Non-Obstrüktif Azoospermi: Tanıdan Tedaviye Güncel Perspektif

European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. Arnhem: EAU Guidelines Office; 2026.

American Urological Association; American Society for Reproductive Medicine. Diagnosis and treatment of infertility in men: AUA/ASRM guideline.

Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14(1):131-5.

Kaltsas A. Micro-TESE in non-obstructive azoospermia: phenotype-guided hormonal optimization and testosterone response—prognostic biomarker or therapeutic target? J Clin Med. 2026;15(15):5805. doi:10.3390/jcm15155805.

Cocuzza M, Alvarenga C, Pagani R. The epidemiology and etiology of azoospermia. Clinics (Sao Paulo). 2013;68 Suppl 1:15-26. doi:10.6061/clinics/2013(sup01)03.

Wang X, Nie L, Hong Z, et al. Genetic and epigenetic insights into non-obstructive azoospermia: mechanisms, biomarkers, and clinical perspectives. Reprod Biol Endocrinol. 2025;23:159. doi:10.1186/s12958-025-01497-7.

Chiba K, Enatsu N, Fujisawa M. Management of non-obstructive azoospermia. Reprod Med Biol. 2016;15(3):165-173. doi:10.1007/s12522-016-0234-z.

Esteves SC, Viana MC, Achermann APP, Santi D. Human chorionic gonadotropin-based clinical treatments for infertile men with non-obstructive azoospermia. Andrology. 2026;14:1029-1063. doi:10.1111/andr.70003.

Krausz C, Riera-Escamilla A. Genetics of male infertility. Nat Rev Urol. 2018;15(6):369-384. doi:10.1038/s41585-018-0003-3.

Achermann APP, Pereira TA, Esteves SC. Microdissection testicular sperm extraction (micro-TESE) in men with infertility due to nonobstructive azoospermia: summary of current literature. Int Urol Nephrol. 2021;53(11):2193-2210. doi:10.1007/s11255-021-02979-4.

Krausz C, Cioppi F. Genetic factors of non-obstructive azoospermia: consequences on patients' and offspring health. J Clin Med. 2021;10(17):4009. doi:10.3390/jcm10174009.

Majzoub A, Arafa M, Al Said S, et al. A systematic review and meta-analysis exploring the predictors of sperm retrieval in patients with non-obstructive azoospermia and chromosomal abnormalities. Andrologia. 2022;54:e14303. doi:10.1111/and.14303.

Krausz C, Navarro-Costa P, Wilke M, Tüttelmann F. EAA/EMQN best practice guidelines for molecular diagnosis of Y-chromosomal microdeletions: State of the art 2023. Andrology. 2024;12(3):487-504. doi:10.1111/andr.13514.

Jiao ZY, Liu MR, et al. Sperm retrieval rate and patient factors in azoospermia factor c microdeletion azoospermia: a systematic review. BJU Int. 2024;134(1):6-12. doi:10.1111/bju.16205.

Zhou F, et al. Exome sequencing diagnostic yield in non-obstructive azoospermia: a systematic review and meta-analysis. PLoS One. 2025. doi:10.1371/journal.pone.0338892.

Hubbard L, Rambhatla A, Glina S. Nonobstructive azoospermia: an etiologic review. Asian J Androl. 2025;27(3):279-287. doi:10.4103/aja202472.

Su HI, Lacchetti C, Letourneau J, Partridge AH, Qamar R, Quinn GP, et al. Fertility preservation in people with cancer: ASCO guideline update. J Clin Oncol. 2025;43(12):1488-1515. doi:10.1200/JCO-24-02782.

Mazonakis M, Damilakis J. Radiotherapy and testicular function: a comprehensive review of the radiation-induced effects with an emphasis on spermatogenesis. Biomedicines. 2024;12(7):1492.

Masarani M, Wazait H, Dinneen M. Mumps orchitis. J R Soc Med. 2006;99(11):573-575. doi:10.1177/014107680609901116.

