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2.\Jarvi K, Lo K, Grober E, Fischer MV, Grantmyre J, Zini A, et al. The workup and management of azoospermic males. Can Urol Assoc J. 2015;9(7–8):229–35.

3.\Jarow J, Sigman M, Kolettis PN, Lipshultz LR, Nangia AK, Naughton CK, et al. The optimal evaluation of the infertile male: American Urologic Association—best practice statements. Linthicum, MD: American Urological Association; 2010.

4.\Cooper TG, Noonan E, von Eckardstein S, Auger J, Gordon Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231–45.

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Chapter 26

Azoospermia

Nahid Punjani and Peter Schlegel

Case

A 30-year-old male patient (BX) with history of infertility for over 1 year presents after having completed a semen analysis which displayed a volume of 3 mL with normal viscosity and appearance, pH 7.5 but concentration was zero. No sperm was seen even after centrifugation. He presents with his wife, a 28-year-old nulligravida.

He has no known allergies and is not on any medication. He is otherwise healthy with no previous surgeries. He is an only child who has never smoked cigarettes or done any recreational drug but he consumed alcohol occasionally. He works as a computer software developer. He is married and never fathered any children. There is no family history of fertility issues or signi cant medical conditions.

Given his normal semen volume and pH, with azoospermia, the differential initially includes a testicular or pre-testicular etiology, while a post-testicular cause such as obstruction is less likely.

His partner is healthy and reports regular monthly menses. She denies any gynecologic issues and has had a completely normal evaluation by her gynecologist which includes AMH, TSH, and prolactin levels as well as a hysterosalpingogram (HSG).

BX has no history of any infection as a child or any childhood surgical procedures. He had been informed that his testicles were properly descended. He has no history of previous inguinal, pelvic or urologic surgery. He has never had a sexually transmitted disease. Neither does he have any hazardous occupational, toxin nor radiation exposure.

BX has a strong sexual drive and desire. He is able to achieve and maintain erections for penetrative intercourse and ejaculate inside his partner. They have

N. Punjani · P. Schlegel (*)

Department of Urology, Weill Medical College of Cornell University, New York, NY, USA e-mail: [e-mail]

© Springer Nature Switzerland AG 2023

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P. H. Chung, Z. Rosenwaks (eds.), Problem-Focused Reproductive Endocrinology and Infertility, Contemporary Endocrinology, https://doi.org/10.1007/978-3-031-19443-6_26