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Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations

Rambhatla A 1 , Shah R 2 , Ziouziou I 3 , Kothari P 4 , Salvio G 5 , Gul M 6 Show all authors , Hamoda T 7 , Kavoussi P 8 , Atmoko W 9 , Toprak T 10 , Birowo P 9 , Ko E 11 , Arafa M 12 , Ghayda RA 13 , Karthikeyan VS 14 , Russo GI 15 , Pinggera GM 16 , Chung E 17 , Harraz AM 18 , Martinez M 19 , Phuoc NHV 20 , Tadros N 21 , Saleh R 22 , Savira M 9 , Colpi GM 23 , Zohdy W 24 , Pescatori E 25 , Park HJ 26 , Fukuhara S 27 , Tsujimura A 28 , Rojas-Cruz C 29 , Marino A 30 , Mak SK 31 , Amar E 32 , Ibrahim W 33 , Sindhwani P 34 , Alhathal N 35 , Busetto GM 36 , Al Hashimi M 37 , El-Sakka A 38 , Ramazan A 39 , Dimitriadis F 40 , Timpano M 41 , Jezek D 42 , Altay B 43 , Zylbersztejn DS 44 , Wong MY 45 , Moon DG 46 , Wyns C 47 , Gamidov S 48 , Akhavizadegan H 49 , Franceschelli A 50 , Aydos K 51 , Quang N 52 , Ashour S 24 , Al Dayel A 53 , Al-Marhoon MS 54 , Micic S 55 , Binsaleh S 56 , Hussein A 57 , Elbardisi H 12 , Mostafa T 24 , Ramsay J 58 , Zachariou A 59 , Abdelrahman IFS 24 , Rajmil O 60 , Kalkanli A 61 , Molina JMC 62 , Bocu K 63 , Duarsa GWK 64 , Çeker G 65 , Serefoglu EC 66 , Bahar F 67 , Gherabi N 68 , Kuroda S 69 , Bouzouita A 70 , Gudeloglu A 71 , Ceyhan E 72 , Hasan MSM 73 , Musa MU 74 , Motawi A 24 , Cho CL 75 , Taniguchi H 76 , Ho CCK 77 , Vazquez JFS 78 , Mutambirwa S 79 , Gungor ND 80 , Bendayan M 81 , Giulioni C 82 , Baser A 83 , Falcone M 41 , Boeri L 84 , Blecher G 85 , Kheradmand A 86 , Sethupathy T 87 , Adriansjah R 88 , Narimani N 89 , Konstantinidis C 90 , Nguyen TT 91 , Japari A 92 , Dolati P 93 , Singh K 94 , Ozer C 72 , Sarikaya S 95 , Sheibak N 96 , Bosco NJ 97 , Özkent MS 98 , Le ST 57 , Sokolakis I 99 , Katz D 100 , Smith R 101 , Truong MN 93 , Le TV 20 , Huang Z 102 , Deger MD 103 , Arslan U 10 , Calik G 104 , Franco G 105 , Rashed A 106 , Kahraman O 72 , Andreadakis S 107 , Putra R 108 , Balercia G 5 , Khalafalla K 17 , Cannarella R 15 , Tuân AÐ 109 , El Meliegy A 24 , Zilaitiene B 110 , Ramirez MLZ 111 , Giacone F 112 , Calogero AE 15 , Makarounis K 113 , Jindal S 114 , Hoai BN 115 , Banthia R 116 , Peña MR 117 , Moorthy D 118 , Adamyan A 119 , Kulaksiz D 120 , Kandil H 121 , Sofikitis N 59 , Salzano C 122 , Jungwirth A 123 , Banka SR 124 , Mierzwa TC 125 , Turunç T 126 , Jain D 127 , Avoyan A 120 , Salacone P 128 , Kadıoğlu A 129 , Gupta C 130 , Lin H 131 , Shamohammadi I 132 , Mogharabian N 133 , Barrett T 134 , Danacıoğlu YO 135 , Crafa A 15 , Daoud S 136 , Malhotra V 137 , Almardawi A 138 , Selim OM 24 , Moussa M 139 , Haghdani S 140 , Duran MB 141 , Kunz Y 16 , Preto M 41 , Eugeni E 142 , Nguyen T 120 , Elshahid AR 106 , Suyono SS 143 , Parikesit D 144 , Nada E 22 , Orozco EG 145 , Boitrelle F 81 , Trang NTM 146 , Jamali M 147 , Nair R 148 , Ruzaev M 149 , Gadda F 84 , Thomas C 90 , Ferreira RH 150 , Gul U 151 , Maruccia S 152 , Kanbur A 153 , Kinzikeeva E 154 , Abumelha SM 138 , Kosgi R 155 , Gokalp F 156 , Soebadi MA 157 , Paul GM 158 , Sajadi H 159 , Gupte D 160 , Ambar RF 125 , Sogutdelen E 161 , Singla K 162 , Basukarno A 163 , Kim SHK 164 , Gilani MAS 159 , Nagao K 165 , Brodjonegoro SR 166 , Rezano A 167 , Elkhouly M 168 , Mazzilli R 169 , Farsi HMA 7 , Ba HN 170 , Alali H 164 , Kafetzis D 171 , Long TQT 172 , Alsaid S 24 , Cuong HBN 173 , Oleksandr K 174 , Mustafa A 88 , Acosta H 175 , Pai H 176 , Şahin B 177 , Arianto E 178 , Teo C 179 , Jayaprakash SP 14 , Rachman RI 9 , Yenice MG 135 , Sefrioui O 180 , Priyadarshi S 181 , Tanic M 182 , Alfatlaw NK 183 , Rizaldi F 167 , Vishwakarma RB 2 , Kanakis G 184 , Cherian DT 185 , Lee J 186 , Galstyan R 187 , Keskin H 73 , Wurzacher J 16 , Seno DH 188 , Noegroho BS 88 , Margiana R 178 , Javed Q 189 , Castiglioni F 190 , Tanwar R 191 , Puigvert A 80 , Kaya C 192 , Purnomo M 193 , Yazbeck C 194 , Amir A 195 , Borges E 196 , Bellavia M 23 , Deswanto IA 9 , Kv V 197 , Liguori G 198 , Minh DH 199 , Siddiqi K 200 , Colombo F 25 , Zini A 201 , Patel N 202 , Çayan S 203 , Al-Kawaz U 204 , Ragab M 205 , Hebrard GH 206 , de la Rosette J 104 , Efesoy O 205 , Hoffmann I 207 , Teixeira TA 208 , Saylam B 203 , Delgadillo D 78 , Agarwal A 209 , Global Andrology Forum

