From the Guidelines
For a semen analysis report showing azoospermia, the comment should recommend a repeat semen analysis in 2-3 months to confirm the finding, as temporary factors can affect sperm production, and referral to a urologist specializing in male fertility for comprehensive evaluation, including physical examination, hormonal testing, and genetic testing (karyotype, Y-chromosome microdeletion analysis) as suggested by the most recent guideline 1. The patient's evaluation should include an assessment for obstructive causes, such as blockage in the reproductive tract, and non-obstructive causes, such as testicular failure, as these require different treatment approaches.
- Potential treatments might include:
- Surgical correction of varicocele or obstruction
- Hormone therapy
- Sperm retrieval techniques (TESE, MESA) combined with assisted reproductive technology The comment should emphasize that approximately 15% of azoospermic men can have sperm successfully retrieved for fertility treatment, and early evaluation is important as some causes of azoospermia are treatable if addressed promptly 1.
- The patient should be advised to avoid:
- Hot baths
- Saunas
- Tight underwear
- Excessive alcohol during this evaluation period It is essential to note that karyotype testing and Y-chromosome microdeletion analysis are crucial for men with severe oligozoospermia or non-obstructive azoospermia, as these tests can provide valuable information for planning therapy and future follow-up, as highlighted in previous studies 1.
From the Research
Comments and Advice for Semen Analysis Report with Azoospermia
- The report should indicate that azoospermia is the complete absence of spermatozoa in the ejaculate, confirmed by two or more semen analyses after centrifugation 2.
- It is essential to note that azoospermia can be due to various underlying causes, including nonobstructive azoospermia (NOA), which accounts for 10%-15% of male factor infertility cases 2.
- The report should recommend further evaluation to determine the underlying cause of azoospermia, including hormonal assessments and possibly genetic testing, such as Y chromosome microdeletion analysis, especially in cases with high follicle-stimulating hormone (FSH) levels 3.
- Patients with azoospermia may benefit from medical treatment to optimize spermatogenesis-regulating hormones, such as clomiphene citrate, human chorionic gonadotropin (hCG), and human menopausal gonadotropin (hMG), which can increase the likelihood of sperm retrieval 4.
- The report should advise that a repeat semen analysis after 3 months may not be necessary before starting an infertility assessment, as the likelihood of finding sperm on the second test is low (1.7%) 5.
- It is crucial to inform patients that azoospermia is a significant factor in male infertility, and prompt evaluation and treatment can improve the chances of successful sperm retrieval and fertility treatment outcomes 6, 4.