Male patients with terminal renal failure exhibit low serum levels of antimüllerian hormone

Abstract

Male reproductive function is impaired during end-stage renal disease (ESRD). Disturbance of the hypothalamic-pituitary-gonadal axis, and therefore the regulation of sex hormones, is one of the major causes. Our focus was to include antimüllerian hormone (AMH) and inhibin B concentrations. Twenty male patients on hemodialysis, median age 40 (26–48) years, were analyzed for follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, sex hormone-binding globulin (SHBG), testosterone, estradiol, AMH and inhibin B levels. We used 144 proven fertile men, median age 32 (19–44) years as a control group and analyzed differences using multiple linear regression. Males with ESRD demonstrated higher mean values for prolactin, 742 versus normal 210 mIE l−1 (95% confidence interval (CI): 60.3, 729), LH, 8.87 versus normal 4.5 IE l−1 (95% CI: 2.75, 6.14), and estradiol 89.7 versus normal 79.0 pmol l−1 (95% CI: −1.31, −0.15). Mean value for AMH was lower, 19.5 versus normal 47.3 pmol l−1 (95% CI: −37.6, −11.6). There were no differences found for FSH, SHBG, inhibin B and testosterone. The most important difference was found for AMH, a marker of Sertoli cell function in the testes, which decreased by close to 60% when compared with controls. Combined with an increase in LH, these findings may indicate a dysfunction of Sertoli cells and an effect on Leydig cells contributing to a potential mechanism of reproductive dysfunction in men with ESRD.

Impact of Kidney Transplantation on Reproductive Hormone Levels in Males: A Longitudinal Study

“…During spermatogenesis, the Sertoli cell has a crucial role by supporting and nourishing developing sperm. We have previously shown that men on hemodialysis experience a substantial decrease in AMH levels compared with healthy fertile controls [3]. In this study, we observed a trend towards increasing levels of AMH at 12 months after transplantation; however, this was not statistically significant.…”

“…Because approximately 40% of men receiving a kidney transplant are less than 50 years of age, reproductive function following transplantation is a major concern [6]. Kidney transplantation was reported to improve sexual function and sex hormone profiles [3, 7, 8]. Although some hormonal disturbances can be fully or partly restored, shortly after successful kidney transplantation, an improvement in semen parameters appears to be slow [5].…”

“…The most prominent effects are elevated luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin, and decreased testosterone levels. Recently, we have shown that the Sertoli cell-derived anti-Müllerian hormone (AMH) is substantially decreased among men on hemodialysis [3] and that low AMH in men with chronic kidney disease was associated with a low percentage of the total number of motile sperm cells [4]. Currently, the best way to treat sexual dysfunction among men on hemodialysis is kidney transplantation [5].…”

MicroRNA-155 and Anti-Müllerian Hormone: New Potential Markers of Subfertility in Men with Chronic Kidney Disease

“…We found no association between miR-155 and CRP in this CKD population, indicating that the elevated miR-155 levels were a response to a mechanism other than inflammation associated with CRP as a cause of impaired semen quality. We have recently reported major decreases in plasma levels of AMH, a marker of Sertoli cell function, in men with CKD [ 6 , 7 ]. To evaluate this in relation to fertility, we included assay of AMH levels in this study, and found an association between low AMH levels and a low percentage of motile sperm cells in the entire study population.…”

“…Deterioration of kidney function may also imply disturbances of the hypothalamic-pituitary-gonadal axis with increased levels of luteinizing hormone and follicle-stimulating hormone and decreased testosterone levels [ 3 , 4 , 5 ]. We have previously shown that anti-müllerian hormone (AMH), a marker of Sertoli cell function, is decreased in all men with CKD [ 6 ], being most pronounced in CKD 5 [ 7 ]. Low AMH levels have also been seen in subfertile men without renal disease [ 8 ] and in men with nonobstructive azoospermia [ 9 ].…”