1. Clinical Management of Men with Nonobstructive Azoospermia Sandro C. Esteves, MD., PhD. Medical & Scientific Director, ANDROFERT Andrology & Human Reproduction Clinic Campinas, BRAZIL Innovation in Male Infertility: Where Assisting Nature Meets Andrologists June 17, Tessaloniki GREECE 2. Learning objectives At the completion of this talk participants should be able to: Understand why nonobstructive azoospermia is one of the most challenging conditions in infertility care Learn how we manage infertile couples in whom the male partner has NOA at Androfert ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 5 2015 ANDROFERT 3. ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 6 2015 ANDROFERT 4. Azoospermia: the complete lack of sperm in ejaculate after centrifugation 10-15% infertile males 1-3% male population Cooper et al. Hum Reprod Update 2009; Esteves & Agarwal, Clinics 2013 ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 7 2015 ANDROFERT 5. Esteves et al Int Braz J Urol 2014; 40: 443-53 Goals of semen analysis are to reduce analytical error and enhance precision Examination of pelleted semen Differentiation between true azoospermia and cryptozoospermia Minimum 2 analyses Transient azoospermia due to medical conditions and biological variability Supernatant is discharged Pellet is meticulously examined Centrifugation at 3,000g for 15 minutes ANDROLOGY AND HUMAN REPRODUCTION CLINIC - REFERRAL CENTER FOR MALE REPRODUCTION S ESTEVES, 8 2015 ANDROFERT 6. Prognosis and management differentially affected by type of azoospermia Obstructive Non- obstructive Hypo-hypo Spermatogenic failure Clinical picture FSH/LH: or nl TT: low or nL Testes: small or nl Normal testes & endocrine profile; Mechanical blockage FSH/LH