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Inhibin B concentration is predictive for long‐term azoospermia in men treated for testicular cancer
Author(s) -
Isaksson S.,
Eberhard J.,
Ståhl O.,
CavallinStåhl E.,
CohnCedermark G.,
Arver S.,
Lundberg Giwercman Y.,
Giwercman A.
Publication year - 2014
Publication title -
andrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.947
H-Index - 43
eISSN - 2047-2927
pISSN - 2047-2919
DOI - 10.1111/j.2047-2927.2014.00182.x
Subject(s) - azoospermia , chemotherapy , obstructive azoospermia , sperm , urology , medicine , gynecology , andrology , infertility , biology , pregnancy , genetics
Summary Azoospermia is a serious potential side effect following treatment for testicular cancer ( TC ). Our purpose was to examine possible predictors of long‐term azoospermia in TC survivors. Ejaculates and blood samples were obtained from 217 patients at post‐orchidectomy but before further treatment (T 0 ) and/or at one or more of the time points 6, 12, 24, 36–60 months after treatment (T 6 , T 12 , T 24 , T 36–60 ). All patients delivered ejaculates at T 36–60 , of which 117 also had confirmed presence of spermatozoa in the ejaculate at T 0 , enabling longitudinal analyses. Types of therapy, cryptorchidism and Inhibin B before and after treatment were evaluated in relation to risk of azoospermia at T 36 . Inhibin B levels at T 6 , T 12 and T 24 were predictors of azoospermia at T 36 with cut‐off levels at 49.7, 55.9 and 97.8 ng/L respectively (sensitivity 100%, specificity 57–78%). The frequency of azoospermia in all patients at T 36–60 was 7.8% (95% CI 4.9–12%). As compared to surveillance patients, only those receiving >4 cycles of chemotherapy or ≥4 cycles of chemotherapy + radiotherapy ( RT ) had increased risk of long‐term azoospermia (63% vs. 4.4% in the surveillance group; p = 0.0018). In conclusion, all patients with sperm production at post‐orchidectomy but before further treatment and Inhibin B >56 ng/L 12 months after treatment had sperm production 3 years post‐treatment. Eight per cent of TC survivors had azoospermia 3–5 years post‐treatment, with highest risk in those receiving >4 cycles of chemotherapy or ≥4 cycles of chemotherapy in combination with RT.