title: Inhibin B concentration is predictive for long-term azoospermia in men treated for testicular cancer.
abstract: 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 (T0 ) and/or at one or more of the time points 6, 12, 24, 36-60 months after treatment (T6 , T12 , T24 , T36-60 ). All patients delivered ejaculates at T36-60 , of which 117 also had confirmed presence of spermatozoa in the ejaculate at T0 , enabling longitudinal analyses. Types of therapy, cryptorchidism and Inhibin B before and after treatment were evaluated in relation to risk of azoospermia at T36 . Inhibin B levels at T6 , T12 and T24 were predictors of azoospermia at T36 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 T36-60 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.
authors: Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden; Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors: S
authors: S
authors: Isaksson
authors: J
authors: J
authors: Eberhard
authors: O
authors: O
authors: Ståhl
authors: E
authors: E
authors: Cavallin-Ståhl
authors: G
authors: G
authors: Cohn-Cedermark
authors: S
authors: S
authors: Arver
authors: Y
authors: Y
authors: Lundberg Giwercman
authors: A
authors: A
authors: Giwercman
mesh_terms: D000293:Adolescent; D000328:Adult; D053713:Azoospermia / Q000097:blood* / Q000453:epidemiology*; D016190:Carboplatin / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003456:Cryptorchidism / Q000150:complications; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007265:Inhibins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000009:adverse effects; D013094:Spermatozoa; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: C422364:inhibin B; D007265:Inhibins; D014747:Vinblastine; D005047:Etoposide; D016190:Carboplatin; D002945:Cisplatin
keywords: Inhibin B; azoospermia; cancer treatment; testicular cancer