Editing CUA: Azoospermia (2015) (section)

== Answers ==

# How many semen analyses are required in the evaluation of azoospermia?
#* 2
# Take a history and describe the physical exam of a patient presenting with azoospermia.
#* History: infertility history, PMHx (general health), PSHx (surgeries of the reproductive tract), any GU infection/inflammation, exposure to medications/treatments (chemo/rads), environmental exposure, recreational drugs, FHx (genetic conditions)
#* Physical: body habitus, state of virilization, scrotal exam (vas deferences, varicoceles), phallus, prostate, abdominal exam (previous surgery scars)
# List gonadotoxic medications
#* Steroids, exogenous testosterone, estrogen, opioids, sulfasalazine, cimetidine, spironolactone, anti-androgens, HIV medications
# What are the indications for renal US in patients being investigated for infertility?
#* Unilateral or bilateral absence of vas
# What is the grading of a varicocele?
#* 0: not palpable, visible only by US
#* I: palpable with Valsalva, not visible
#* II: palpable at rest, not visible
#* III: visible at rest
# List causes of reduced volume azoospermia
#* Artifact, retrograde ejaculation, semen vesicles obstruction or abnormality, ejaculatory duct obstruction, emission failure
# What investigations should be ordered in a patient with reduced vs. normal volume azoospermia:
#* Reduced volume azoospermia: rule out artifact, then post-ejaculate urinalysis, then TRUS
#* Normal volume azoospermia: LH/FSH to categorize pre-testicular vs. testicular; if normal LH/FSH, cannot rule out obstruction vs. testicular failure and therefore consider biopsy
# What finding on TRUS is consistent with seminal vesicle obstruction?
#* Dilated seminal vesicle >1.5cm
# What are the indications for genetic testing?
#* Pre-testicular failure: all should be referred to genetic counselling
#* Testicular failure: karyotype and Y micro-deletion
# What are the indications for CF testing?
#* Absence or obstruction of the reproductive tract structures
#* Partner should also be tested
# What are the management options?
#* Pre-testicular: FSH/LH or gonadotropin-releasing hormone (GnRH) analogues
#* Testicular: testicular sperm extraction
#* Retrograde ejaculation: alpha agonist
#* Obstruction: repair obstruction vs. obtain sperm from reproductive tract
# After starting a patient with pre-testicular failure on hormonal therapy, how long should you wait before evaluating efficacy?
#* 6 months
# When should a varicocelectomy be considered in men with infertility?
#* Palpable varicocele and testicular failure; however, low probability that this will result in any improvement in semen parameters