Reclassification of azoospermia: the time has come?

sit together, rather uncomfortably, in the same category, and Assisted Conception Services, Birmingham Women’s Hospital, is a recipe for potential misdiagnosis and mismanagement. Birmingham B15 2TG, UK It is a truism that one needs to appreciate the normal in This opinion was previously published on Webtrack 93, order to understand the abnormal. Normally, the hormones of November 4, 1999 the hypothalamic–pituitary axis stimulate the testis, the testis Azoospermia (the absence of spermatozoa from the ejaculate) produces spermatozoa which travel to the exterior through is not uncommon, and is present in ~5% of all investigated patent and properly functioning seminal ducts. Logically, infertile couples (Irvine, 1998), and in 10–20% of infertile therefore, azoospermia could be divided into causes due men with abnormal seminal fluid analysis (Stanwell-Smith and to deficient hormonal stimulation of the testis, testicular Hendry, 1984). Over the past few years there has been dysfunction, and seminal ducts obstruction or dysfunction; much renewed interest in the condition because of increased pre-testicular, testicular, and post-testicular causes respectively. understanding of its genetic basis and aetiology (Mak and Indeed, a similar classification of male factor infertility in Jarvi, 1996) as well as the availability of surgical sperm general has been previously described in some textbooks and retrieval methods and intracytoplasmic sperm injection (ICSI) papers (Berkow and Fletcher, 1992; Mak and Jarvi, 1996). for the treatment of the resulting infertility (Palermo et al., However, almost all current clinical and research papers on 1999). As more advances are being made and publicised, azoospermia use the ‘obstructive/non-obstructive’ classificaclinicians of different disciplines will be dealing with more tion with its aforementioned drawbacks. The following azoospermic patients than any other time in the past. It is, classification should provide a more logical framework. therefore, both desirable and timely that there is a clear, logical