Azoospermic Infertility and Intracytoplasmic Sperm Injection
Azoospermic Infertility and Intracytoplasmic Sperm Injection
A complete medical history and examination (including of the genitals), complemented by semen analysis and morning reproductive hormone testing (FSH, LH, T, SHBG, calculated free T, prolactin), assists in identifying remediable causes of infertility (Table 1), and co-existent testosterone deficiency in this 'at risk' population. Testicular examination should include volume estimation by orchidometry or ultrasound (normally 15–35 ml); reduced size suggests testicular failure whereas volumes are normal in OA. In some cases of NOA, testis size and serum FSH overlap the normal range, classically germ cell arrest at the spermatocyte stage can 'masquerade' as OA, and testicular biopsy is required for diagnosis.
Reversible Causes of Azoospermia
A complete medical history and examination (including of the genitals), complemented by semen analysis and morning reproductive hormone testing (FSH, LH, T, SHBG, calculated free T, prolactin), assists in identifying remediable causes of infertility (Table 1), and co-existent testosterone deficiency in this 'at risk' population. Testicular examination should include volume estimation by orchidometry or ultrasound (normally 15–35 ml); reduced size suggests testicular failure whereas volumes are normal in OA. In some cases of NOA, testis size and serum FSH overlap the normal range, classically germ cell arrest at the spermatocyte stage can 'masquerade' as OA, and testicular biopsy is required for diagnosis.
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