leptin and Azoospermia

Non-obstructive azoospermia (NOA) is one of the leading causes of male factor infertility, which results from impaired spermatogenesis. Currently, the sole feasible therapeutic option for men with NOA to father their biologic children is sperm retrieval by testicular sperm extraction (TESE) approaches followed by an intracytoplasmic sperm injection program. Nevertheless, the rate of sperm retrieval from NOA men following TESE has remained as low as 50%, leading to a significant number of unsuccessful TESE operations. Given that TESE is associated with multiple side effects, the prediction of TESE outcome preoperatively can abolish unnecessary operations and thereby prevent NOA patients from sustaining adverse side effects. As the process of spermatogenesis is under the regulation of hormones, the hormonal profile of serum and/or seminal plasma may contain useful information about spermatogenesis status and can potentially predict the chance of sperm retrieval from NOA patients. A large body of literature is available on the predictive capability of different serum and seminal plasma hormones such as FSH, LH, testosterone, inhibin B, AMH, estradiol, prolactin, and leptin in a stand-alone basis or combinational fashion with respect to the TESE outcome. The present review aimed to evaluate the potential of these hormonal markers as noninvasive predictors of sperm retrieval in men with NOA.

Topics: Azoospermia; Estradiol; Follicle Stimulating Hormone, Human; Hormones; Humans; Inhibins; Leptin; Luteinizing Hormone; Male; Prolactin; Semen; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Spermatogenesis; Testosterone

At present, non-invasive methods are not comprehensive enough to enable urologists to predict sperm retrieval results accurately in patients with non-obstructive azoospermia (NOA). Our aim was to improve the prediction accuracy of sperm retrieval by using leptin and artificial neural networks (ANNs).. Data from May 2004 to July 2010 for 280 patients with NOA were reviewed and assigned into the training and testing set for ANNs. All patients underwent standard diagnostic infertility evaluation and testicular sperm extraction (TESE). Twelve factors were recorded as the input variables for ANNs: (1)testicular volume, (2)semen volume, seminal pH, seminal alpha-glucosidase and fructose, (3)serum hormones including FSH, LH, total testosterone (TT), prolactin, estradiol, (4)serum and seminal leptin. Three ANN models were constructed with the following input variables: ANN1-(1)(2)(3)(4), ANN2-(1)(2)(3) and ANN3-(1)(2)(4). The prediction accuracy for FSH, leptin and ANN models was compared by receiver operating characteristic (ROC) curve analysis.. All ANN models were better than FSH. ANN1 had the largest area under the curve (AUC = 0.83) and demonstrated significant improvement compared with FSH (AUC = 0.63, P < 0.01) and leptin (AUC = 0.59, P< 0.01).. ANNs improve the prediction accuracy of sperm retrieval. Although the leptin AUC is low, combined use of leptin and FSH can significantly improve the prediction accuracy for sperm recovery in NOA patients. Leptin may be a good assistant marker for diagnosing NOA. However, studies with larger numbers of patients are required to confirm the improved predictive performance of ANNs.

Topics: Azoospermia; Biomarkers; Follicle Stimulating Hormone; Humans; Leptin; Male; Neural Networks, Computer; ROC Curve; Semen Analysis; Sperm Retrieval

To detect the levels of seminal plasma leptin (SPL) and serum leptin (SL) in patients with azoospermia, and to explore the methods of using SPL and SL alone or the combination of SPL, SL and follicle stimulating hormone (FSH) for the differential diagnosis of obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).. We enrolled in this study 45 patients with diagnosed OA, 41 with unexplained NOA and 30 men with normal semen parameters as controls. The azoospermia patients underwent percutaneous aspiration from the epididymis (PESA) or aspiration/extraction from the testis (TESA/TESE), and all the subjects were detected for the levels of serum FSH, SPL and SL. Individual and multiple indexes were evaluated by Fisher's discriminant analysis combined with ROC curve analysis.. There were no significant differences in the body mass index (BMI) among the three groups. Compared with the normal control, the OA patients showed an obviously elevated level of SPL (P = 0.048), and the NOA patients remarkably increased levels of FSH (P = 0.000), SL (P = 0.000) and SPL (P = 0.000). In comparison with the OA group, the levels of FSH (P = 0.000), SL (P = 0.006) and SPL (P = 0.033) were significantly increased in the NOA group. For the differential diagnosis of OA and NOA, the areas under the ROC curve of SPL and SL were 0.658 (P = 0.014) and 0.702 (P = 0.002) , respectively, both significantly greater than 0.5, while that of the combination of SPL, SL and FSH was the greatest (0.953). In addition, with 0.026 x SPL +0.05 x SL +0.106 x FSH -2.197 as the combined indicator value and -0.289 as the cut-off value (> or = cut-off value for NOA), the sensitivity and specificity of the combination were 0.878 and 0.902, respectively, both reached the maximum.. Both the levels of SPL and SL are valuable for the differential diagnosis of OA and NOA, but the joint consideration of SPL, SL and FSH may provide better indicators.

Topics: Adult; Azoospermia; Case-Control Studies; Diagnosis, Differential; Humans; Leptin; Male