Inhibin B and anti-Mullerian hormone as markers of persistent spermatogenesis in men with non-obstructive azoospermia: a meta-analysis of diagnostic accuracy studies.
BACKGROUND
A non-invasive test, which could predict the presence of sperm during a testicular sperm extraction (TESE) procedure in men with non-obstructive azoospermia (NOA), would be of profound clinical importance. Inhibin B (Inh-B) and anti-Müllerian hormone (AMH) have been proposed as direct markers of Sertoli cell function and indirect markers of spermatogenesis.


METHODS
A search was conducted in the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from inception through June 2009. Thirty-six different studies reported data on the predictive value of one or more index markers (serum Inh-B: 32 studies, seminal Inh-B: 5 studies, serum AMH: 2 studies, seminal AMH: 4 studies) and were included in the systematic review. Nine studies, which had serum Inh-B as index marker, met the predefined criteria and were included in the meta-analysis.


RESULTS
Serum Inh-B demonstrated a sensitivity of 0.65 (95% confidence interval [CI]: 0.56-0.74) and a specificity of 0.83 (CI: 0.64-0.93) for the prediction of the presence of sperm in TESE. When the pre-test probability of 41% was incorporated in a Fagan's nomogram, resulted in a positive post-test probability of 73% and a negative post-test probability of 23% for the presence of sperm in TESE.


CONCLUSIONS
Serum Inh-B cannot serve as a stand-alone marker of persistent spermatogenesis in men with NOA. Although limited, evidence on serum AMH and serum/seminal AMH do not support their diagnostic value in men with NOA.
Toulis
Konstantinos A
KA
Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, 54603 Thessaloniki, Greece. touliskos@gmail.com
Iliadou
Paschalia K
PK
Venetis
Christos A
CA
Tsametis
Christos
C
Tarlatzis
Basil C
BC
Papadimas
Ioannis
I
Goulis
Dimitrios G
DG
D054304:Anti-Mullerian Hormone / Q000097:blood*; D053713:Azoospermia / Q000175:diagnosis / Q000378:metabolism*; D006801:Humans; D007265:Inhibins / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D013091:Spermatogenesis / Q000502:physiology*
C422364:inhibin B; D007265:Inhibins; D054304:Anti-Mullerian Hormone