Affiliations 

  • 1 Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
  • 2 Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
  • 3 Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
  • 4 Department of Urology, Topiwala National Medical College, B.Y.L Nair Charitable Hospital, Mumbai, India
  • 5 Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
  • 6 Department of Urology, Selçuk University School of Medicine, Konya, Turkey
  • 7 Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
  • 8 Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
  • 9 Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 10 Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
  • 11 Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
  • 12 Department of Urology, Hamad Medical Corporation, Doha, Qatar
  • 13 Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
  • 14 Andrology Unit, Department of Urology, Apollo Hospitals, Chennai, India
  • 15 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  • 16 Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
  • 17 Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
  • 18 Department of Urology, Mansoura University Urology and Nephrology Center, Mansoura, Egypt
  • 19 Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
  • 20 Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
  • 21 Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
  • 22 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
  • 23 Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
  • 24 Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
  • 25 Andrology and Reproductive Medicine Unit, Next Fertility GynePro, Bologna, Italy
  • 26 Department of Urology, Pusan National University School of Medicine, Busan, Korea
  • 27 Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
  • 28 Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
  • 29 Department of Urology, University Hospital of Rostock, Rostock, Germany
  • 30 Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
  • 31 Department of Surgery, Union Hospital Reproductive Medicine Centre (Tsim Sha Tsui), Kowloon, China
  • 32 Department of Urology, American Hospital of Paris, Paris, France
  • 33 Department of Obstetrics Gynecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt
  • 34 Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
  • 35 Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  • 36 Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
  • 37 Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
  • 38 Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
  • 39 45Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
  • 40 1st Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • 41 Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
  • 42 Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
  • 43 Department of Urology, Ege University Medical School, Bornova, Turkey
  • 44 Department of Surgery, Discipline of Urology, Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil
  • 45 Department of Andrology, International Urology, Fertility and Gynecology Centre, Mount Elizabeth Hospital, Singapore
  • 46 Department of Urology, Korea University Guro Hospital, Seoul, Korea
  • 47 Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
  • 48 V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia
  • 49 Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • 50 Andrology Unit, University Hospital S. Orsola, Bologna, Italy
  • 51 Department of Urology, Ankara University, Ankara, Turkey
  • 52 Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
  • 53 Men's Health Clinic Dammam, Dammam, Saudi Arabia
  • 54 Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Oman
  • 55 Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
  • 56 Division of Urology, Deparment of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 57 Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
