Inhibin-B and FSH Are Good Indicators of Spermatogenesis but Not the Best  Indicators of Fertility

Katarzyna Jankowska; Natalia Suszczewicz; Michał Rabijewski; Piotr Dudek; Wojciech Zgliczyński; Radosław B Maksym

doi:10.3390/life12040511

Diagnostics Hormone Testing

Inhibin-B and FSH Are Good Indicators of Spermatogenesis but Not the Best Indicators of Fertility

Jankowska K, Suszczewicz N, Rabijewski M, Dudek P, Zgliczyński W, Maksym RB

Published March 30, 2022 Life (Basel, Switzerland), 12(4), 511

DOI 10.3390/life12040511 PMID 35455002 PMC PMC9030543

RRM Academy Synopsis

Sperm Count Outperforms Hormone Levels at Predicting Fertility

In a 3-year study of 100 men with infertility, sperm count predicted pregnancy better than inhibin B or FSH levels did. 81% of pregnancies happened without IVF or insemination. Sperm count was the stronger predictor, and pregnancies occurred even in men with very low inhibin B or very high FSH.

About 8 in 10 pregnancies in men with infertility happened without IVF or insemination. Source: Jankowska K et al., 2022, PMID 35455002.

Study at a glance, cohort study of 100 men with infertility: Sperm Count Outperforms Hormone Levels at Predicting Fertility. Source: Jankowska K et al., 2022, PMID 35455002.

Key Findings

Among 100 men with infertility, sperm count correlated strongly with inhibin B level (r = 0.74, p < 0.001) and inversely with FSH level (r = −0.46, p < 0.001).
Of 95 men followed for up to 3 years, partners of 59 achieved pregnancy: 48 spontaneously, 5 after IVF, and 6 after intrauterine insemination.
Thirteen men remained childless despite IVF or IUI, and 23 couples chose not to pursue assisted reproduction despite no spontaneous pregnancy.
Inhibin B predicted a low sperm count with an area under the ROC curve of 0.92, correctly identifying 83% of true positives and 88% of true negatives.
81% of the pregnancies in the study (48 of 59) occurred without IVF or IUI. Separately, pregnancies occurred even in men with very low inhibin B or very high FSH levels.

Interpretation

This cohort study followed 100 men with infertility for up to three years. Sperm count correlated strongly with inhibin B level and with testicular volume. Inhibin B correlated inversely with FSH and LH. Hormone levels predicted fatherhood less reliably than sperm count did. Pregnancies occurred even when inhibin B was very low and FSH was very high, and some men with normal hormone levels stayed childless. The findings support larger studies of sperm count as a predictor of male fertility potential.

RRM Context

This finding fits the idea behind restorative reproductive medicine: look for and treat the cause of infertility. Male factors cause about 20% of infertility cases on their own, and play a part in another 30 to 40%. A single hormone test cannot replace a full check of both partners.

Our editorial summary of this paper, not the article's abstract.

Abstract

Biochemical markers of spermatogenesis and fertility assessment are important in the practical management of infertile males and the determination of an individual’s prognosis. We performed an analysis on 100 males with a male infertility factor. The following study inclusion parameters were analyzed: seminogram, FSH, LH, testosterone, estradiol, prolactin, TSH, and inhibin B concentrations. The patients were subsequently treated by reproductive endocrinologists in accordance with AUA/ASRM and EAU guidelines. The reproductive status was evaluated over a period of 3 years. We found a strong correlation of sperm count with inhibin B (r = 0.74, p < 0.001) and FSH concentration levels (r = −0.46, p < 0.001). Among 95 patients at follow-up, pregnancies occurred for 59 of their partners (48 spontaneous, 5 after IVF−ET, and 6 after IUI). Thirty-six patients remained childless despite the therapy. Sperm count and inhibin B level were the best predictors of natural fertilization (ROC AUC: 0.86 and 0.84; cut-off: 2.7 mln/mL and 45 pg/mL). Although inhibin B and FSH can be used to evaluate spermatogenesis and fertility, the initial sperm concentration appeared to be the best predictor of success. Pregnancy was achieved in a surprisingly large proportion of patients with a very low concentration of inhibin B and a low initial sperm count. It is noteworthy that 81% of the pregnancies were achieved without medically assisted reproduction.

Topics

Diagnostics › Hormone Testing › Serum Panels · Male Fertility › Male Endocrine and Genetic Factors › Testicular Function · Fertility Awareness › Biomarkers › Urinary Hormone Monitoring

Katarzyna Jankowska, Natalia Suszczewicz, Michał Rabijewski, Piotr Dudek, Wojciech Zgliczyński, Radosław B Maksym

K Jankowska, N Suszczewicz, M Rabijewski, P Dudek, W Zgliczyński, R Maksym

PMID 35455002 35455002 DOI 10.3390/life12040511 10.3390/life12040511 Jankowska et al. 2022, Jankowska 2022