سرم به عنوان يك نشانگر مطمين براي پيش بيني وجود اسپرم بيضه هاي مردان آزواسپرميك INHIBIN B بررسي

Survey of Serum Inhibin B as a Reliable Marker for Prediction of Testicular Spermatozoa in Testes of Aloospermic Patients

Introduction: Different conventional markers for prediction of the presence of spermatozoa in azoosic men have been investigated. Objective: A reliable marker for prediction of the presence of germinal epithelium in testes from azoospermic patients is of utmost importance in planning treatment in the ARTs era. The objective of this study has been the assessment of sensitivity and specificity of serum inhibin B levels as an indicator of the presence of testicular spermatozoa in azoospermic infertile men and the comparison of its sensitivity and specificity with the traditional serum FSH marker. Materials and Methods: This study was performed between 11 October 2002 and 9 October 2003 in the urology clinic of Razi University Hospital in Rasht. 45 infertile men including 33 azoospermic patients and 12 men with previous history of vasectomy were studied. After history taking and physical examination, hormonal evaluation including FSH, LH, inhibin B, and scrotal ultrasonography for the assessment of the size of testes, and then bilateral testicular biopsies were performed in azoospermic men. Statistical comparisons between groups were made with one-way ANOVA by SPSS 9 software. Results: The results of our study showed that patients with nonobstructive azoospermia have significantly higher levels of serum FSH (16.14±14.09 IU/m1 vs. 5.041 6.49 lU/ml) and significantly lower levels of inhibin B (80.2±23.9 pg/ml vs. 225.42±86.3 pg/ml). This difference was more significant for inhibin B (p<0.001 vs. P=0.01). Mean serum inhibin B levels were significantly higher in .patients with nonobstructive azoospermia (high serum FSH & small size testes) who had spermatozoa on TESE than in those in whom no spermatozoa were found (215.53 1 55.19 pg/ml vs. 79.54 ± 26.68 pg/ml), but mean serum FSH levels did not have similar predictive power (26.4 ± 13.9 lU/ml vs. 17.8 ± 8.2 IU/ml). The cut-off level of inhibin B separating both groups, as determined by ROC curves, was > 133.4 pg/ml (sensitivity = 100% & specificity = 94.4%). Conclusion: Serum inhibin B level seems to be more accurate than serum FSH level in prediction of the presence of testicular spermatozoa in patients with nonobstructive azoospermia.