What do you do for a man with non-obstructive azoospermia, FSH of 14, total testosterone of 280, and testes of 12 mL who wants biological children?

Traditionally, these men would be counseled regarding undergoing a microTESE (microscopic testicular sperm extraction). While the overall success rate is relatively low (30-50%), it may be different based on the underlying histology. Therefore, some reproductive urologists will offer some form of te...

In the circumstance of nonobstructive azoospermia, my typical course of action is to offer testicular FNA mapping to determine testicular histology and to guide sperm retrieval recommendations. Details of this technique can be found here: Santamaria et al., VJSM 2024.

A debate comparing FNA mapping-...

Start with a good history of toxin exposure, chemo, mumps, alcohol abuse; check karyotype and Y microdeletion. Make sure NOA diagnosis is made with the centrifuged pellet. Assuming all negative, ensure he, and if partnered to a cis-female, his partner are ok using IVF, and have her evaluated. If all...