Abstract
For successful sperm retrieval in azoospermic men, a reliable prediction of success rate is necessary. The aim of this study is to assess the gene expression of SPEM1 in testicular tissue and serum inhibin B levels in patients with primary azoospermia and to evaluate their predictive power for sperm retrieval.
Material and Methods: 60 non-obstructive azoospermic patients and 20 obstructive azoospermic patients undergoing testicular tissue microdissection for intracytoplasmic sperm injection were studied. SPEM1 gene expression was analyzed by real-time reverse transcription-polymerase chain reaction using the DDCt method. Chemiluminescence technique was used to measure the levels of serum inhibin B.
Results: The relative expression of SPEM1 and serum inhibin B levels were significantly lower in patients compared to controls. The relative expression of SPEM1 and serum inhibin B levels was significantly higher in patients with positive sperm retrieval than patients with negative sperm retrieval. A positive correlation was found between SPEM1 relative expression and serum Inhibin B levels in the studied group.
Conclusion: Results suggest that SPEM1 and serum inhibin B can both be utilized in predicting the success of sperm retrieval. SPEM1 could be considered a stronger predictor of sperm retrieval than serum inhibin B.
Keywords: Azoospermi, Inhibin B, Microdissection testicular sperm extraction, SPEM, Sperm retrieval.
References
- Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 2012;9:1-12. doi.org/10.1371/journal.pmed.1001356.
- Gurunath S, Pandian Z, Anderson RA, Bhattacharya S. Defining infertility-a systematic review of prevalence studies. Hum Reprod Update 2011;17:575-88. doi.org/10.1093/humupd/dmr015.
- Cocuzza M, Alvarenga C, Pagani R. The epidemiology and etiology of azoospermia. Clinics (Sao Paulo) 2013;68:15-26. doi: 10.6061/clinics/2013(sup01)03.
- Wosnitzer M, Goldstein M, Hardy MP. Review of Azoospermia. Spermatogenesis 2014;4:e28218. doi.10.4161/spmg.28218.
- Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 2007;13:539-49. doi.org/10.1093/humupd/dmm029.
- Tournaye H, Liu J, Nagy PZ, Camus M, Goossens A, Silber S, et al. Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1996;11:127-32. doi.org/10.1093/oxfordjournals.humrep.a019004.
- Jezek D, Knuth UA, Schulze W. Successful testicular sperm extraction (TESE) in spite of high serum follicle stimulating hormone and azoospermia: correlation between testicular morphology, TESE results, semen analysis and serum hormone values in 103 infertile men. Hum Reprod 1998;13:1230-4. doi.org/10.1093/humrep/13.5.1230.
- von Eckardstein S, Simoni M, Bergmann M, Weinbauer GF, Gassner P, Schepers AG, et al. Serum inhibin B in combination with serum follicle-stimulating hormone (FSH) is a more sensitive marker than serum FSH alone for impaired spermatogenesis in men, but cannot predict the presence of sperm in testicular tissue samples. J Clin Endocrinol Metab 1999;84:2496-501. doi: 10.1210/jcem.84.7.5855.
- Ballesca JL. Serum inhibin B determination is predictive of successful testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 2002;15:1734-8. doi.org/10.1093/humrep/15.8.1734.
- Kleiman SE, Yogev L, Hauser R, Botchan A, Maymon BB, Paz G, et al. Expression profile of AZF genes in testicular biopsies of azoospermic men. Hum Reprod 2007; 22:151-8. doi.org/10.1093/humrep/del341.
- Lardone MC, Parodi DA, Valdevenito R, Ebensperger M, Piottante A, Madariaga M, et al. Quantification of DDX3Y , RBMY1 , DAZ and TSPY mRNAs in testes of patients with severe impairment of spermatogenesis. Mol Hum Reprod 2007;13:705-12. doi.org/10.1093/molehr/gam057.
- Hashemi MS, Mozdarani H, Ghaedi K, Nasr-Esfahani MH. Among seven testis-specific molecular markers, SPEM1 appears to have a significant clinical value for prediction of sperm retrieval in azoospermic men. Andrology 2018;6:890-5. doi.org/10.1111/andr.12528.
