Category: Reproductive Endocrinology
Azoospermia is uncommon - prevalence rates in the general population range from 0 - 4%. Obstructive azoospermia (OA) is a potentially treatable/reversible condition, which may restore fertility. Non-obstructive azoospermia (NOA) may be the presenting feature of an undiagnosed congenital or acquired condition, which may have implications for the man and/or his relatives. Cost of male azoospermia evaluation necessitates an efficient and practical approach. Past studies were done prior to the availability of current genetic testing or focused more on subsets of azoospermia. Here we report characteristics/findings of men with azoospermia presenting to our clinic.
Between 07/01/12 and 06/30/16, 140 men were found to have azoospermia on semen analysis during their fertility evaluation at our clinic. Each of these patients had a thorough history, physical exam, semen analysis, and laboratory testing. Using this data, we categorized patients into three groups: 103 patients had NOA, 29 had OA, and 8 had an indeterminate etiology (IE). Data was analyzed using SAS. Groups were compared with respect to continuous variables using one-factor ANOVA and for categorical variables by Chi-square.
Both left and right testicular volume were significantly different among groups (NOA average 10cc ± 5cc, OA 19cc ± 5cc, and IE 17cc ± 6cc; p = <.0001). Absent vas deferens or epididymis was most common in OA, accounting for 58% of men with this finding (7 men NOA, 11 OA, and 1 IE). Semen pH was significantly different among groups (average for OA 7.09 ± 0.79, NOA 7.66 ± 0.40, and indeterminate 7.56 ± 0.55; p = <.0001). Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were significantly higher in the NOA group (average FSH for NOA of 20.7 IU/L ± 13.4, OA 4.2 ± 2.2, and IE 3.7 ± 0.5; p = <.0001). Of the 9 patients who tested positive for Klinefelter’s syndrome and the 6 patients with a y chromosome microdeletion, all were in the NOA group. Lastly, 43 of the 140 men underwent testes biopsy, which definitively categorized them into either OA or NOA.
Small testes volume almost guarantees NOA. Unsuprisingly, elevated FSH/LH also suggests NOA. Semen pH was significantly lower in OA, but other semen parameters were not useful. Genetic testing was useful in certain cases, and when positive was able to classify the patient into a certain group, but the yield was low.
Conclusion : The history, physical exam, and gonadotropins are powerful, cost-effective tools in evaluating azoospermia. Genetic testing, when positive, is very useful, however these tests are expensive and should be used judiciously.
John Schempf– Endocrine fellow, University of Minnesota, Minneapolis, Minnesota
J. Bruce Redmon– Professor, Dept of Medicine, Division of Diabetes, Endocrinology and Metabolism, Univ of Minnesota Medical School, Minneapolis, Minnesota
Joshua Bodie– Assistant Professor, Univ of Minnesota Urology Department, Arden Hills, Minnesota
University of Minnesota
Completed medical school at the Loyola University Chicago Stritch School Medicine. Completed an internal medicine residency at the University of Minnesota. Current endocrinology fellow at the University of Minnesota.
Professor, Dept of Medicine, Division of Diabetes, Endocrinology and Metabolism
Univ of Minnesota Medical School
Dr. Redmon is an endocrinologist with a specific interest in andrology. He has a joint appointment with the Department of Urologic Surgery at the University of Minnesota Medical School.