Azoospermia is the absence of sperm in the ejaculate. We say it is secretory, when such absence is due to a lack of sperm production in the testicles (spermatogenesis). This sperm alteration may be reversible or irreversible.
When we find a patient with a secretory azoospermia the first thing we must do is complete the diagnosis with genetic tests, analytical, testicular ultrasound and assessment by a urologist.
In the case of patients with hyperprolactinemia, magnetic resonance imaging of the sella turcica should be requested to rule out possible hyperprolactinoma. Depending on the outcome, it could be treated with surgery if necessary or with bromocriptine.
The main gonadotropins are FSH (follicle-stimulating hormone) and LH (luteinizing hormone). An increase in gonadotropins of 2-3 times their value in any azoospermia is a poor prognostic factor indicating that the germinal epithelium is not functioning.
Reversible azoospermia is most often due to medication (antiandrogen or anabolic). In these cases it is indicated to suspend such medication and wait at least 3-6 months to see if spermatogenesis is restored.
Secretory azoospermia of unknown origin are the most frequent and do not usually remit, so they are not treated.