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Principles of Pathophysiology of Infertility Assessment and Treatment*
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Joseph G. Schenker, Aby Lewin, Menashe Ben-David
The examination of ejaculate is undertaken with regard to morphological, biochemical, and vitality aspects (Figure 8). Approximately 20% of infertile males are azoospermic. Azoospermia may be due to spermatogenic failure, obstruction of any level of the genital tract, or retrograde ejaculation. The algorithmic approach to the evaluation and treatment of the azoospermic male is shown in Figure 10. In most azoospermic males, there is little hope of restoring normal spermatogenesis. Only in cases of hypogonadotrophic hypogonadism was fertility achieved following administration of HMG-HCG therapy and more recently following application of Gn-RH analogs. Cryptorchidism is a potentially preventable cause of infertility, if the testis is brought into the scrotum early in life. When the epididimis or vas has become obstructed because of veneral disease, tuberculosis, or after acute nonspecific epididimitis, the obstruction can often by surgically corrected in about 40 to 50% of the cases. Pregnancies in cases of retrograde ejaculation were obtained following pharmacological therapy or recovery of sperm from the urinary bladder.
Knowledge Area 11: Subfertility
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
You are in clinic, and you are about to see a 28-year-old couple who have been trying to conceive for the last 2 years, primary infertility. The female patient has no past medical history, and all her investigations have been normal. Her male partner had mumps as a teenager. He smokes five cigarettes a day and drinks socially. His results have shown high FSH and LH levels and low testosterone. His semen analysis shows azoospermia. His karyotyping is normal. What is the correct treatment?
Contraceptive Intervention
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
The earliest attempt was to solve the difficult problem of reversal of vasectomy. A reversible occlusion of the vas deferens was aimed at. To block the passage of the spermatic fluid in dogs, Lee1 placed a nylon thread inserted through a needle puncture into the lumen of the vas deferens. A thread of smaller diameter was left outside the vas deferens. Over a short span of time, azoospermia was obtained. Later, by pulling on the free end of the small-diameter thread, the intravasal thread could be removed to restore patency of the vas deferens. Time duration of effectiveness was limited to a few weeks; thereafter, it was noted that spermatozoa leak past the thread. Although far from successful, this study laid the foundation for a variety of other occlusive techniques that followed. Moon and Bunge2 reported trials on a plastic plug inserted into the lumen of the vas deferens. Free3,4 modified the plug with the provision of a stem to facilitate removal. Result in respect of the period of azoospermia obtained was not significantly improve.
Immunohistochemical examination of androgen receptor and estrogen receptor alpha expressions in obstructive and non-obstructive azoospermia
Published in Systems Biology in Reproductive Medicine, 2021
Yurdun Kuyucu, Gülfidan Coşkun, Dilek Şaker, Özdem Karaoğlan, İbrahim Ferhat Ürünsak, Volkan İzol, İbrahim Atilla Arıdoğan, Şeyda Erdoğan, Hülya Özgür, Sait Polat
Azoospermia is the absence of spermatozoa, and spermatogenetic cells in semen. It is found in 1% of the men in the general population. Azoospermia comprises approximately 10% of the male infertility cases and can be categorized as obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) (Wosnitzer et al. 2014). OA, which comprises 40% of azoospermia cases, occurs secondary to acquired or congenital causes of obstruction of the male reproductive tracts. Non-obstructive azoospermia occurs in ~60% of cases. In contrast, to those that remain idiopathic, common etiologies associated with NOA include genetic (Klinefelter syndrome and Y chromosome microdeletions), congenital abnormalities (cryptorchidism), postinfection (mumps orchitis), exposure to gonadotoxins (radiotherapy and chemotherapy), testicular trauma (Esteves 2015). Genitourinary infections, surgical complications, vasectomy, pelvic or scrotal traumas, vas deferens absence, may lead to OA (Esteves 2015).
Medical management of non-obstructive azoospermia: A systematic review
Published in Arab Journal of Urology, 2021
Mohammad H. Alkandari, Armand Zini
Men screened on initial evaluation and found to be azoospermic should be further evaluated with a complete reproductive history and physical examination. The evaluation is designed to identify potential causes of azoospermia. A physical examination will specifically help evaluate testicular volume and consistency and confirm presence or absence of vasa and varicocele. A repeat semen analysis is often requested to confirm the diagnosis of azoospermia. A hormonal evaluation will help differentiate between primary (hypergonadotrophic hypogonadism) and secondary testicular failure (HH). Men with hypergonadotrophic hypogonadism generally present with testicular atrophy and have an elevated serum FSH on hormonal profiling. Men with idiopathic hypergonadotrophic hypogonadism should also be offered genetic evaluation with a karyotype and Y chromosome microdeletion analysis. Genetic evaluation is required to uncover the cause of infertility and to counsel couples regarding the risk of possible transmission of genetic defects to the offspring.
Current updates and future perspectives in the evaluation of azoospermia: A systematic review
Published in Arab Journal of Urology, 2021
Nahid Punjani, Caroline Kang, Dolores J. Lamb, Peter N. Schlegel
Infertility occurs in up to 15% of couples, in which a male factor is contributory in up to 50% of cases [1, 2]. Unfortunately, the precise aetiology is commonly unknown. Male factor infertility in its most severe form is known as azoospermia, or absence of sperm in the ejaculate, and may be classified as obstructive azoospermia (OA) or non-obstructive azoospermia (NOA). The evaluation and management of patients with azoospermia has progressed significantly as we continue to understand more about the infertile male. There is growing evidence that infertile men may harbour systemic disease and therefore an in-depth evaluation of these patients is critical [3]. For example, men with a history of azoospermia are, in general, at increased risk of developing cancer, and their life expectancy is limited relative to population-based control men [4–6]. In the present review, we discuss the standard evaluation of men with azoospermia and future perspectives in the evaluation and counselling of this patient population.