• Review of Azoospermia: From Diagnosis to Treatment
  • Behzad Bahramzadeh,1 Saeid Ghorbian,2,*
    1. Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz-Iran and also Department of Biology, Faculty of Basic Sciences, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
    2. Department of Biology, Faculty of Basic Sciences, Ahar Branch, Islamic Azad University, Ahar - Iran


  • Introduction: The most severe form of male infertility is termed azoospermia, where no sperm are identified in semen. Azoospermia can be observed in about 1% of men. In terms of numbers, it is estimated to affect between 10% and 15% of men in infertile couples. Azoospermia is usually a condition with no noticeable symptoms. Affected men usually have no complaints.WHO recommends that two semen analyses be performed two to three months a part. If in the first and second semen analysis the sperm count is zero, the diagnosis of azoospermia is confirmed.
  • Methods: we were conducted used the PubMed/MEDLINE , EMBASE databases and search restrictions included the English.
  • Results: Azoospermia can be further divided into obstructive azoospermia (OA), as a result of an obstruction in the ejaculatory pathway or non-obstructive azoospermia (NOA), as a result of defective spermatogenesis .The reproductive prognosis in obstructive azoospermia is good. The Y chromosome is one of the smallest chromosomes in the human genome and only chromosome that can be missing entirely without lethal consequences . The Y chromosome is essential for testis development and spermatogenesis. The Y chromosome is generally divided into two domains, the pseudoautosomal regions (PAR1 and PAR2) and an area known as male specific Y region (MSY). Within the MSY and on the long arm of the Y chromosome, are regions known as the azoospermia factor (AZF) regions, which contain genes critical for spermatogenesis and male fertility .The AZFa region is the shortest of the regions, This region is found deleted about 0.5–4% of the time when AZF deletions are found . Despite being the smallest of the AZF regions, complete deletion leads to the most severe phenotype, Sertoli cell only Syndrome. The AZFb region is in the mid portion of Yq11 and overlapping with the AZFc region. It is generally accepted that AZFb deletions lead to azoospermia. AZFc is the largest of the coding regions and most complex. complete deletions are found in 80% of all AZF deletions . but AZFc have a 50% chance of retrieving sperm in testicular extraction.
  • Conclusion: most common genetic disorder causing NOA is the Klinefelter syndrome (KS), which is characterized by the presence of an extra X chromosome. However, there are other implications for beyond just the AZF deletions that can affect spermatogenesis. Copy number variations of DAZ, RBMY1, CDY1, TSPY1 the DYZ1 array, have all be implicated in affecting spermatogenesis. If the azoospermia is caused by a stress problem or a current drug, it sometimes helps to stop the causative agent. reduce the stress or stop taking the drug. If the root cause is a hormonal problem, as in hypogonadotropic hypogonadism, treatment with FSH may be effective in getting the testicles to produce sperm again. However, in obstructive azoospermia, the first treatment is surgical repair to remove the blockage and connect the ducts, and the second treatment, if surgical repair is not possible, is sperm extraction from the testis (TESE) or epididymis (PESA).
  • Keywords: Azoospermia, Male Infertility, Y Chromosome, Sertoli cell only, Testis