Abstract
Objective
To determine whether men with elevated follicle-stimulating hormone (FSH) and normal
semen analysis (SA) are more likely to experience a decline in semen parameters over
time compared to men with normal FSH.
Methods
Men presenting for fertility evaluation between 2002 and 2020 with normal initial
SA were dichotomized according to baseline FSH as normal (<7.6 IU/mL) vs elevated
(≥7.6 IU/mL). Primary outcomes included the development of abnormal sperm concentration
(<15 million/mL) and total motile sperm count <9 million. Secondary outcomes included
abnormal sperm motility (<40%), morphology (<4%), and total number of SA abnormalities.
Results
The final sample consisted of 858 men; 776 had normal FSH, and 82 had elevated FSH
at presentation. Compared to men with normal FSH, men with elevated FSH had lower
total motile sperm count (64.1 vs 107.3, P < .001) and higher testosterone levels (339 ng/dL vs 309 ng/dL, P = .03). At each follow-up timepoint, more men with elevated FSH had oligospermia
compared to men with normal FSH. Men with elevated FSH were more likely to experience
a decline in total motile sperm count below the intrauterine insemination threshold
of 9 million and more likely to develop SA abnormalities over time.
Conclusion
In men presenting for fertility evaluation with normal index SA, elevated FSH was
associated with subsequent decline in semen parameters over time. Men with elevated
FSH and normal SA, a condition we have termed compensated hypospermatogenesis, represent
an at-risk population for whom close follow-up is warranted.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Structure of follicle-stimulating hormone in complex with the entire ectodomain of its receptor.Proc Natl Acad Sci U S A. 2012; 109: 12491-12496
- Role of follicle-stimulating hormone in spermatogenesis.Front Endocrinol (Lausanne). 2018; 9: 763
- The role of testicular biopsy in the modern management of male infertility.J Urol. 2002; 167: 197-200
- Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I.Fertil Steril. 2021; 115: 54-61
- Inhibin B as a potential biomarker of testicular toxicity.Cancer Biomark. 2005; 1: 75-91
- Effects of nonsteroidal anti-inflammatory drug (NSAID) use upon male gonadal function: a national, population-based study.Andrologia. 2020; 52: e13542
- World Health Organization reference values for human semen characteristics.Hum Reprod Update. 2010; 16: 231-245
- Clarifying the relationship between total motile sperm counts and intrauterine insemination pregnancy rates.Fertil Steril. 2021; 115: 1454-1460
- Optimal timing for repeat semen analysis during male infertility evaluation.F S Rep. 2021; 2: 172-175
- Sperm morphology, motility, and concentration in fertile and infertile men.N Engl J Med. 2001; 345: 1388-1393
- Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study.J Clin Endocrinol Metab. 2010; 95: 1810-1818
Article info
Publication history
Published online: January 27, 2023
Accepted:
January 16,
2023
Received:
October 6,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: None.
We can attest that all authors have made a substantial contribution to the material submitted for publication.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
