{"id":1217,"date":"2026-01-24T08:35:20","date_gmt":"2026-01-24T08:35:20","guid":{"rendered":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/2026\/01\/24\/serum-inhibin-b-and-follicle-stimulating-hormone-as-predictors-of-the-presence-of-sperm-in-testicula\/"},"modified":"2026-01-24T08:35:20","modified_gmt":"2026-01-24T08:35:20","slug":"serum-inhibin-b-and-follicle-stimulating-hormone-as-predictors-of-the-presence-of-sperm-in-testicula","status":"publish","type":"post","link":"https:\/\/peaceful-mccarthy.213-158-90-25.plesk.page\/index.php\/2026\/01\/24\/serum-inhibin-b-and-follicle-stimulating-hormone-as-predictors-of-the-presence-of-sperm-in-testicula\/","title":{"rendered":"Serum inhibin-B and follicle stimulating hormone as predictors of the presence of sperm in testicular fine needle aspirate in men with azoospermia"},"content":{"rendered":"
Dimitrios G. Goulis, Paris Polychronou, Themistokis Mikos, Grigorios Grimbizis, Sriridon Gerou, Vassiliki Pavlidou, Athanasios Papanikolaou, Basil C. Tarlatzis, Ioannis N. Bontis, Ioannis Papadimas<\/div>\n
Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece<\/div>\n
\n

Abstract<\/h2>\n

Objective: Inhibin-B (Inh-B) is produced by Sertoli cells and controls Follicle Stimulating Hormone (FSH) secretion through a negative feedback mechanism. The primary aim of this study was to compare Ιnh-B with FSH as predictors of the recovery of sperm in testicular fine needle aspirate in men with azoospermia. Design: In 51 men with azoospermia basal values of Luteinizing Hormone (LH), FSH, prolactin and testosterone as well as Inh-B values before and 24 h and 48 h after the administration of 300 IU recombinant human FSH were determined. Testicular Fine Needle Aspiration (FNA) was also carried out. Thirty-one young healthy men were also enrolled in the study as controls. Results: There was significant difference between men with azoospermia and controls with regard to the basal Inh-B levels [median (interquartile range) 37.2 (36) vs. 103.0 (90) pg\/mL, respectively, p=0.003] but not to the stimulated Inh-B levels [40.5 (41) vs. 73.0 (44) pg\/mL, p=0.113 at 24 h and 34.3 (34) vs. 82.0 (50) pg\/mL, p=0.098 at 48 h)]. The Area Under Curve in Receiver Operating Characteristic curves were similar for Inh-B and FSH (0.610 vs. 0.716, respectively, p=0.151) as far as prediction of sperm retrieval is concerned. Conclusions: Basal serum Inh-B values are significantly lower in men with azoospermia compared to controls. However, Inh-B is not superior to FSH in predicting the presence of sperm in testicular fine needle aspirate.<\/p><\/div>\n

INTRODUCTION<\/strong><\/p>\n

Inhibin-B (Inh-B), a dimeric glycoprotein, member of the Transforming Growth factor-β (TGF-β) superfamily, is produced and secreted in males, almost exclusively, by Sertoli cells.1<\/sup> Inh-B main action seems to be inhibition of Follicle Stimulating Hormone (FSH) synthesis and secretion through a negative feedback mechanism.2<\/sup> On the other hand, FSH induces Inh-B secretion.3<\/sup> Inh-B is considered as a marker of spermatogenesis, as there is evidence that there is a significant positive correlation between basal serum Inh-B levels and sperm concentration.4<\/sup><\/p>\n

The introduction of Intra-Cytoplasmic Sperm Injection (ICSI) has made the recovery of even a single sperm during a testicular biopsy an event of utmost importance for azoospermic men. This recovery is usually attempted through a Testicular Sperm Extraction (TESE) procedure. Cytological analysis obtained by testicular Fine Needle Aspiration biopsy (FNA) has been proposed as a more practical alternative to TESE,5,6<\/sup> as it allows evaluation of the tubular status and permits identification of both germ (i.e. spermatogonia, primary and secondary spermatocytes, spermatids and spermatozoa) and Sertoli cells. Nevertheless, there are no reliable predictors of the recovery of sperm from testicular tissue in men with non-obstructive azoospermia; serum levels of FSH provide only a rough estimation of a successful outcome during a TESE procedure.7<\/sup><\/p>\n