  • 58 Department of Andrology, Hammersmith Hospital, London, UK
  • 59 Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
  • 60 Department of Andrology, Fundació Puigvert, Barcelona, Spain
  • 61 Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
  • 62 Department of Urology, Hospital Clínico de Barcelona, Barcelona, Spain
  • 63 Urology Department, Niğde Omer Halis Demir University, Faculty of Medicine, Sirnak, Turkey
  • 64 Department of Urology, Udayana University, Denpasar, Indonesia
  • 65 Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
  • 66 Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
  • 67 Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
  • 68 Department of Medicine, University of Algiers 1, Algiers, Algeria
  • 69 Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
  • 70 Department of Anatomy, Faculty of Medicine, Faculty Tunis Manar, Tunis, Tunisia
  • 71 Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
  • 72 Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
  • 73 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
  • 74 Urology Unit, Department of Surgery, Federal Medical Center, Katsina State, Nigeria
  • 75 Department of Surgery, S. H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
  • 76 Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
  • 77 Department of Surgery, School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia
  • 78 IVF Department, CITMER Reproductive Medicine, Mexico City, Mexico
  • 79 Department of Urology, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Science University, Medunsa, South Africa
  • 80 Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
  • 81 Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
  • 82 Department of Urology, Polytechnic University of Marche, Ancona, Italy
  • 83 Department of Urology, Faculty of Medicine, Bandırma Onyedi Eylül University, Balıkesir, Turkey
  • 84 Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
  • 85 Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
  • 86 Department of Urology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  • 87 Department of Obstetrics and Gynaecology, CK Medical Centre Hospital, Erode, India
  • 88 Department of Urology, Hasan Sadikin General Hospital, Faculty of Medicine of Padjadjaran University, Bandung, Indonesia
  • 89 Department of Urology, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Science, Tehran, Iran
  • 90 Urology and Neuro-Urology Unit, National Rehabilitation Center, Athens, Greece
  • 91 Department of Urology, University of California, Irvine, CA, USA
  • 92 Department of Urology, Fertility Clinic, Telogorejo Hospital, Central Java, Indonesia
  • 93 Department of Animal Science, Faculty of Agriculture, University of Shiraz, Shiraz, Iran
  • 94 Department of Preclinical and Health Sciences, Faculty of Medical Sciences, The University of West Indies, Bridgetown, Barbados
  • 95 Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
  • 96 Department of Anatomical Sciences, Reproductive Sciences and Technology Research Center, Iran University of Medical Sciences, Tehran, Iran
  • 97 Department of Dermatology, Venereology & Andrology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
  • 98 Department of Urology, Konya City Hospital, Konya, Turkey
  • 99 Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
  • 100 Men's Health Melbourne, Victoria, Australia
  • 101 Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
  • 102 Department of Obstetrics and Gynaecology, National University Health Systems, Singapore
  • 103 Department of Urology, Edirne Sultan 1st Murat State Hospital, Edirne, Turkey
  • 104 Department of Urology, Istanbul Medipol University, Istanbul, Turkey
  • 105 Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
  • 106 123Department of Urology, Faculty of Medicine, 6th of October University, Giza, Egypt
  • 107 Private Practice, Thessaloniki, Greece
  • 108 Department of Urology, RSUD Ciawi Regional General Hospital, West Java, Indonesia
