Azoospermia is the absence of sperm in the ejaculate. It is observed around 1% in the general population and at a rate of 10-15% in men who were applied to infertility.

There are two types of azoospermia: 1) Non-obstructive azoospermia develops due to sperm production disorders in the testicle, and 2) Obstructive Azoospermia occurs due to subsequent obstruction or congenital absence of the sperm ducts in consequence of infection, surgery or injury.

Non-obstructive azoospermia is more common (60%) than obstructive azoospermia. It may develop due to many reasons such as hormonal (endocrine) diseases, genetic disorders, undescended testis (cryptorchidism), varicocele, testicular toxic substances (gonadotoxins, radiotherapy, chemotherapy), testicular injury, testicular infections (especially mumps orchitis=parotitis), environmental toxic factors (Pb / Cd industry, battery / battery industry employees, high temperature, etc.).

For the diagnosis of azoospermia, it was taken a detailed history/information from the patient and a careful physical examination should be performed, as well as semen analysis, hormonal evaluation (FSH, LH, Total Testosterone, Prolactin, Estradiol, Inhibin B), and radiological examination (Doppler ultrasound) if it is indicated.

Genetic evaluation is an essential examination in azoospermia cases. Peripheral chromosomal abnormalities are observed in 5-10% of cases and chromosome-Y abnormalities are in 10-15% in azoospermia men.

In cases of non-occlusive azoospermia, the cause of endocrine problem-induced azoospermia, which is called "hypogonadotropic hypogonadism" because of a lack of hormones that produce sperm due to a hormonal disorder, can be achieved in these patients with drug therapy. In all cases of non-occlusive azoospermia, drug therapy is experimental.

In cases of non-occlusive azoospermia, if azoospermia results from the endocrine problem as a due to hormonal deficiencies in sperm production, it is called as "hypogonadotropic hypogonadism", and sperm can be achieved in these patients with drug therapy.  Medical treatment is empiric in other non-obstructive azoospermia cases.

In cases of non-obstructive azoospermia, the sperm canals are observed are better observed under the operation microscope with general anesthesia and enlarged and dilated canals are collected, and sperm is tried to be found. This process is called as micro TESE (m-TESE). The sperm retrieval rate is between 50-60% with this method.



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