In August 2007 we performed a Medline search with Medical Subject Headings (MeSH) terms “Inhibin-B” and “Biopsy”\/“Biopsy, Fine-Needle” as keywords; “humans” and “male” were used as limits. After manual searching of the results, we located 12 studies on Inh-B2,8-18<\/sup> that directly examined the role of this hormone as predictor of sperm retrieval during a testicular biopsy in men with azoospermia. Nevertheless, in none of these studies was there any correlation of results obtained with specific cause of azoospermia. Moreover, there were very few reports on FNA, as the majority of the studies had applied TESE.<\/p>\n

The primary aim of the present study was to compare Ιnh-B and FSH as predictors of the recovery of sperm in FNA performed in men with azoospermia (Sub-study “FNA”). A secondary aim was to investigate the clinical value of basal and stimulated serum Inh-B levels as a marker of Sertoli cell function (Sub-study “EFSERT”).<\/p>\n

SUBJECTS AND METHODS

Subjects<\/em><\/strong><\/p>\n

We prospectively studied 51 subfertile Caucasian men of Greek nationality [median age 32, interquartile range (IQR) 5 years] attending the outpatient clinic of the Unit of Reproductive Endocrinology. Inclusion criteria were: i) infertility defined as not achievement of a pregnancy after 12 months of unprotected intercourse and ii) two spermiograms showing azoospermia with a time interval of at least 70 days. Exclusion criteria were: i) fever and ii) use of hormonal preparations during the last three months. Thirty-one healthy Caucasian men of Greek origin from the general population [age 31, (8) years] were used as controls.

Methods<\/strong><\/em><\/p>\n

All men with azoospermia as well as controls underwent complete andrologic evaluation, including history, physical examination, hormonal profile [serum FSH, Luteinizing Hormone (LH), total testosterone (T), prolactin, Inh-B, Exogenous FSH Sertoli Reserve Test (EFSERT)] and spermiogram. All men with azoospermia underwent testicular FNA. Imaging (scrotum ultrasonography, colour Doppler, pelvic computed tomography) and genetic (karyotype, Yq microdeletions) studies were performed, as clinically indicated. The study was approved by the Bioethics Committee, Aristotle University of Thessaloniki, Greece.<\/p>\n

Blood samples were obtained at 09:00 and centrifuged for 20 min. The serum was separated and stored at -20o<\/sup>C until analysis was performed. The serum levels of FSH, LH, T and prolactin were measured by immunochemiluminescent method (Immulite 2000, DPC, USA). Serum levels of Inh-B were measured by an enzymatically amplified two-site two-step sandwich-type immunoassay (DSL-10-84100 ACTIVE Inhibin-B ELISA kit, Diagnostic Systems Laboratories Inc., Texas, USA). Inter-assay and intra-assay coefficients of variation were 6.2% and 3.5%, respectively. Assay sensitivity was 7 pg\/mL.<\/p>\n

All men with azoospermia as well as controls underwent EFSERT [estimation of serum Inh-B levels before, 24 h and 48 h after the administration of 300 IU recombinant human FSH, intramuscularly (Gonal-F®, Serono)]. The blood specimens for the EFSERT were collected at 09:00 from the median antebrachial vein for three consecutive days. On day one, two blood samples were collected with a time difference of 30 minutes to measure basal Inh-B levels. <\/p>\n

Sperm was obtained by masturbation after 3–5 days of abstinence. The samples were centrifuged at 600 g for 10 minutes and if no sperm was detected in the pellet, a diagnosis of azoospermia was confirmed. Sperm concentration, motility and morphology were evaluated according to the World Health Organization (WHO) criteria.19<\/sup><\/p>\n

FNA was performed under local anaesthesia using a 23-G butterfly needle attached to an empty 20-mL disposable syringe in each pole of each testis for a total of four specimens per patient. Each retrieved specimen was vacated into a thin-Prep vial and stained with May-Grunwald-Giemsa. FNA interpretation took place in two steps. Initially, in low magnification, a group of two cytologists and one pathologist, who were blinded to the clinical data, assessed the adequacy of the material. Then, in high magnification, the cells were recognized and the spermatogenesis status was classified according to the Meng system, based on the predominant type of cells: <\/p>\n