  • 109 Tam Anh IVF Center, Tam Anh General Hospital, Hanoi, Vietnam
  • 110 Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 111 Reproductive Medicine Unit, Español Hospital, Mexico City, Mexico
  • 112 HERA Center, Unit of Reproductive Medicine, Sant'Agata Li Battiati, Catania, Italy
  • 113 Department of Urology and Andrology, Locus Medicus, Athens, Greece
  • 114 Department of Andrology & Reproductive Medicine, Jindal Hospital & Fertility Center, Meerut, India
  • 115 Department of Andrology and Sexual Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
  • 116 Department of Urology, Western General Hospital, Edinburgh, UK
  • 117 Institute of Gynecology and Fertility (IFER), University of Buenos Aires, Buenos Aires, Argentina
  • 118 IVF Department, Swarupa Fertility & IVF Centre, Vijayawada, India
  • 119 Department of Urology, Astghik Medical Center, Yerevan, Armenia
  • 120 Department of Obstetrics and Gynecology, Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
  • 121 Fakih IVF Fertility Center, Abu Dhabi, UAE
  • 122 PO San Giovanni Bosco, ASL Napoli 1 Centro, Napoli, Italy
  • 123 St. Barabara Private Clinic, Bad Vigaun, Austria
  • 124 Department of Andrology, Androcare Institute of Andrology and Men's Health, Hyderabad, India
  • 125 Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
  • 126 Urology Clinic, Iskenderun Gelisim Hospital, Iskenderun, Turkey
  • 127 Department of Obstetrics and Gynecology, Jaipur Golden Hospital, New Delhi, India
  • 128 Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
  • 129 Section of Andrology, Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey
  • 130 Department of Urology, Jaipur National University, Jaipur, India
  • 131 Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
  • 132 Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
  • 133 Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
  • 134 Perth Urology Clinic, Perth, WA, Australia
  • 135 Department of Urology, University of Health Science, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
  • 136 Laboratory of Histo-Embryology and Reproductive Biology, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
  • 137 Department of Urology and Andrology, VNA Hospital, New Delhi, India
  • 138 Department of Urology, Prince Sultan Millitary Medical City, Riyadh, Saudi Arabia
  • 139 Department of Urology, Lebanese University, Beirut, Lebanon
  • 140 Andrology Research Center, Yazd Reproductive Science Institute, Isfahan Fertility and Infertility Center, Isfahan, Iran
  • 141 Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
  • 142 Department of Medicine and Surgery, University of Perugia, Perugia, Italy
  • 143 Gladiool IVF, Magelang, Indonesia
  • 144 Department of Urology, Faculty of Medicine, Universitas Indonesia Hospital, Depok, Indonesia
  • 145 IVF Department, CITMER Reproductive Medicine, Nuevo Leon, Mexico
  • 146 Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
  • 147 Department of Urology, Military Teaching Hospital, Rabat, Morocco
  • 148 Department of Reproductive Medicine, Mitera Hospital, Kottayam, India
  • 149 Urology Clinic, Moscow, Russia
  • 150 Department of Urology, Santa Casa de Ribeirão Preto, São Paulo, Brazil
  • 151 Private EPC Hospital, Adana, Turkey
  • 152 Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy
  • 153 Department of Andrology, Kanbur Clinic, Thane, India
  • 154 Andrology Unit, Zucchi Clinical Institutes, Monza, Italy
  • 155 Department of Andrology and Men's Health, Apollo Hospitals, Hyderabad, India
  • 156 Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Turkey
  • 157 Department of Urology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • 158 Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  • 159 Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India
  • 160 Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey
  • 161 Urology Department, Clarity Health, Chandigarh, India
  • 162 Department of Urology, Dr. Dradjat Hospital, Serang, Indonesia
