Aim:

To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration (MESA) procedure in patients with suspected primary obstructive azoospermia (OA) and if inhibin-B can replace testicular biopsy in the diagnostic work-up of these patients.

Methods:

Inhibin-B levels and testicular biopsy scores were related to the outcome of MESA in 43 patients with suspected primary OA. MESA was considered to be successful when epididymal sperm could be identified during the procedure.

Results:

Spermatozoa were present in the epididymal aspirate in 28 out of the 43 patients (65%). Inhibin-B values were not significantly different in patients with successful or unsuccessful MESA. The modified Johnsen score, however, was significantly lower in patients with unsuccessful MESA (P = 0.003). Arete testis obstruction or epididymal malfunctioning was found in 15% of patients with suspected primary OA, reflected by unsuccessful MESA despite normal inhibin-B levels and normal testicular histology.

Conclusion:

Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.

References

1. Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989; 142: 62–5. | PubMed | ChemPort |
2. Pierik FH, Vreeburg JT, Stijnen T, De Jong FH, Weber RF. Serum inhibin B as a marker of spermatogenesis. J Clin Endocrinol Metab 1998; 83: 3110–4. | Article | PubMed | ChemPort |
3. Tournaye H. Surgical sperm recovery for intracytoplasmic sperm injection: which method is to be preferred?. Hum Reprod 1999; 14 (Suppl 1): 71–81. | Article | PubMed |
4. Bettella A, Ferlin A, Menegazzo M, Ferigo M, Tavolini IM, Bassi PF, et al. Testicular fine needle aspiration as a diagnostic tool in non-obstructive azoospermia. Asian J Androl 2005; 7: 289–94. | Article | PubMed | ChemPort |
5. Schroeder-Printzen I, Zumbe J, Bispink L, Palm S, Schneider U, Engelmann U, et al. Microsurgical epididymal sperm aspiration: aspirate analysis and straws available after cryopreservation in patients with non-reconstructable obstructive azoospermia. MESA/TESE Group Giessen. Hum Reprod 2000; 15: 2531–5. | ChemPort |
6. Schlegel PN. Causes of azoospermia and their management. Reprod Fertil Dev 2004; 16: 561–72. | Article | PubMed | ISI | ChemPort |
7. Berardinucci D, Zini A, Jarvi K. Outcome of microsurgical reconstruction in men with suspected epididymal obstruction. JUrol 1998; 159: 831–4. | ChemPort |
8. Bohring C, Krause W. Serum levels of inhibin B in men with different causes of spermatogenic failure. Andrologia 1999; 31: 137–41. | Article | PubMed | ChemPort |
9. Jensen TK, Andersson AM, Hjollund NH, Scheike T, Kolstad H, Giwercman A, et al. Inhibin B as a serum marker of spermatogenesis: correlation to differences in sperm concentration and follicle-stimulating hormone levels. A study of 349 Danish men. J Clin Endocrinol Metab 1997; 82: 4059–63. | Article | PubMed | ChemPort |
10. Klingmuller D, Haidl G. Inhibin B in men with normal and disturbed spermatogenesis. Hum Reprod 1997; 12: 2376–8. | Article | PubMed | ChemPort |
11. von Eckardstein S, Simoni M, Bergmann M, Weinbauer GF, Gassner P, Schepers AG, et al. Serum inhibin B in combination with serum follicle-stimulating hormone (FSH) is a more sensitive marker than serum FSH alone for impaired spermatogenesis in men, but cannot predict the presence of sperm in testicular tissue samples. J Clin Endocrinol Metab 1999; 84: 2496–501. | Article | PubMed | ChemPort |
12. Andersson AM, Petersen JH, Jorgensen N, Jensen TK, Skakkebaek NE. Serum inhibin B and follicle-stimulating hormone levels as tools in the evaluation of infertile men: significance of adequate reference values from proven fertile men. J Clin Endocrinol Metab 2004; 89: 2873–9. | Article | PubMed | ChemPort |
