Increased serum inhibin B levels after varicocele treatment

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Abstract
OBJECTIVE Inhibin B is secreted by Sertoli cells in response to FSH and is the major feedback regulator of FSH secretion in man. The serum inhibin B level has emerged as a good marker of spermatogenesis and Sertoli cell function. Varicocele has been associated with infertility and disturbed spermatogenesis. We have studied the effect of varicocele treatment on serum inhibin B levels, with the aim of investigating the effect on spermatogenesis and the involvement of the Sertoli cell in varicocele pathophysiology. DESIGN AND PATIENTS In a pre–post test design, the effect of varicocele surgery on inhibin B levels was studied in 30 infertile men. MEASUREMENTS Endocrinology (inhibin B, FSH, LH, SHBG and testosterone) and semen analysis (sperm concentration, motility and morphology). RESULTS In men receiving varicocele treatment, a significant increase in serum inhibin B levels was observed from 133·9 ± 13·4 pretreatment to 167·8 ± 16·1 ng/l after treatment (mean ± SEM, P < 0·0001). No significant changes were observed in serum levels of FSH, LH and testosterone. The serum SHBG level decreased from 32·9 ± 3·5 to 28·6 ± 3·4 nmol/l (mean ± SEM, P = 0·04) and the free androgen index was significantly increased from 66 ± 5·9 pretreatment to 85 ± 6·8 after treatment (P = 0·02, mean ± SEM). Semen analysis showed a significant improvement in sperm concentration, from 6·5 ± 1·9 pretreatment to 19·3 ± 4·9 × 106/ml after treatment (P = 0·003, mean ± SEM), and in sperm motility from the baseline level of 17 ± 3 to 32 ± 4% after treatment (P = 0·001, mean ± SEM). CONCLUSIONS Varicocele treatment can increase serum inhibin B levels, indicating improvement of spermatogenesis and Sertoli cell function. This finding suggests that the pathophysiology of varicocele involves impairment of Sertoli cell function or a different distribution of germ cell stages.

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