A couple comes for evaluation of infertility. The HSG was normal but semen analysis revealed azoospermia. What is the diagnostic test to differentiate between testicular failure and vas deferens obstruction?
Ans: A. Serum FSH
- Before initiating treatment for a couple, in whom the man has azoospermia, it is important to distinguish whether the lack of sperm in the ejaculate is from an obstructive or non-obstructive process.
- The presence of normal volume testes with bilaterally indurated epididymis and/or absent vas deferens will point to an obstructive aetiology for azoospermia.
- A history of cryptorchidism in the presence of small or soft testes suggests non-obstructive azoospermia, especially if associated with an elevated serum (FSH) level.
- A decreased spermatogenesis leads to a decrease in the production of inhibin, which causes an elevation in FSH.