Skip to main content Accessibility help
Hostname: page-component-848d4c4894-jbqgn Total loading time: 0 Render date: 2024-06-22T21:08:50.361Z Has data issue: false hasContentIssue false

Part I - Introduction

Published online by Cambridge University Press:  09 April 2021

Ashok Agarwal
The Cleveland Clinic Foundation, Cleveland, OH, USA
Ahmad Majzoub
Hamad Medical Corporation, Doha, Qatar
Sandro C. Esteves
Andrology & Human Reproduction Clinic, Sao Paulo, Brazil
Get access


Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



Kaprara, A, Huhtaniemi, IT. The hypothalamus–pituitary–gonad axis: tales of mice and men. Metabolism 2018;86:317.CrossRefGoogle ScholarPubMed
Turek, PJ. Male reproductive physiology. In Wein, AJ, Kavoussi, LR, Campbell, MF, Walsh, PC (eds.) Campbell–Walsh Urology. Elsevier, Philadelphia, PA, 2016, pp. 516537.Google Scholar
Matsumoto, AM, Bremner, WJ. Testicular disorders. In Melmed, S, Koenig, R, Rosen, C, et al. (eds.) Williams Textbook of Endocrinology. Elsevier, Philadelphia, PA, 2016, pp. 694784.CrossRefGoogle Scholar
Mruk, DD, Cheng, CY. Sertoli–Sertoli and Sertoli–germ cell interactions and their significance in germ cell movement in the seminiferous epithelium during spermatogenesis. Endocrine Rev 2004;25(5):747806CrossRefGoogle ScholarPubMed
Stukenborg, JB, Kjartansdóttir, KR, Reda, A, et al. Male germ cell development in humans. Hormone Res Paediatr 2014;81:212.Google Scholar
Potter, SJ, DeFalco, T. Role of the testis interstitial compartment in spermatogonial stem cell function. Reproduction 2017;153(4):R151R162.CrossRefGoogle ScholarPubMed
Mruk, DD, Cheng, CY. The mammalian blood–testis barrier: its biology and regulation. Endocrine Rev 2015;36(5):564591.Google Scholar
de Kretser, DM, Loveland, K, O’Bryan, M. Spermatogenesis. In Jameson, JL and De Groot, LJ (eds.) Endocrinology: Adult and Pediatric. Saunders, Philadelphia, PA, 2015, pp. 23252353.Google Scholar
Standring, S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st edn., Elsevier, Philadelphia, PA, 2016.Google Scholar
Johnson, L, Varner, DD. Effect of daily spermatozoan production but not age on transit time of spermatozoa through the human epididymis. Biol Reprod 1988;39:812817.Google Scholar
Jones, RC. To store or mature spermatozoa? The primary role of the epididymis. Int J Androl 2002;22(2):5766.Google Scholar
Bedford, JM. The epididymis re-visited: a personal view. Asian J Androl 2015;17:693698.Google Scholar
Hoffer, AP. The ultrastructure of the ductus deferens in man. Biol Reprod 1976;14:425443.Google Scholar
Braithwaite, JL. The arterial supply of the male urinary bladder. Br J Urol 1952;24:6471.Google Scholar


Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril 2015;103:e18e25.CrossRefGoogle Scholar
Chandra, A, Copen, CE, Stephen, EH. Infertility service use in the United States: data from the National Survey of Family Growth, 1982–2010. Natl Health Stat Report 2014;1–21. Available from: Scholar
Pastuszak, AW, Sigalos, JT, Lipshultz, LI. The role of the urologist in the era of in vitro fertilization-intracytoplasmic sperm injection. Urology 2017;103:1926.Google Scholar
Palermo, G, Joris, H, Devroey, P, Van Steirteghem, AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992;340:1718.Google Scholar
Niederberger, CS. Male infertility. In Wein, AJ, Kavoussi, LR, Partin, AW, Peters, CA (eds.) Campbell Walsh Urol, 11th edn. Elsevier, Amsterdam, 2016, pp. 556579.e1.Google Scholar
Katz, DJ, Teloken, P, Shoshany, O. Male infertility: the other side of the equation. Aust Fam Physician 2017;46:641646.Google Scholar
Pan, MM, Hockenberry, MS, Kirby, EW, Lipshultz, LI. Male infertility diagnosis and treatment in the era of in vitro fertilization and intracytoplasmic sperm injection. Med Clin North Am 2018;102:337347.CrossRefGoogle ScholarPubMed
Patel, ZP, Niederberger, CS. Male factor assessment in infertility. Med Clin North Am 2011;95:223234.CrossRefGoogle ScholarPubMed
Anguiano, A, Oates, RD, Amos, JA, et al. Congenital bilateral absence of the vas deferens: a primarily genital form of cystic fibrosis. JAMA 1992;267:17941797.CrossRefGoogle ScholarPubMed
Choi, WS, Kim, SW. Current issues in varicocele management: a review. World J Mens Health 2013;31:1220.Google Scholar
Cooper, TG, Noonan, E, Eckardstein, S et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update 2010;16:231245.Google Scholar
Guzick, DS, Overstreet, JW, Factor-Litvak, P, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 2001;345:13881393.Google Scholar
Hwang, K, Smith, JF, Coward, RM, et al. Evaluation of the azoospermic male: a committee opinion. Fertil Steril 2018;109:777782.Google Scholar
Shin, DH, Turek, PJ. Sperm retrieval techniques. Nat Rev Urol 2013;10:723730.CrossRefGoogle ScholarPubMed
Esteves, SC, Miyaoka, R, Agarwal, A. An update on the clinical assessment of the infertile male. Clinics (Sao Paulo) 2011;66:691700.Google Scholar
WHO. Laboratory Manual for the Examination and Processing of Human Semen, 5th edn., WHO, Geneva, 2010. Available from:;jsessionid=C7110716A3650EF69976E4C912ED8D19?sequence=1.Google Scholar
Agarwal, A, Majzoub, A, Esteves, SC, et al. Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios. Transl Androl Urol 2016;5:935950.Google Scholar
Hamada, A, Esteves, S, Agarwal, A. A comprehensive review of genetics and genetic testing in azoospermia. Clinics 2013;68:3960.Google Scholar
Wosnitzer, M, Goldstein, M, Hardy, MP. Review of azoospermia. Spermatogenesis 2014;4:e28218.Google Scholar
Schoor, Ra, Elhanbly, S, Niederberger, CS, Ross, LS. The role of testicular biopsy in the modern management of male infertility. J Urol 2002;167:197200.Google Scholar
Esteves, SC, Miyaoka, R, Roque, M, Agarwal, A. Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis. Asian J Androl 2016;18:246253.CrossRefGoogle ScholarPubMed
Practice Committee of the American Society for Reproductive Medicine. Management of nonobstructive azoospermia: a committee opinion. Fertil Steril 2018;110:12391245.Google Scholar
Oates, RD. The natural history of endocrine function and spermatogenesis in Klinefelter syndrome: what the data show. Fertil Steril 2012;98:266273.Google Scholar
Terribile, M, Stizzo, M, Manfredi, C, et al. 46,XX testicular disorder of sex development (DSD): a case report and systematic review. Medicina (B Aires) 2019;55:371.CrossRefGoogle ScholarPubMed
Mehta, A, Sigman, M. Management of the dry ejaculate: a systematic review of aspermia and retrograde ejaculation. Fertil Steril 2015;104:10741081.Google Scholar
Practice Committee of the American Society for Reproductive Medicine and The Society for Male Reproduction and Urology. The management of obstructive azoospermia: a committee opinion. Fertil Steril 2019 ; 111 :873880.CrossRefGoogle Scholar
Tournaye, H. Male factor infertility and ART. Asian J Androl 2012;14:103108.CrossRefGoogle ScholarPubMed
Esteves, SC, Roque, M, Bradley, CK, Garrido, N. Reproductive outcomes of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with high levels of DNA fragmentation in semen: systematic review and meta-analysis. Fertil Steril 2017;108:456467.e1.Google Scholar
Van Peperstraten, AM, Proctor, ML, Johnson, NP, Philipson, G. Techniques for surgical retrieval of sperm prior to intracytoplasmic sperm injection (ICSI) for azoospermia. Cochrane Database Syst Rev 2008;16:CD002807.Google Scholar
Donoso, P, Tournaye, H, Devroey, P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 2007;13:539549.Google Scholar


