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Tests of sperm DNA damage and sperm chromosome anomalies have also been developed. The advanced sperm tests yield information on the fertilizing capacity of human spermatozoa, as well as their ability to support normal embryonic development. The most common abnormalities involve the structure of the sperm tail, with defects in either the axoneme or outer dense fibers. Postcoital test (PCT) assesses the ability of sperm to traverse the cervical mucus, and is performed by examining the cervical mucus several hours after intercourse for the presence of sperm. The sperm penetration assay (SPA) utilizes hamster ova, which have had the zona pellucida enzymatically removed, allowing penetration by human spermatozoa. The hemizona assay uses zona pellucida from nonfertilizable, nonliving oocytes. Reactive oxygen species (ROS) are ubiquitous in aerobic biologic systems and are formed as a by-product of oxygen metabolism.
Although obstruction of the reproductive tract leading to azoospermia is not the major cause of infertility, accurate diagnosis of its cause and its anatomic location is essential and may permit successful reconstruction. The diagnostic, laboratory, and surgical procedures utilized to arrive at the appropriate diagnosis and the available therapeutic modalities will be discussed.
Approach to the azoospermic male
A thorough reproductive, developmental, medical, surgical, and exposure history is essential for the accurate assessment of the azoospermic male. Male reproduction is dependent upon the normalcy of the hypothalamic–pituitary–gonadal axis, the testicle, the anatomic reproductive tract, and sexual function.
Azoospermia is defined as the absence of sperm from the ejaculate. There must be a normal conduit system and normal sexual function to allow for delivery of the sperm. The azoospermic individual has, by definition, an abnormality within one of these loci, and the appropriate evaluation should identify the site of the abnormality. The couple's reproductive, sexual, developmental, medical, and surgical histories should be elicited in an attempt to identify abnormalities within each of these processes necessary for normal reproductive function. A sexual and reproductive history may define the problem and its duration.
The developmental history attempts to define the normalcy of pubertal development, which is dependent on a normally functioning hypothalamic–pituitary–gonadal axis. The medical and surgical histories should identify potential risk factors which may contribute to an individual's infertility.
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