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Male Infertility pp 107–134Cite as

Management of Infertile Men with Nonobstructive Azoospermia due to Spermatogenic Failure

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Abstract

Spermatogenic failure has been recognized as the most severe presentation of male infertility in humans, and it usually results in azoospermia. Approximately 30–60 % of men with spermatogenic failure and azoospermia have sparse foci of sperm production within their dysfunctional testes, which can be extracted and used for in vitro fertilization techniques to produce a viable offspring. The scope of spermatogenic failure-related infertility covers a wide spectrum from genetic studies to hormonal control, microsurgical and medical therapy to assisted reproduction techniques, as well as innovative stem cell research aiming at creating artificial gametes. From a medical perspective, the management of men with spermatogenic failure seeking fertility involves a series of steps that includes the differential diagnosis of azoospermia, selection of the candidates for surgical sperm retrieval using molecular biology diagnosis, identification of who could benefit from medical and surgical interventions prior to sperm retrieval, application of the best method to surgically retrieve testicular spermatozoa, and the use of state-of-the-art in vitro fertilization techniques. A coordinated effort of a multidisciplinary team involving urologists, andrologists, geneticists, reproductive endocrinologists, and embryologists will offer the best possible chance of biological offspring for men with spermatogenic failure.

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Abbreviations

ART:

Assisted reproduction techniques

AZF:

Azoospermia factor

EAA:

European Association of Andrology

EMQN:

European Molecular Genetics Quality Network

FSH:

Follicle-stimulating hormone

hCG:

Human chorionic gonadotropin

HH:

Hypogonadotropic hypogonadism

ICSI:

Intracytoplasmic sperm injection

ITT:

Intratesticular testosterone

IVF:

In vitro fertilization

LH:

Luteinizing hormone

Micro-TESE:

Microdissection testicular sperm extraction

NOA:

Nonobstructive azoospermia

OA:

Obstructive azoospermia

PCR:

Polymerase chain reaction

SCOS:

Sertoli cell-only syndrome

SCO:

Sertoli cell only

SF:

Spermatogenic failure

SRR:

Sperm retrieval rates

SR:

Sperm retrieval

STS:

Sequence-tagged sites

TEFNA:

Testicular fine-needle aspiration

TESA:

Testicular sperm aspiration

TESE:

Testicular sperm extraction

YCMD:

Y chromosome microdeletion

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Authors and Affiliations

  1. ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Av. Dr. Heitor Penteado, 1464, 13075-460, Campinas, São Paulo, Brazil

    Sandro C. Esteves MD, PhD (Medical and Scientific Director)

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  1. Metro Male Clinic, Gunasekaran Hospital Pvt Ltd, Chennai, India

    Karthik Gunasekaran

  2. Department of Andrology and Reproductive, Chettinad Hospital and Research Institut, Chennai, India

    N Pandiyan

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Esteves, S.C. (2017). Management of Infertile Men with Nonobstructive Azoospermia due to Spermatogenic Failure. In: Gunasekaran, K., Pandiyan, N. (eds) Male Infertility. Springer, New Delhi. https://doi.org/10.1007/978-81-322-3604-7_7

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