- Zheng H, Stratton CJ, Morozumi K, Jin J, Yanagimachi R, Yan W. Lack of Spem1 causes aberrant cytoplasm removal, sperm deformation, and male infertility. Proc Natl Acad Sci 2007;104:6852-7. doi.org/10.1073/pnas.0701669104.
- World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010.
- Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999;14:131-5. doi: 10.1093/humrep/14.1.131.
- Bernie AM, Mata DA, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructiveazoospermia: a systematic review and meta-analysis. FertilSteril 2015;104: 1099-103.e1-3. doi: 10.1016/j.fertnstert.2015.07.1136.
- Ezeh UI, Martin M, Cooke ID, Moore HD. Correlation of testicular pathology and sperm extraction in azoospermic men with ejaculated spermatids detected by immunofluorescent localization. Hum Reprod 1998;13:3061-5. doi: 10.1093/humrep/13.11.3061.
- Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2-ΔΔCT method. Methods 2001;25:402-8. doi.org/10.1006/meth.2001.1262.
- Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999;14:131-5. doi: 10.1093/humrep/14.1.131.
- Abdel Raheem A, Garaffa G, Rushwan N, De Luca F, Zacharakis E, Abdel Raheem T, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non‐obstructive azoospermia. BJU Int 2013;111:492-9. doi: 10.1111/j.1464-410X.2012.11203.x.
- Bernie AM, Ramasamy R, Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic ClinAndrol 2013;23:1-7. doi.org/10.1186/2051-4190-23-5.
- Seo JT, Ko WJ. Predictive factors of successful testicular sperm recovery in non-obstructive azoospermia patients. Int J Androl 2001;310:306-10. doi: 10.1046/j.1365-2605.2001.00307.x.
- Tsujimura A, Matsumiya K, Miyagawa Y, Tohda A, Miura H, Nishimura K, et al. Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod 2002;17:2924-9. doi: 10.1093/humrep/17.11.2924.
- Nagata Y, Fujita K, Banzai J, Kojima Y, Kasima K, Suzuki M, et al. Seminal plasma inhibin-B level is a useful predictor of the success of conventional testicular sperm extraction in patients with non-obstructive. J ObstetGynaecol Res 2005;31:384-8. doi: 10.1111/j.1447-0756.2005.00306.x.
- Anawalt BD, Bebb RA, Matsumoto AM, Groome NP, Illingworth PJ, McNeilly AS, et al. Serum inhibin B levels reflect Sertoli cell function in normal men and men with testicular dysfunction. J ClinEndocrinolMetab 1996;81:3341-5. doi: 10.1210/jcem.81.9.8784094.
- De Kretser DM, McLachlan RI, Robertson DM, Burger HG. Serum inhibin levels in normal men and men with testicular disorders. J Endocrinol 1989;120:517-23. doi.org/10.1677/joe.0.1200517.
- Alhalabi M. Predictive value of serum Inhibin-B levels as an indicator of the presence of testicular spermatozoa in non-obstructive azoospermia. Middle East FertilSoc J 2016;21:246-52. doi.org/10.1016/j.mefs.2016.05.001.
- Ziaee SA, Ezzatnegad M, Nowroozi M, Jamshidian H, Abdi H, HosseiniMoghaddam SM. Prediction of successful sperm retrieval in patients with nonobstructiveazoospermia. Urol J 2006;3:92-6. doi.org/10.22037/uj.v3i2.202.
- Bonarriba CR, Burgués JP, Vidaña V, Ruiz X, Pizá P. Factorespredictivos de recuperaciónespermática en lasazoospermias. ActasUrolEsp 2013;37:266-72. doi.org/10.1016/j.acuro.2012.06.002.
- Wang J, Lu N, Zhang S, Tang Z, Huang Y, Li W, et al. Reference range and cutoff value of serum inhibin B to predict successful sperm retrieval: A cross-sectional study of 30 613 Chinese men. ClinEndocrinol (Oxf) 2020;92:232-40. doi.org/10.1111/cen.14138.
Corresponding Author
Walid Marei Ahmed
Resident, Department of Dermatology, Venereology and Andrology, Alexandria University, 21561 Alexandria, Egypt
ORCID ID: 0000-0003-2200-8719