Clinical management of infertile men with nonobstructive azoospermia

作     者：Sandro C Esteves 

作者机构：ANDROFERT Center for Male Reproduction Campinas 13075-460 Brazil 

出 版 物：《Asian Journal of Andrology》 (亚洲男性学杂志（英文版）)

年 卷 期：2015年第17卷第3期

页      面：459-470页

核心收录：

学科分类：090603[农学-临床兽医学] 0710[理学-生物学] 07[理学] 09[农学] 0906[农学-兽医学] 071007[理学-遗传学] 

主　　题：intracytoplasmic sperm injection male infertility nonobstructive azoospermia pregnancy outcome sperm retrieval spermatogenic failure 

摘      要：The clinical management of men with nonobstructive azoospermia （NOA） seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. This review presents a personal perspective on the clinical management of NOA, including the lessons learned over 15 years dealing with this male infertility condition. A five-consecutive-step algorithm is proposed to manage such patients. First, a differential diagnosis of azoospermia is made to confirm/establish that NOA is due to spermatogenic failure. Second, genetic testing is carried out not only to detect the males in whom NOA is caused by microdeletions of the long arm of the Y chromosome, but also to counsel the affected patients about their chances of having success in sperm retrieval. Third, it is determined whether any intervention prior to a surgical retrieval attempt may be used to increase sperm production. Fourth, the most effective and efficient retrieval method is selected to search for testicular sperm. Lastly, state-of-art laboratory techniques are applied in the handling of retrieved gametes and cultivating the embryos resulting from sperm injections. A coordinated multidisciplinary effort is key to offer the best possible chance of achieving a biological offspring to males with NOA.