Emerging trends in the management of non‐obstructive azoospermia

Abstract Ten percent of infertile males have azoospermia, classified into obstructive and nonobstructive types, which require specific medical or surgical treatments. In nonobstructive azoospermia, advancements in microsurgery allow for effective sperm retrieval in about half of cases. This review aimed to highlight the most recent studies utilizing whole exome sequencing (WES) and seminal/serum biomarkers aim to predict micro‐dissection testicular sperm extraction (micro‐TESE) outcomes and reduce failure rates. WES identifies rare genetic mutations affecting spermatogenesis that could explain micro‐TESE failures, improving preoperative assessments. Despite its potential, WES is limited by high costs. Biomarkers such as Anti‐Müllerian Hormone and testis‐expressed sequence 101 protein can indicate spermatogenic activity, though standardization of these measurements is needed for accuracy. Additionally, microRNAs as non‐invasive markers offer potential in assessing spermatogenic reserve and classifying azoospermia types, but their efficacy in identifying specific spermatogenic disorders remains under researched, necessitating further studies on multivariate miRNA models.