title: Inhibin B and anti-Mullerian hormone as markers of persistent spermatogenesis in men with non-obstructive azoospermia: a meta-analysis of diagnostic accuracy studies.
abstract: 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.
authors.affiliation: 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
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Toulis
authors.forename: Paschalia K
authors.initials: PK
authors.lastname: Iliadou
authors.forename: Christos A
authors.initials: CA
authors.lastname: Venetis
authors.forename: Christos
authors.initials: C
authors.lastname: Tsametis
authors.forename: Basil C
authors.initials: BC
authors.lastname: Tarlatzis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papadimas
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Goulis
mesh_terms: 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*
chemical_list: C422364:inhibin B; D007265:Inhibins; D054304:Anti-Mullerian Hormone