: Krause W, Weidner W, editors. Andrologie. Stuttgart: Enke Verlag; 1998. p. 66-71.
3 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.   DOI
4 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.
5 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.   DOI
6 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.   DOI
7 Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male [corrected]. Clinics (Sao Paulo) 2011;66:691-700.   DOI
8 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.   DOI
9 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.   DOI
10 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.   DOI
11 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/.
12 Schlegel PN, Li PS. Microdissection TESE: sperm retrieval in non-obstructive azoospermia. Hum Reprod Update 1998;4:439.   DOI
13 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.   DOI
14 Simoni M, Gromoll J, Nieschlag E. The follicle-stimulating hormone receptor: biochemistry, molecular biology, physiology, and pathophysiology. Endocr Rev 1997;18:739-73.   DOI
15 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.   DOI
16 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.   DOI
17 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.   DOI
18 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.   DOI
19 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.   DOI
20 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.   DOI
21 Namwanje M, Brown CW. Activins and inhibins: roles in development, physiology, and disease. Cold Spring Harb Perspect Biol 2016;8:a021881.   DOI
22 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.   DOI
23 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.   DOI
24 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.   DOI
25 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.   DOI
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.   DOI