Non-obstructive azoospermia: current and future perspectives

Fac Rev. 2021 Jan 26:10:7. doi: 10.12703/r/10-7. eCollection 2021.


Infertility affects 1 in 6 couples, and male factor infertility has been implicated as a cause in 50% of cases. Azoospermia is defined as the absence of spermatozoa in the ejaculate and is considered the most extreme form of male factor infertility. Historically, these men were considered sterile but, with the advent of testicular sperm extraction and assisted reproductive technologies, men with azoospermia are able to biologically father their own children. Non-obstructive azoospermia (NOA) occurs when there is an impairment to spermatogenesis. This review describes the contemporary management of NOA and discusses the role of hormone stimulation therapy, surgical and embryological factors, and novel technologies such as proteomics, genomics, and artificial intelligence systems in the diagnosis and treatment of men with NOA. Moreover, we highlight that men with NOA represent a vulnerable population with an increased risk of developing cancer and cardiovascular comorbodities.

Keywords: Male infertility; artificial intelligence; azoospermia; genetics; sperm retrieval.

Publication types

  • Review

Grants and funding

Tharu Tharakan has received funding from an Imperial Private Services Fellowship, and Channa N. Jayasena has received funding from an NIHR Post-Doctoral Fellowship. Channa N. Jayasena has received an investigator-led grant from Logixx Pharmaceuticals Ltd.