Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Endocrine. 2024 Apr;84(1):265-272. doi: 10.1007/s12020-023-03617-y. Epub 2023 Nov 29.
To establish a medically valuable normal reference interval of follicle-stimulating hormone (FSH) levels in males with normal semen and to assess the predictive value of FSH in males exhibiting semen abnormalities.
The study involved male patients who underwent their initial serum sex hormone test and semen test between October 2013 and June 2023. The reference interval was identified as the 95% confidence interval (CI) of FSH values in the patients with normal semen parameters. Then, in the total study population, receiver operating characteristic (ROC) curves were performed to evaluate the discriminatory ability of FSH for oligozoospermia and non-obstructive azoospermia (NOA). Besides, multivariable logistic regression was performed to investigate the association of FSH with oligozoospermia and NOA adjusted by age.
A total of 11,929 patients were finally enrolled in the study. The normal reference interval of FSH ranged from 1.70 IU/L to 7.60 IU/L (median: 3.98 IU/L) based on 4595 patients with normal semen routine parameters. In the total patients, ROC curves showed FSH to have a "fair" discriminatory ability for oligozoospermia (area under receiver operating characteristic curve (AUC) 0.747, threshold 7.32 IU/L, accuracy 0.734, positive predictive value (PPV) 0.754, negative predictive value (NPV) 0.726), while ROC curves showed FSH to have a "excellent" discriminatory ability for NOA (AUC: 0.921, threshold 10.18 IU/L, accuracy 0.903, PPV 0.593, NPV 0.972). Besides, multivariable logistic regression showed that FSH ≥ 7.32 IU/L was associated with a 8.51-fold increase in the risk of oligozoospermia adjusted by age, while FSH ≥ 10.18 IU/L was associated with a 38.93-fold increase in the risk of NOA.
Our findings indicated that the reference interval for FSH in males with normal semen was 1.70-7.60 IU/L and found that FSH was capable of effectively discerning oligospermia and NOA.
建立正常精液男性促卵泡激素（FSH）水平的有医学价值的正常参考区间，并评估 FSH 在出现精液异常的男性中的预测价值。
本研究纳入了 2013 年 10 月至 2023 年 6 月间首次进行血清性激素检测和精液检测的男性患者。参考区间定义为精液参数正常患者的 FSH 值 95%置信区间（CI）。然后，在总研究人群中，进行受试者工作特征（ROC）曲线分析，以评估 FSH 对少精子症和非阻塞性无精子症（NOA）的鉴别能力。此外，进行多变量逻辑回归分析，以调查 FSH 与年龄调整后的少精子症和 NOA 的关联。
最终共有 11929 名患者纳入研究。根据 4595 名精液常规参数正常的患者，FSH 的正常参考区间范围为 1.70IU/L 至 7.60IU/L（中位数：3.98IU/L）。在总患者中，ROC 曲线显示 FSH 对少精子症具有“中等”的鉴别能力（ROC 曲线下面积（AUC）为 0.747，阈值为 7.32IU/L，准确性为 0.734，阳性预测值（PPV）为 0.754，阴性预测值（NPV）为 0.726），而 ROC 曲线显示 FSH 对 NOA 具有“优秀”的鉴别能力（AUC：0.921，阈值 10.18IU/L，准确性 0.903，PPV 为 0.593，NPV 为 0.972）。此外，多变量逻辑回归显示，FSH≥7.32IU/L 与年龄调整后的少精子症风险增加 8.51 倍相关，而 FSH≥10.18IU/L 与 NOA 风险增加 38.93 倍相关。
我们的研究结果表明，正常精液男性的 FSH 参考区间为 1.70-7.60IU/L，并且发现 FSH 能够有效区分少精子症和 NOA。
