Azoospermia: diagnosis and management.

By using a detailed history and physical examination, endocrinologic studies, and, in some cases, testicular biopsy, we assign azoospermic men to three pathogenic groups: pretesticular, testicular, and posttesticular. This and further subclassification allow physicians to provide prognostic information. A few patients will have lesions amenable to surgical correction, or endocrinologic abnormalities that can be treated by replacement therapy or, as in the case of prolactin elevation, by surgery, irradiation, or bromocriptine therapy. Patients afflicted with irreversible sterility should be advised to accept the diagnosis and consider other pathways to parenthood, such as adoption or artificial insemination.