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Azoospermia: Diagnosis and Management

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Male Infertility

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Azoospermia, or the complete absence of sperm in the ejaculate, accounts for 10–20% of males presenting with infertility (Jarow et al. 1989). Azoospermia is diagnosed when two semen samples, given at least 2 weeks apart, show no sperm before or after centrifugation (Sharlip et al. 2006). The presence of any sperm in the centrifuged pellet is considered severe oligospermia, also called cryptospermia, ruling out obstruction. The initial evaluation of the azoospermic patient should be to classify the condition as obstructive or nonobstructive.

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References

  • Ballesca JL, Balasch J, Calafell JM, et al. Serum inhibin B determination is predictive of successful testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod. 2000;18:1734–1738

    Article  Google Scholar 

  • Bird VG, Brackett NL, Lynne CM, et al. Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury. Spinal Cord. 2001;39:514–519

    Article  PubMed  CAS  Google Scholar 

  • Brackett NL, Ferrell SM, Aballa TC, et al. An analysis of 653 trials of penile vibratory stimulation in men with spinal cord injury. J Urol. 1998;159:1931–1934

    Article  PubMed  CAS  Google Scholar 

  • Brugo-Olmedo S, De Vincentiis S, Calamera JC, et al. Serum inhibin B may be a reliable marker of the presence of testicular spermatozoa in patients with nonobstructive azoospermia. Fertil Steril. 2001;76:1124–1129

    Article  PubMed  CAS  Google Scholar 

  • Chan PTK, Palermo GD, Veeck LL, et al. Testicular sperm extraction combined with intracytoplasmic sperm injection in the treatment of men with persistent azoospermia postchemotherapy. Cancer. 2001;92:1632–1637

    Article  PubMed  CAS  Google Scholar 

  • Chillón M, Casals T, Mercier B, et al. Mutations in the cystic fibrosis gene in patients with congential absence of the vas deferens. NEJM. 1995;332:1475–1480

    Article  PubMed  Google Scholar 

  • Danish RK, Lee PA, Mazur T, et al. Micropenis. II. Hypogonadotropic hypogonadism. Johns Hopkins Med J. 1980;146:177–184

    PubMed  CAS  Google Scholar 

  • De Rosa M, Colao A, Di Sarno A, et al. Cabergoline treatment rapidly improves gonadal function in hyperprolactinemic males: a comparison with bromocriptine. Eur J Endocrinol. 1998;138:286–293

    Article  PubMed  Google Scholar 

  • Devroey P, Liu J, Nagy Z, et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod. 1995;10:1457–1460

    Article  PubMed  CAS  Google Scholar 

  • El Garem YF, El Arinin AF, El Beheiry AH, et al. Possible relationship between seminal plasma inhibin B and spermatogenesis in patients with azoospermia. J Androl. 2002;23:825–829

    PubMed  CAS  Google Scholar 

  • Fahmy I, Kamal A, Shamloul R, et al. ICSI using testicular sperm in male hypogonadotropic hypogonadism unresponsive to gonadotropin therapy. Hum Reprod. 2004;19:1558–1561

    Article  PubMed  CAS  Google Scholar 

  • Friedler S, Raziel A, Strassburger D, et al. Testicular sperm retrieval by percutaneous fine needle aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum reprod. 1997;12:1488–1493

    Article  PubMed  CAS  Google Scholar 

  • Friedler S, Raziel A, Strassburger D, et al. Factors influencing the outcome of ICSI in patients with obstructive and non-obstructive azoospermia: a comparative study. Hum Reprod. 2002;17:3114–3121

    Article  PubMed  CAS  Google Scholar 

  • Ghazzawi IM, Sarraf MG, Taher MR, et al. Comparison of the fertilizing capability of spermatozoa from ejaculates, epididymal aspirates, and testicular biopsies using intracytoplasmic sperm injection. Hum Reprod. 1998;13:348–352

