Operating characteristics of follicle stimulating hormone in azoospermic men

Capsule:
In a retrospective cohort study of azoospermic patients, the full operating characteristics of follicle stimulating hormone were determined to allow for proper education of patients and individualized treatment based on specific risk.

Authors:
Matthew S. Christman, M.D., Suzanne R. Gudeman, M.D., Justin J. Nork, D.O., Rustin C. Walters, M.D., James O. L’Esperance, M.D., Donald S. Crain, M.D.

Volume 101, Issue 5, Pages 1261–1265

Abstract:

Objective:
To validate factors predictive of nonobstructive azoospermia (NOA) and to determine the operating characteristics of FSH for predicting NOA.

Design:
Retrospective cohort study.

Setting:
Tertiary care military treatment facility.

Patient(s):
One hundred forty azoospermic males undergoing infertility evaluation.

Intervention(s):
Standard evaluation included history and physical, hormonal workup, and genetic evaluation. Diagnostic testicular biopsy was offered to characterize patients as obstructive azoospermia (OA) or NOA.

Main Outcome Measure(s):
Semen volume, semen fructose, FSH, T, E2, PRL, testicular atrophy.

Result(s):
Seventy-eight of 140 azoospermic patients underwent a biopsy. The ability to predict NOA based on logistic regression was statistically significant for FSH and testicular atrophy. On multivariate analysis, only FSH remained predictive of NOA. The area under the FSH receiver operating characteristic curve was 0.847, which is significant. The cut point of FSH with the highest likelihood ratio of predicting NOA on biopsy was ≥12.3 mIU/mL.

Conclusion(s):
FSH remains the best predictor of NOA. With full knowledge of the operating characteristics of FSH in this population, a patient can be properly educated and treatment can be individualized, based on the specific risk associated with that subject’s measured FSH.

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