Clinically, men with azoospermia or severe oligospermia due to obstruction generally have normal testicular volume and texture, and normal serum hormonal profiles. Additional clinical findings suggestive of obstruction include dilation of the epididymides, hydroceles and absence of vas. In addition to azoospermia, in cases of ejac-ulatory duct obstruction, biochemical characteristics of seminal fluid may reveal decreased volume, pH of less than 7.4 or negativity for fructose. On the other hand, azoospermia from obstruction in the vasa or epididymides generally has a normal biochemical profile in the seminal fluid. A recent study suggested that a high titre of antisperm antibodies, measured by indirect immunobead assays in seminal fluid and serum, has a clinical value in predicting the presence of obstruction of the excurrent ductal system. birth control pills
As stated previously, testicular biopsy is indicated in azoospermic men with normal testicular examinations and hormonal profiles. However, if a congenital absence of vas deferens is diagnosed clinically, testicular biopsy is generally not necessary, because virtually all of these men have active spermatogenesis. For this latter group of patients, surgical sperm retrieval for assisted reproduction yields a high success rate.
In addition, unlike men with nonobstructive azoospermia, men with azoospermia due to obstruction (hence, ‘normal’ spermatogenesis) do not require karyotypical evaluation. However, for men with congenital absence of vas, the evaluation of cystic fibrosis transmembrane conductance regulator mutation, which is found in 50% to 80% of these men, is required for the couple because they are at a higher risk of having offspring with cystic fibrosis.