    Article  PubMed  CAS  Google Scholar 

  • Hopps CV, Mielnik A, Goldstein M, et al. Detection of sperm in men with Y chromosome microdeletions of the AZFa, AZFb, and AZFc regions. Hum Reprod. 2003;18:1660–1665

    Article  PubMed  CAS  Google Scholar 

  • Howell SJ, Shalet SM. Spermatogenesis after cancer treatment: damage and recovery. J Natl Cacner Inst Monogr. 2005;34:12–17

    Article  CAS  Google Scholar 

  • Ishikawa T, Ooba T, Kondo Y, et al. Assessment of gonadotropin therapy in male hypogonadotropic hypogonadism. Fertil Steril. 2007;88:1697–1698

    Article  PubMed  CAS  Google Scholar 

  • Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol. 1989;142:62–65

    PubMed  CAS  Google Scholar 

  • Kahraman S, Özgür S, Alatas C, et al. Fertility with testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermic men. Hum Reprod. 1996;11: 756–760

    Article  PubMed  CAS  Google Scholar 

  • Kim HH, Schlegel PN. A guidelines based approach to obstructive azoospermia. AUA Update Ser. 2008;27:49–56

    Google Scholar 

  • Lampe H, Horwich A, Norman A, et al. Fertility after chemotherapy for testicular germ cell cancers. J Clin Oncol. 1997;15:239–245

    PubMed  CAS  Google Scholar 

  • Mahmoud AM, Comhaire FH, Depuydt CE. The clinical and biological significance of serum inhibins in infertile men. Reprod Toxicol. 1998;12:591–599

    Article  PubMed  CAS  Google Scholar 

  • Matsimuya K, Namiki M, Takahara S, et al. Clinical study of azoospermia. Int J Androl. 1994;17:140–142

    Article  Google Scholar 

  • Mau Kai C, Juul A, McElreavey K, et al. Sons conceived by assisted reproduction techniques inherit deletions in the azoospermia factor (AZF) region of the Y chromosome and the DAZ gene copy number. Hum Reprod. 2008;23:1669–1678

    Article  PubMed  CAS  Google Scholar 

  • Meacham RB. Strategies for enhancing sperm survival in specimens obtained from patients with retrograde ejaculation. J Androl. 2005;26:174–175

    PubMed  Google Scholar 

  • Meacham RB, Hellerstein DK, Lipshultz LI. Evaluation and treatment of ejaculatory duct obstruction in the infertile male. Fertil Steril. 1993;59:393–397

    PubMed  CAS  Google Scholar 

  • Monoski MA, Li PS, Baum N, et al. No-scalpel, no-needle vasectomy. Urology. 2006;68:9–14

    Article  PubMed  Google Scholar 

  • Nagata Y, Fujita K, Banzai J, et al. Seminal plasma inhibin-B level is a useful predictor of the success of conventional testicular sperm extraction in patients with non-obstructive azoospermia. J Obstet Gynaecol Res. 2005;31:384–388

    Article  PubMed  CAS  Google Scholar 

  • Ohl DA, Menge AC, Sønksen J. Penile vibratory stimulation in spinal cord injured men: optimized vibration parameters and prognostic factors. Arch Phys Med Rehabil. 1996;77:903–905

    Article  PubMed  CAS  Google Scholar 

  • Okada H, Dobashi M, Yamazaki T, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol. 2002;168:1063–1067

    Article  PubMed  Google Scholar 

  • Palermo GD, Schlegel PN, Hariprashad JJ, et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod. 1999;14:741–748

    Article  PubMed  CAS  Google Scholar 

  • Rao MM, Rao DM. Cytogenetic studies in primary infertility. Fertil Steril. 1977;28:209–210

    PubMed  CAS  Google Scholar 

  • Sabanegh ES, Thomas AJ. Effectiveness of crossover transseptal vasoepididymostomy in treating complex obstructive azoospermia. Fertil Steril. 1995;63(2):392–395

    PubMed  Google Scholar 

  • Sadeghi-Nejad H, Farrokhi F. Genetics of azoospermia: Current knowledge, clinical implications, and future directions. Part II Y chromosome microdeletions. Urol J. 2007;4:192–206

    PubMed  Google Scholar 

  • Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue escision. Hum Reprod. 1999;14:131–135

    Article  PubMed  CAS  Google Scholar 

  • Schlegel PN, Palermo GD, Goldstein M, et al. Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia. Urology. 1997;49:435–440

    Article  PubMed  CAS  Google Scholar 

  • Sharlip ID, Jarow J, Belker AM, et al. The Male Infertility Best Practice Policy Committee of the American Urological Association and the Practice Committee of the American Society for Reproductive Medicine. Report on evaluation of the azoospermic male. Fertil Steril. 2006;86:S210–S215

    Google Scholar 

  • Sheynkin YR, Hendin BH, Schlegel PN, et al. Microsurgical repair of iatrogenic injury to the vas deferens. J Urol. 1998;159:139–141

    Article  PubMed  CAS  Google Scholar 

  • Shlegel PN, Shin D, Goldstein M. Urogenital anomalies in men with congenital absence of the vas deferens. J Urol. 1996;155:1644–1648

    Article  Google Scholar 

  • Silber SJ, Nagy Z, Devroey P, et al. Distribution of spermatogenesis in the testicles of azoospermic men: the presence or absence of spermatids in the testes of men with germinal failure. Hum Reprod. 1997;12:2422–2428

    Article  PubMed  CAS  Google Scholar 

  • Tsujimura A, Matsumiya K, Miyagawa Y, et al. Conventional multiple or microdissection testicular sperm extaction: a comparative study. Hum Reprod. 2002;17:2924–2929

    Article  PubMed  CAS  Google Scholar 

  • Tsujimura A, Miyagawa Y, Takao T, et al. Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol. 2006;175:1446–1449

    Article  PubMed  Google Scholar 

  • Turek PJ, Magana JO, Lipshultz LI. Semen parameters before and after transurethral surgery for ejaculatory duct obstruction. J Urol. 1996;155:1291–1293

    Article  PubMed  CAS  Google Scholar 

  • Vernaeve V, Staessen C, Verheyen G, et al. Can biological or clinical parameters predict testicular sperm recovery in 47,XXY Klinefelter’s syndrome patients? Hum Reprod. 2004;19:1135–1139

    Article  PubMed  CAS  Google Scholar 

  • Warne DW, Decosterd G, Okada H, et al. A combined analysis of data to identify predictive factors for spermatogenesis in men with hyopgonadotropic hypogonadism treated with recombinant human follicle-stimulating hormone and human chorionic gonadotropin. Fertil Steril. 2009;92:594–603

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization, WHO Laboratory Manual for the Examination of Human Semen and Sperm Cervical Mucus Interactions. 4th ed. Cambridge United Kingdom: Cambridge University Press;1999

    Google Scholar 

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Author information

Authors and Affiliations

  1. Center for Male Fertility/Andrology, Glickman Urological and Kidney Institute, Mailcode Q10, 9500 Euclid Ave, 44113, Cleveland, OH, USA

    John C. Kefer

  2. Dallas Center for Pelvic Medicine, Suite 200, 10501 N Central Expressway, 75231, Dallas, TX, USA

    Dan B. French

Authors
  1. John C. Kefer
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  2. Dan B. French
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Correspondence to Dan B. French .

Editor information

Editors and Affiliations

  1. Glickman Urologic Institute, Cleveland Clinic Foundation, Euclid Ave. 9500, Cleveland, 44195, Ohio, USA

    Edmund S. Sabanegh

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Kefer, J.C., French, D.B. (2011). Azoospermia: Diagnosis and Management. In: Sabanegh, E. (eds) Male Infertility. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-193-6_3

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  • DOI: https://doi.org/10.1007/978-1-60761-193-6_3

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-192-9

  • Online ISBN: 978-1-60761-193-6

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