Significance of serum FSH levels and testicular morphology in infertile males

Evaluation of FSH, LH and testosterone levels in different subgroups of infertile males

Gonadotropins (FSH, LH) and testosterone are the prime regulators of germ cell development. Abnormal spermatogenesis is often associated with altered serum gonadotropins and testosterone. FSH, LH and testosterone levels were estimated in 96 infertile men of whom 35 were azoospermic, 35 were oligozoospermic, 11 were with varicocele and 15 were with histopathological abnormalities like hypospermatogenesis, spermatid arrest and sertoli-cell only syndrome. Results showed statistically significant (p<0.05), increase in the mean FSH and LH levels in all the infertile males studied when compared with the fertile controls (n=35). However, there is no significant difference in the mean levels of testosterone between the infertile and fertile men.

Genome-wide expression of azoospermia testes demonstrates a specific profile and implicates ART3 in genetic susceptibility

Infertility affects about one in six couples attempting pregnancy, with the man responsible in approximately half of the cases. Because the pathophysiology underlying azoospermia is not elucidated, most male infertility is diagnosed as idiopathic. Genome-wide gene expression analyses with microarray on testis specimens from 47 non-obstructive azoospermia (NOA) and 11 obstructive azoospermia (OA) patients were performed, and 2,611 transcripts that preferentially included genes relevant to gametogenesis and reproduction according to Gene Ontology classification were found to be differentially expressed. Using a set of 945 of the 2,611 transcripts without missing data, NOA was further categorized into three classes using the non-negative matrix factorization method. Two of the three subclasses were different from the OA group in Johnsen's score, FSH level, and/or LH level, while there were no significant differences between the other subclass and the OA group. In addition, the 52 genes showing high statistical difference between NOA subclasses (p < 0.01 with Tukey's post hoc test) were subjected to allelic association analyses to identify genetic susceptibilities. After two rounds of screening, SNPs of the ADP-ribosyltransferase 3 gene (ART3) were associated with NOA with highest significance with ART3-SNP25 (rs6836703; p = 0.0025) in 442 NOA patients and 475 fertile men. Haplotypes with five SNPs were constructed, and the most common haplotype was found to be under-represented in patients (NOA 26.6% versus control 35.3%, p = 0.000073). Individuals having the most common haplotype showed an elevated level of testosterone, suggesting a protective effect of the haplotype on spermatogenesis. Thus, genome-wide gene expression analyses were used to identify genes involved in the pathogenesis of NOA, and ART3 was subsequently identified as a susceptibility gene for NOA. These findings clarify the molecular pathophysiology of NOA and suggest a novel therapeutic target in the treatment of NOA.

Fecundability according to male serum inhibin B—a prospective study among first pregnancy planners

BACKGROUND

New biological markers of male fecundity are needed for use in large-scale epidemiological studies. We studied the association between male inhibin B and fecundability.

METHODS

Four hundred and thirty Danish couples without previous reproductive experience were followed from termination of contraception until pregnancy or for a maximum of six menstrual cycles. At enrolment we obtained semen samples (n = 418) and blood samples to measure reproductive hormones, including inhibin B (n = 343).

RESULTS

The fecundability odds ratio for an increment of male inhibin B by 1 log pg/ml was 1.428 (95% confidence interval 1.022-1.994), adjusted for factors influencing the crude estimate. Only inhibin B values below 100 pg/ml were strongly related to fecundability. We designed a receiver operating characteristic curve based on the 29 males with serum inhibin B #100 pg/ml. The area under the curve (AUC) for inhibin B was 0.787 and the corresponding AUCs for sperm density and FSH were 0.913 and 0.800, respectively.

CONCLUSION

Serum inhibin B may be a reliable marker of male fecundity for epidemiological research and may have some advantages over sperm density. Our findings do not support the replacement of sperm density by male inhibin B when obtaining sperm data is an option.

Predictive factors for motile sperm recovery using testicular biopsy in nonobstructive azoospermic patients

OBJECTIVE

The objective of the present study was to assess the predictive value of hormone values, histological analysis for the finding of motile spermatozoa on testicular biopsy in nonobstructive azoospermia.

METHODS

This cross-sectional study assessed serum follicle-stimulating hormone (FSH), luteinizing hormone, prolactin and total testosterone values in 50 patients undergoing testicular biopsy prior to ICSI. P < 0.05 was considered significant.

RESULTS

Recovery was successful in 28 cases, and motile spermatozoa were retrieved in 7. Significant differences were detected between presence of motile spermatozoa and absence of spermatozoa in terms of FSH values (P = 0.003, one-way ANOVA). The other variables did not present statistical differences. A receiver operating characteristic curve showed that FSH levels below 17.00 IU/L were predictive of motile spermatozoa recovery.

CONCLUSIONS

FSH values can serve as a predictive factor for the recovery of motile spermatozoa using biopsy in azoospermic patients. On the other hand, histological analysis and other hormone values were not helpful in the prediction of motile sperm.

Possible predictive factors for ICSI? Molecular biology techniques in combination with therapeutic testicular biopsies

Applying intracytoplasmic sperm injection (ICSI), the selection of an unsuccessful spermatozoon results in great emotional consequences for the couple. Therefore, there is a need for a prognostic parameter to estimate their chances for successful fertility treatment. This review summarizes both the main reasons for spermatogenic impairment, and possible predictive factors for successful sperm retrieval applying testicular sperm extraction and outcome of ICSI. While basic sperm parameters, aetiology and type of spermatozoa, and serum follicle-stimulating hormone and inhibin levels have been shown to be unrelated to the outcome of ICSI, Y-chromosome microdeletions are known to have a negative influence on the fertilizing capacity of spermatozoa. Recently, a significant correlation has been reported between the protamine-1 to protamine-2 mRNA ratio in haploid spermatids of testicular biopsies and the ability of spermatozoa for successful fertilization of an oocyte. In future, both the outstanding role of the haploid spermatids and the involvement of molecular biological techniques will improve the role of therapeutic testicular biopsies.

Nonobstructive azoospermia

Nonobstructive azoospermia (NOA) remains a challenging condition in reproductive medicine to manage. The genetic basis of NOA related to partial deletions of the Y-chromosome has been intensely investigated. Such information is of prognostic value and allows more insightful genetic counseling of couples who opt for assisted reproductive technology. Testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection has allowed many men with NOA to father their own biologic children. Although studies in the current literature support open testicular biopsy as the most reliable method to obtain testicular sperm, less invasive techniques such as testicular fine-needle aspiration and percutaneous needle biopsy are feasible alternatives in selected groups of patients. Measures to improve the efficacy of TESE, including the application of microsurgical techniques, are addressed. Other recent developments related to the management of NOA reviewed include processing of testicular tissue, cryopreservation of retrieved spermatozoa, in-vitro maturation of germ cells and microinjection of immature spermatogenic precursor cells.