Distribution and Positive Predictive Value of Follicle Stimulating Hormone Among Nonazoospermic Men

No AccessJournal of UrologyAdult Urology11 Apr 2024Distribution and Positive Predictive Value of Follicle Stimulating Hormone (FSH) Levels Among Non-azoospermic Men Solomon Hayon, Sai Kaushik SR. Kumar, Daniel Greenberg, Xinlei Mi, Richard J. Fantus, Robert E. Brannigan, and Joshua A. Halpern Solomon HayonSolomon Hayon , Sai Kaushik SR. KumarSai Kaushik SR. Kumar , Daniel GreenbergDaniel Greenberg , Xinlei MiXinlei Mi , Richard J. FantusRichard J. Fantus , Robert E. BranniganRobert E. Brannigan , and Joshua A. HalpernJoshua A. Halpern Corresponding Author: Joshua A. Halpern, MD, MS, Department of Urology, Northwestern University Feinberg School of Medicine, 675 N. Clair St, Chicago, IL 60611 ( (email protected) ). View All Author Informationhttps://doi.org/10.1097/JU.0000000000003957AboutPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: To characterize the distribution of follicle stimulating hormone (FSH) in fertile and subfertile non-azoospermic men, and to determine the ability of various FSH thresholds to predict fertility status. Materials and Methods: We performed a retrospective cohort study of 1389 non-azoospermic men who presented for fertility evaluation. Men with at least 2 semen analyses (SA) and one FSH level were included. Men were dichotomized into fertile and subfertile groups based on total motile sperm count (TMSC). FSH was evaluated within a multivariable model, and positive predictive values (PPVs) for subfertility were used to assess the clinical utility of various FSH thresholds. Results: One thousand fifteen (80%) men were classified as fertile and 274 (20%) as subfertile. Age, presence of varicocele, and testosterone levels were not statistically different between the groups. Median FSH was 4.0 vs 6.0 (P < .001) among fertile vs subfertile men. Multiple FSH thresholds ranging from 2.9 to 9.3 performed similarly in predicting fertility status (PPV 0.49-0.59). Only FSH thresholds above the 95th percentile (12.1) had PPVs greater than 0.7. The highest PPV (0.84) was seen at an FSH of 20.8 (99th percentile). Conclusions: While there were significant differences in FSH levels among fertile and subfertile non-azoospermic men, multiple FSH cutoffs between 2.2 and 9.3 performed poorly for prediction of fertility status as determined by TMSC. It was not until the 95th percentile FSH value that a clinically useful level of predictability for subfertility was reached, indicating that FSH should not be used as a standalone test of fertility status. Nonetheless, FSH testing remains clinically useful and may be most informative in the setting of extreme values or discordant FSH and SA results. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsfollicle stimulating hormonemale infertilitytotal motile sperm countspermatogenesisMetrics Author Information Solomon Hayon More articles by this author Sai Kaushik SR. Kumar More articles by this author Daniel Greenberg More articles by this author Xinlei Mi More articles by this author Richard J. Fantus More articles by this author Robert E. Brannigan More articles by this author Joshua A. Halpern Corresponding Author: Joshua A. Halpern, MD, MS, Department of Urology, Northwestern University Feinberg School of Medicine, 675 N. Clair St, Chicago, IL 60611 ( (email protected) ). More articles by this author Expand All Advertisement PDF downloadLoading ...