Abstract

Preoperative Measures of Serum Inhibin B, and FSH Levels Predict Sperms Retrieval Outcome in Non-Obstructive Azoospermic Males

Background: Azoospermia has defined as totally absent sperms from ejaculate after two separate semen analyses that roughly could ensue in 10%- 15% of infertile males with the atypical seminal examination. The main two sub classification of infertility are ''Obstructive (OA) and Non-Obstructive (NOA). The sperm retrieval of testicles by ''Fine-Needle Aspiration (FNA) or Testicular Sperm Extraction (TESE)'' can give a promising result of reproduction. Currently, the use of diagnostic tests like a Follicular Stimulating Hormone (FSH) besides Inhibin-B for the valuation of spermio genesis by several trials has widely spread. This study aimed to investigate the association of serum Inhibin B and FSH with testicular biopsy and to reduce avoidable analytic testicular biopsies in males with NOA.

Methodology: The study was a case-control observational, included 100 infertile males and 100 control males, attending Teba Fertility Private Center, Babylon, Iraq. All participants underwent full history, physical examination, hormonal assays for Testosterone, FSH, LH, Prolactin, Inhibin-B, and seminal analysis. Those who justify the study standards were chosen and undergone two-sided Testicular Sperm Extraction (TESE). Statistical scrutiny carried out by SPSS/V-25. Categorical parameters had presented as frequency and percentage. Continuous parameters had present as (Means ± SD). Student test had applied to match means between any 2-groups. Mann-Whitney test had applied to match means between 2-groups in case variable was not normally distributed. Pearson’s correlation coefficient (r) had used to find the relationship between two continuous variables. The ‘’Research Operating Characteristics (ROC) curve’’ analyses had done to predict sensitivity and specificity of Inhibin B and FSH for positive TESE results. ‘’Pearson chi-square’’ had applied to show the link between categorical parameters. Any P ≤ 0.05 value was selected as significant.

Results: Significant difference were shown in the means of years of infertility, besides significant variations between the serum inhibin means between the two study groups (P<0.001). There were significant differences between means of inhibin B (pg/ml) according to (positive and negative) TESE results among the Azoospermia group (P=0.003). The differences Inhibin B, FSH, LH, prolactin, and testosterone according to TESE results revealed significant differences between medians of Inhibin Band FSH(0.003 and 0.007), respectively. The ROC curve for sensitivity and specificity of Inhibin Bto predict positive TESE and FSH to predict positive TESE results, which revealed P-value, optimal cut off value to predict positive TESE test, sensitivity, and specificity were [0.001, ≥ 22.65pg/ml, 74.1%, and 65.1%] and [0.007, ≥ 13.95, 74.4%, and 59.3%], sequentially. A significant negative (r= -0.482 and P-0.001) correlation between Inhibin B and FSH among the studied participants was observed.

Conclusion: Higher sperm retrieval from TESE was significantly correlated with higher levels of Inhibin B and lower FSH in the serum among the NOA patients. Preoperative Inhibin B and FSH can apply for prediction and counseling. Inhibin B>22.65 pg/ml predicts positive, and FSH ≥ 13.95 mIU/ ml predicts negative TESE with a sensitivity and specificity of (74.1%, 65.1) and (74.1%, 65.1), respectively. Hence, could be a real, non-invasive, accessible, and economic model for assessing NOA males to predict the outcome of sperm retrieval.

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