Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of primary/secondary infertility. Semen analysis confirms azoospermia on two separate occasions. No history of obstructive symptoms (vasectomy, hernia repair, or recurrent epididymitis). Denies history of mumps orchitis, cryptorchidism, or testicular torsion. No exposure to gonadotoxins, radiation, or anabolic steroids. Reports normal libido and erectile function. Family history negative for genetic infertility syndromes.
Clinical Examination Findings
Genitourinary exam: Penis normal in appearance. Testicular volume: Right [X] mL, Left [X] mL (typically small/atrophic). Consistency: Soft/firm. Epididymides: Non-tender, non-indurated, palpable bilaterally. Vas deferens: Palpable bilaterally. No evidence of varicocele (or Grade [I-III] varicocele noted). Secondary sexual characteristics: Normal (Tanner stage V). No gynecomastia.
Treatment Protocol
Plan: 1. Hormonal profile (FSH, LH, Testosterone, Prolactin, Estradiol). 2. Genetic testing (Karyotype, Y-chromosome microdeletion). 3. Scrotal ultrasound. 4. Counseling regarding Micro-TESE (Microdissection Testicular Sperm Extraction) for sperm retrieval. 5. Referral to reproductive endocrinology for partner evaluation. 6. Consider empirical medical therapy (e.g., Clomiphene citrate or hCG) if hypogonadotropic profile identified.