Differential Diagnosis of Azoospermia in Men with Infertility

The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.

Automated summary

The differential diagnosis between obstructive and nonobstructive azoospermia involves a comprehensive evaluation including medical history, physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. Testicular biopsy may be necessary in cases of doubt, and should be combined with sperm extraction for sperm cryopreservation. A multidisciplinary approach involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists is crucial for the best diagnostic path for men with azoospermia.