  • 163 IVF Australia, Sydney, Australia
  • 164 Department of Urology, Macquarie University Faculty of Medicine and Health Sciences, Sydney, Australia
  • 165 Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
  • 166 Division of Urology, Department of Surgery, Prof. Dr. Sardjito Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
  • 167 Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • 168 IVF Department, Bourn Hall Fertility Center, Dubai, UAE
  • 169 Unit of Endocrinology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
  • 170 Andrology Unit, ART Center, Vinmec Times City International Hospital, Hanoi, Vietnam
  • 171 Orchid IVF Clinic, Dubai, UAE
  • 172 Department of Obstetrics and Gynecology, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
  • 173 Department of Surgery, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
  • 174 Department of Urology, Nephrology and Andrology Kharkiv National Medical University, Kharkiv, Ukraine
  • 175 Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
  • 176 IVF Department, Bloom IVF Group, Mombai, India
  • 177 Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
  • 178 Department of Urology, Prof R.D. Kandou Hospital, Manado, Indonesia
  • 179 Department of Urology, Gleneagles Hospital, Singapore
  • 180 African Fertility Center, Casablanca, Morocco
  • 181 Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
  • 182 Department of Urology, General Hospital, Cuprija, Serbia
  • 183 Fertility Center of Al-Najaf, Al-Sadr Medical City, Babylon Health Directorate, Iraqi Ministry of Health, Baghdad, Iraq
  • 184 Department of Endocrinology, Diabetes and Metabolism, Athens Naval & VA Hospital, Athens, Greece
  • 185 Urology Department, Aster Medcity, Kochi, India
  • 186 Department of Urology, National University Hospital, Singapore
  • 187 Department of Urology, Yerevan State Medical University, Yerevan, Armenia
  • 188 Division of Urology, Department of Surgery, Persahabatan General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 189 Department of Urology, Al-Ahlia Hospital, Abu Dhabi, UAE
  • 190 Andrology Unit, ART Center - San Carlo Clinic, Milan, Italy
  • 191 Urology Center, Jyoti Hospital, Gurugram, India
  • 192 Department of Urology, Health Science University Eskisehir City HPRH, Eskisehir, Turkey
  • 193 Department of Urology, Brawijaya University, Malang, Indonesia
  • 194 Department of Obstetrics Gynecology and Reproductive Medicine, Reprogynes Medical Institute, Paris, France
  • 195 Department of Urology, Dr Wahidin Sudirohusodo Hospital, Makassar, Indonesia
  • 196 IVF Department, Fertility Assisted Fertilization Center, São Paulo, Brazil
  • 197 Department of Urology, Cure & SK Hospital, Trivandrum, India
  • 198 Department of Urology, University of Trieste, Trieste, Italy
  • 199 Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
  • 200 Department of Urology, Cleveland Clinic, Abu Dhabi, UAE
  • 201 Department of Surgery, McGill University, Montreal, QC, Canada
  • 202 Akanksha Hospital and Research Institute, Anand, Gujarat, India
  • 203 Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
  • 204 High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq
  • 205 Department of Andrology, Tanta University, Tanta, Egypt
  • 206 IVF Department, CITMER Reproductive Medicine, Puebla, Mexico
  • 207 Department of Reproductive Medicine and Andrology, University Clinic Halle (Saale), Halle, Germany
  • 208 Division of Urology, University Hospital, Federal University of Amapa, Macapá, Brazil
  • 209 Cleveland Clinic Foundation, Cleveland, OH, USA. agarwaa32099@outlook.com
World J Mens Health, 2024 Apr 04.
PMID: 38606867 DOI: 10.5534/wjmh.230339

Abstract

PURPOSE: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA.

MATERIALS AND METHODS: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process.

RESULTS: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit.

CONCLUSIONS: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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