Page 6 - CUA Guideline: The workup and management of azoospermic males

Jarvi et al.

should only be performed in centres with the exper- We cannot presently recommend the use of any hormone
tise to perform the needed microsurgery and with a therapy for men with non-obstructive azoospermia.
laboratory with the capacity to cryopreserve sperm. The use of androgens is contraindicated in men with azo-
34
A bilateral diagnostic testicular biopsy is generally not ospermia (Level of Evidence 1, Grade of Recommendation
required. If there is a discrepancy in testicular size, the larger A).
of the two testes should be biopsied.
Competing interests: Dr. Jarvi is a member of the advisory board for Eli Lilly. Dr. Grober is a
What is the role of varicocelectomy in men with azo- member of the advisory boards and speaker’s bureau for Eli Lilly, Abbott, and Paladin. He has also
received a grant from Eli Lilly and Paladin. Dr. Mak has received a grant from Amgen and Janssen.
ospermia? Dr. Chow is on the advisory boards for Astellas and Johnson & Johnson. Dr. Domes has received
speaker honoraria from Eli Lilly and Abbott. Dr. Lo, Dr. Fischer, Dr. Grantmyre, Dr. Zini, Dr. Chan,
and Dr. Patry declare no competing financial or personal interests.
The role of varicocelectomy in men with azoospermia
remains controversial. There is some evidence that a small
percentage of men with azoospermia due to testicular fail- This paper has been peer-reviewed.
ure may benefit from treatment of a clinical varicocele. 30
Schlegel and colleagues reported that close to 20% of men
with azoospermia had sperm in the ejaculation following a
30
varicocele repair. It is considered reasonable to offer a vari- References
cocele repair to men with clinical varicoceles and testicular
failure, but men should be warned that there is a low prob- 1. Fogle RH, Steiner AZ, Marshall FE, et al. Etiology of azoospermia in a large nonreferral inner-city population.
ability that this will result in any improvement in his semen Fertil Steril 2006;86:197-9. http://dx.doi.org/10.1016/j.fertnstert.2005.12.047
parameters. Most men will still need ICSI to help conceive 2. Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989;142:62-5.
3. Fedder J, Cruger D, Oestergaard B, et al. Etiology of azoospermia in 100 consecutive nonvasectomized
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What is the role of hormone therapy for men with 5. Matsumiya K, Namiki M, Takahara S, et al. Clinical study of azoospermia. Int J Androl 1994;17:140-2.
azoospermia? http://dx.doi.org/10.1111/j.1365-2605.1994.tb01233.x
6. Services, U.D.o.H.a.H. Assisted Reproductive Technology Success Rates 2003: National Summary and
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hypogonadism, the use of hormones to treat men with azo- 8. Sullivan EA, Zegers-Hochschild F, Mansour R, et al. International Committee for Monitoring Assisted
ospermia remains controversial. Reproductive Technologies (ICMART) world report: Assisted reproductive technology 2004. Hum Reprod
2013;28:1375-90. http://dx.doi.org/10.1093/humrep/det036
Based on a multicentre study, Hussein and colleagues 9. Bachir BG, Jarvi K. Infectious, inflammatory, and immunologic conditions resulting in male infertility. Urol
reported that in men with non-obstructive azoospermia Clin North Am 2014;41:67-81. http://dx.doi.org/10.1016/j.ucl.2013.08.008
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(HCG) to increase FSH to a target level of 1.5-fold times the semen and hormone parameters. Fertil Steril 2013;100:1542-6. http://dx.doi.org/10.1016/j.
initial FSH levels and a target serum testosterone of 600 to fertnstert.2013.07.2000
800 ng/dL, the yield of sperm on a micro-TESE was 57% 11. Cooper TG, Noonan E, von Eckardstein S, et al. World Health Organization reference values for human
semen characteristics. Hum Reprod Update 2010;16:231-45. http://dx.doi.org/10.1093/humupd/
compared to 33.6% in the control group. 31 dmp048
Further support for the concept that hormonal thera - 12. Delfino M, Imbrogno N, Elia J, et al. Prevalence of diabetes mellitus in male partners of infertile couples.
pies might benefit men with non-obstructive azoospermia Minerva Urol Nefrol 2007;59:131-5.
came from Shiraishi and colleagues. The authors studied 13. Jhaveri KS, Mazrani W, Chawla TP, et al. The role of cross-sectional imaging in male infertility: A picto-
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the effects of HCG 5000 U 3 times/week with FSH for men 14. Mak V, Jarvi KA. The genetics of male infertility. J Urol 1996;156:1245-56.
with a declining FSH and with no sperm found on initial 15. Jarvi K, McCallum S, Zielenski J, et al. Heterogeneity of reproductive tract abnormalities in men with
micro-TESE surgery. In total, 6 of the 28 men who received absence of the vas deferens: Role of cystic fibrosis transmembrane conductance regulator gene mutations.
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had higher testosterone levels initially. 33 failure. Hum Reprod 2000;15:436-9. http://dx.doi.org/10.1093/humrep/15.2.436

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