Editing CUA: Azoospermia (2015) (section)

== Normal semen volume azoospermia ==

* '''Categorized based on the luteinizing hormone (LH) and follicular stimulating hormone (FSH) levels, without the need for a testicular biopsy'''
** '''Pre-testicular failure: ↓LH and ↓ FSH levels and low or normal testosterone levels'''
** '''Testicular failure: ↑LH and ↑FSH and small testis bilaterally'''
*** '''Congenital causes of testicular failure DUNKY XX:'''
**** '''Down syndrome'''
**** '''Undescended testis'''
**** '''Noonan syndrome'''
**** '''Kleinfelter syndrome'''
**** '''Y-microdeletions'''
**** '''XX-male'''
* '''Men with normal levels of FSH and LH [and normal semen volume] could have either testicular failure or [pre-ejaculatory duct] obstructive azoospermia. There is no non-invasive method to differentiate these and a testicular biopsy is usually required to provide a definitive diagnosis.''' However, a testis biopsy should only be offered to men in whom this diagnosis would alter management
** '''The biopsy could be performed either:'''
*** '''As a diagnostic procedure alone'''
*** '''As the initial part of the procedure where after the biopsy results are available for quick section, the surgery would proceed with a reconstruction and/or sperm retrieval'''
** A bilateral diagnostic testicular biopsy is generally not required. '''If there is a discrepancy in testicular size, the larger of the two testes should be biopsied'''
*** '''Men with congenital bilateral absence of the vas deferens typically have normal spermatogenesis and a diagnostic biopsy is usually not required to diagnose active spermatogenesis.'''