Abstract
Infertility affects 1 in 6 couples, and male factor infertility has been implicated as a cause in 50% of cases. Azoospermia is defined as the absence of spermatozoa in the ejaculate and is considered the most extreme form of male factor infertility. Historically, these men were considered sterile but, with the advent of testicular sperm extraction and assisted reproductive technologies, men with azoospermia are able to biologically father their own children. Non-obstructive azoospermia (NOA) occurs when there is an impairment to spermatogenesis. This review describes the contemporary management of NOA and discusses the role of hormone stimulation therapy, surgical and embryological factors, and novel technologies such as proteomics, genomics, and artificial intelligence systems in the diagnosis and treatment of men with NOA. Moreover, we highlight that men with NOA represent a vulnerable population with an increased risk of developing cancer and cardiovascular comorbodities.
Highlights
Infertility affects 1 in 6 couples, and male factor infertility has been implicated as a cause in 50% of cases[1]
This review provides an up-to-date summary of current techniques used in the management of non-obstructive azoospermia (NOA) and highlights future areas of research
NOA occurs when there is an impairment of spermatogenesis, whilst OA is caused by occlusion of the testicular and genital ductular system
Summary
Infertility affects 1 in 6 couples, and male factor infertility has been implicated as a cause in 50% of cases[1]. Modarresi et al observed that the additional use of enzymatic digestion (e.g. collagenase) yielded sperm in approximately 9% of cases where conventional mechanical extraction of sperm from testicular tissue had failed[22] This suggests that there is a learning curve for both mTESE and biological techniques, but it must be appreciated that surgical complications such as haematoma, fibrosis, and testicular atrophy have been reported to be less frequent in mTESE compared to cTESE20. The lowest sperm retrieval rates are associated with a histological pattern of SCO syndrome (24%)[70,71,72] In this regard, the predominant histological subtype may be used to counsel men regarding the likelihood of a successful secondary surgical sperm retrieval procedure, this has no value as a prognostic tool in predicting testicular sperm extraction at the time of a primary procedure. This value was predictive of a sperm yield of greater than 100 spermatozoa in 91.1% of cases
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