13. World Health Organization. WHO Laboratory Manual for the Examination of Human Semen and Sperm-cervical Mucus Interaction. 4th edition. Cambridge: Cambridge University Press, 1999.
14. Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol 1998; 159: 1951–3. | Article | PubMed | ISI | ChemPort |
15. Marmar JL. Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol 2000; 163: 483–6. | Article | PubMed | ISI | ChemPort |
16. Verjans HL, Cooke BA, de Jong FH, de Jong CM, van der Molen HJ. Evaluation of a radioimmunoassay for testosterone estimation. J Steroid Biochem 1973; 4: 665–76. | Article | PubMed | ChemPort |
17. Groome N, O'Brien M. Immunoassays for inhibin and its subunits. Further applications of the synthetic peptide approach. J Immunol Methods 1993; 165: 167–76. | Article | PubMed | ChemPort |
18. de Waal WJ, Vreeburg JT, Bekkering F, de Jong FH, de Muinck Keizer-Schrama SM, Drop SL, et al. High dose testosterone therapy for reduction of final height in constitutionally tall boys: does it influence testicular function in adulthood? Clin Endocrinol (Oxf) 1995; 43: 87–95. | Article | PubMed | ChemPort |
19. Johnsen SG. Testicular biopsy score count-a method for registration of spermatogenesis in human testes: normal values and results in 335 hypogonadal males. Hormones 1970; 1: 2–25. | Article | PubMed | ChemPort |
20. Aafjes JH, van der Vijver JC, Schenck PE. Value of a testicular biopsy rating for prognosis in oligozoospermia. Br Med J 1978; 1: 289–90. | PubMed | ChemPort |
21. Palermo GD, Schlegel PN, Hariprashad JJ, Ergun B, Mielnik A, Zaninovic N, et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod 1999; 14: 741–8. | Article | PubMed | ChemPort |
22. Jarow JP, Oates RD, Buch JP, Shaban SF, Sigman M. Effect of level of anastomosis and quality of intraepididymal sperm on the outcome of end-to-side epididymovasostomy. Urology 1997; 49: 590–5. | Article | PubMed | ChemPort |
23. Kolettis PN, Thomas AJ Jr. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol 1997; 158: 467–70. | Article | PubMed | ChemPort |
24. Schlegel PN, Goldstein M. Microsurgical vasoepididymostomy: refinements and results. J Urol 1993; 150: 1165–8. | PubMed | ChemPort |
25. Silber SJ. Results of microsurgical vasoepididymostomy: role of epididymis in sperm maturation. Hum Reprod 1989; 4: 298–303. | PubMed | ISI | ChemPort |
26. Anderson RA, Wallace EM, Groome NP, Bellis AJ, Wu FC. Physiological relationships between inhibin B, follicle stimulating hormone secretion and spermatogenesis in normal men and response to gonadotrophin suppression by exogenous testosterone. Hum Reprod 1997; 12: 746–51. | Article | PubMed | ChemPort |
27. Ramos L, Wetzels AM, Hendriks JC, Hulsbergenvan de Kaa CA, Sweep CG, Kremer JA, et al. Percutaneous epididymal sperm aspiration: a diagnostic tool for the prediction of complete spermatogenesis. Reprod Biomed Online 2004; 8: 657–63. | PubMed | ChemPort |
28. Andersson AM, Muller J, Skakkebaek NE. Different roles of prepubertal and postpubertal germ cells and Sertoli cells in the regulation of serum inhibin B levels. J Clin Endocrinol Metab 1998; 83: 4451–8. | Article | PubMed | ChemPort |
29. Foresta C, Bettella A, Petraglia F, Pistorello M, Luisi S, Rossato M. Inhibin B levels in azoospermic subjects with cytologically characterized testicular pathology. Clin Endocrinol (Oxf) 1999; 50: 695–701. | Article | PubMed | ChemPort |
30. Krause W, Bohring C. Why do we determine alpha-glucosidase activity in human semen during infertility work-up?. Andrologia 1999; 31: 289–94. | Article | PubMed | ChemPort |

MORE ARTICLES LIKE THIS

These links to content published by NPG are automatically generated.