Editing CUA: Azoospermia (2015) (section)

== Management ==

=== Pre-testicular azoospermia ===

* '''FSH/LH or gonadotropin-releasing hormone (GnRH) analogues stimulate spermatogenesis'''
* '''In > 90% of cases, spermatogenesis is induced and men have ejaculated sperm.'''
* '''Treatment may take >6 months to be effective'''

=== Testicular failure ===

* '''Testicular sperm extraction (TESE) may be used'''.
** Large sections of the seminiferous tubules of the testis are examined with an operating microscope.
*** Larger tubules are more likely to have spermatogenesis than smaller diameter tubules.

=== Failure to ejaculate ===

* '''Men with a neurological cause for a failure to ejaculate should be offered either vibro-stimulation or electro-ejaculation.'''
** '''Both procedures may cause autonomic dysreflexia in men with high spinal cord injuries.'''

=== Retrograde ejaculation ===

* Since retrograde ejaculation may be due to a failure of the bladder neck to close with orgasm, '''use of an alpha agonist (60 mg''' or other alpha agonist) '''[or SNRI such as imipramine]''' before ejaculation may close the bladder neck and convert retrograde into ante-grade ejaculation.
* '''If this is not successful, it is often possible to retrieve sperm from the bladder (either using a post-ejaculatory voided or catheterized urine specimen).''' This sperm could then be used for one of the assisted reproductive technologies.

=== Obstructive azoospermia ===

# '''Sperm retrieved from the reproductive tract'''
#* The method of sperm retrieval used may be a percutaneous or an open microscopic aspiration of sperm from the epididymis or a percutaneous or open biopsy of the testis.
# '''Bypass/repair of the obstructed area of the reproductive tract.'''
#* '''The most common area of obstruction is the epididymis'''
#* Men should be offered the option to cryo-bank sperm retrieved during the course of the operation in case the surgery is not successful
#* '''Transurethral resection of the ejaculatory duct can be used to treat ejaculatory duct obstruction'''