Management of Azoospermia: A Systematic Approach

ABSTRACT Key Content Work‐up of azoospermic men includes a detailed history, physical examination and investigations to find the underlying cause. Causes and management of azoospermia (pre‐testicular, testicular and post‐testicular) with case presentations. Importance of multidisciplinary team input including fertility specialists, healthcare scientists, urologists, endocrinologists and geneticists. Impact of genomics and novel biomarkers in diagnosis and prognosis of retrieving sperm surgically. Learning Objectives To understand how to take a detailed history, perform a physical examination and interpret the results of investigations of the azoospermic male. To recognise the link between azoospermia and certain medical conditions and poor general health. To know the surgical sperm retrieval techniques, the alternative options and understand patient selection. To familiarise with the process of spermatogenesis induction in hypogonadotropic hypogonadism. Ethical Considerations Azoospermia is a distressing diagnosis. Insufficient understanding of the condition and its implications can be a missed opportunity to improve these patients' health and wellbeing. Increased risk of birth defects or transmission of genetic abnormalities with intracytoplasmic sperm injection (ICSI) using surgically retrieved sperm is still under debate.