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“Azoospermia” is defined as the absence of sperm in a centrifuged semen sample, while “aspermia” refers to an absent ejaculate. Azoospermia is classified as either obstructive or nonobstructive. Obstructive azoospermia is characterized by a testis biopsy demonstrating sufficient spermatogenesis and a physical occlusion of the reproductive tract distal to the testis that prevents sperm from entering the semen. Nonobstructive azoospermia (NOA) is caused by severely reduced sperm production, resulting in the absence of sperm in the semen. Even if sperm retrieval and intracytoplasmic sperm injection (ICSI) are being employed, this distinction is still important for 2 reasons. First, successful sperm retrieval is far more likely with obstructive azoospermia. Second, the potential underlying genetic defects is different in the 2 types of azoospermia.
The evaluation of the azoospermic man consists of a complete history, a physical examination, and the appropriate laboratory testing (Figure). Most men will have either ductal obstruction or testicular failure. Endocrine abnormalities such as Kallmann syndrome will be confirmed with endocrine testing. Ejaculatory dysfunction would not be expected to present with azoospermia but rather, with a low volume or absent ejaculate.
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