Nicopoullos, JD, Gilling-Smith, C, Almeida, PA, et al. Use of surgical sperm retrieval in azoospermic men: a meta-analysis. Fertil Steril 2004;82:691701.CrossRefGoogle ScholarPubMed
Esteves, SC, Myaoka, R, Orosz, JE, Agarwal, A. An update on sperm retrieval techniques for azoospermic males. Clinics 2013;68:99110.Google Scholar
Salehi, P, Derakhshan-Horeh, M, Nadeali, Z, et al. Factors influencing sperm retrieval following testicular sperm extraction in nonobstructive azoospermia patients. Clin Exp Reprod Med 2017;44(1):2227.Google Scholar
Schlegel, PN. Causes of a azoospermia and their management. Reprod Fertil Dev 2004;16:561572.CrossRefGoogle ScholarPubMed
Tournaye, H, Verheyen, G, Nagy, P, et al. Are there any predictive factors for successful testicular sperm recovery in azoospermic patients? Hum Reprod 1997;12:8086.Google Scholar
Cito, G, Coccia, ME, Picone, R, et al. Novel method of histopathological analysis after testicular sperm extraction in patients with nonobstructive and obstructive azoospermia. Clin Exp Reprod Med 2018;45(4):170176.Google Scholar
Caroppo, E, Colpi, EM, Gazzano, G, et al. Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study. J Assist Reprod Genet 2017;34(1):149154.Google Scholar
Martin-du-Pan, RC, Bischof, P. Increased follicle stimulating hormone in infertile men: is increased plasma FSH always due to damaged germinal epithelium? Hum Reprod 1995;10:19401945.Google Scholar
Tuttelmann, F, Laan, M, Grigorova, M, et al. Combined effects of the variants FSHB-211G>T and FSHR 2039A>G on male reproductive parameters. J Clin Endocrinol Metab 2012;97:36393647.Google Scholar
Tsujimura, A, Matsumiya, K, Miyagawa, Y, et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol 2004;172:19441947.Google Scholar
Colpi, GM, Colpi, EM, Piediferro, G, et al. Microsurgical TESE versus conventional TESE for ICSI in non-obstructive azoospermia: a randomized controlled study. Reprod Biomed Online 2009;18:315319.Google Scholar
Sousa, M, Cremades, N, Silva, J, et al. Predictive value of testicular histology in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen-thawed sperm and spermatids. Hum Reprod 2002;17:18001810.CrossRefGoogle ScholarPubMed
Cissen, M, Meijerink, AM, D’Hauwers, KW, et al. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 2016;31(9):19341941.Google Scholar
Schlegel, PN, Su, LM. Physiological consequences of testicular sperm extraction. Hum Reprod 1997;12:16881692.Google Scholar
Plas, E, Riedl, CR, Engelhardt, PF, Mühlbauer, H, Pflüger, H. Unilateral or bilateral testicular biopsy in the era of intracytoplasmic sperm injection. J Urol 1999;162:20102013.Google Scholar
Colpi, GM, Pozza, D. Diagnosing Male Infertility: New Possibilities and Limits, Karger, Basel, 1992.Google Scholar
Cito, G, Coccia, ME, Dabizzi, S, et al. Relevance of testicular histopathology on prediction of sperm retrieval rates in case of non-obstructive and obstructive azoospermia. Urologia 2018;85(2):6067.Google Scholar
Shoshany, O, Shtabholtz, Y, Schreter, E, et al. Predictors of spermatogenesis in radical orchiectomy specimen and potential implications for patients with testicular cancer. Fertil Steril 2016;106(1):7074.Google Scholar
Banz-Jansen, C, Nikorowitsch, C, Drechsler, T, et al. Incidence of testicular malignancies and correlation to risk factors in a TESE population of subfertile men. Arch Gynecol Obstet 2012;285(1):247253.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats