Azoospermia: Indeterminate Etiology

Abstract

In some cases it may be difficult to ­distinguish between obstructive and nonobstructive azoospermia based on the initial clinical evaluation. These indeterminate cases include patients with borderline clinical findings such as mild serum FSH elevations and mildly low testicular ­volumes, as well as patients in which discrepancies exist between the clinical history, physical examination, and serum hormone evaluation. The classic approach in these cases has been performance of diagnostic testicular biopsy for direct histologic assessment of spermatogenesis and remains the gold standard for diagnostic evaluation. However, most experts (including the authors) advocate directly proceeding to exploratory surgery without performance of a separate testicular biopsy. The advantage of this approach is that it is both diagnostic and therapeutic, allowing for management of the patient with indeterminate azoospermia with a single procedure.