Çayan S, Şahin S, Akbay E, et al. The effects of varicocele repair on testicular sperm retrieval, sperm recovery in the ejaculate and clinical pregnancy rates in non-obstructive azoospermic men with clinical varicocele: a systematic review and meta-analysis. World J Mens Health. 2026;44(3):593-607. doi:10.5534/wjmh.250065.

Mehta A, Goldstein M. Varicocele repair for nonobstructive azoospermia. Curr Opin Urol. 2012;22(6):507-512. doi:10.1097/MOU.0b013e328358e115.

Hong Y, Zhang X, Huang J, et al. Endocrine disruptors and male infertility: multi-omics identification of key genes in non-obstructive azoospermia. J Assist Reprod Genet. 2025;42:3767-3780. doi:10.1007/s10815-025-03664-6.

McLachlan RI, Rajpert-De Meyts E, Hoei-Hansen CE, de Kretser DM, Skakkebaek NE. Histological evaluation of the human testis—approaches to optimizing the clinical value of the assessment: mini review. Hum Reprod. 2007;22(1):2-16. doi:10.1093/humrep/del279.

Kasak L, Laan M. Monogenic causes of non-obstructive azoospermia: challenges, established knowledge, limitations and perspectives. Hum Genet. 2021;140(1):135-154. doi:10.1007/s00439-020-02112-y.

Multimodal ultrasonography predicts sperm retrieval success in nonobstructive azoospermia: a retrospective diagnostic study. 2026. PMID: 42575738.

World Health Organization. WHO laboratory manual for the examination and processing of human semen. 6th ed. Geneva: World Health Organization; 2021. ISBN 9789240030787.

Tan Y, Yuan Y, Yang X, Wang Y, Liu L. Diagnostic value of oxidation-reduction potential for male infertility: a systematic review and meta-analysis. Transl Androl Urol. 2024;13(7):1228-1238. doi:10.21037/tau-24-32.

Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, et al. Antisperm antibody testing: a comprehensive review of its role in the management of immunological male infertility and results of a global survey of clinical practices. World J Mens Health. 2022;40(3):380-398.

Jamalirad H, Jajroudi M, Khajehpour B, Sadighi Gilani MA, Eslami S, Sabbaghian M, et al. AI predictive models and advancements in microdissection testicular sperm extraction for non-obstructive azoospermia: a systematic scoping review. Hum Reprod Open. 2025;2025(1):hoae070. doi:10.1093/hropen/hoae070.

Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. doi:10.1210/jc.2018-00229.

Arshad MA, Majzoub A, Esteves SC. Predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature. Int Urol Nephrol. 2020;52(11):2015-2038. doi:10.1007/s11255-020-02529-4.

Ramasamy R, Lin K, Gosden LV, Rosenwaks Z, Palermo GD, Schlegel PN. High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction. Fertil Steril. 2009;92(2):590-593. doi:10.1016/j.fertnstert.2008.07.1703.

Pozzi E, Corsini C, Belladelli F, Bertini A, Negri F, Raffo M, et al. Role of follicle-stimulating hormone, inhibin B, and anti-Müllerian hormone in predicting sperm retrieval from men with nonobstructive azoospermia undergoing microdissection testicular sperm extraction: a systematic review and meta-analysis. Eur Urol Open Sci. 2024;65:3-12. doi:10.1016/j.euros.2024.05.001.

Stumpf MAM, Queiroz NL, Glezer A. Fertility and pregnancy in patients with prolactinoma. Best Pract Res Clin Endocrinol Metab. 2026;40(2):102081. doi:10.1016/j.beem.2026.102081.

Flores JM, et al. Testosterone replacement therapy and spermatogenesis in reproductive age men. Nat Rev Urol. 2025;22:703-719.

Tharakan T, Corona G, Foran D, Salonia A, Sofikitis N, Giwercman A, et al. Does hormonal therapy improve sperm retrieval rates in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update. 2022;28(5):609-628. doi:10.1093/humupd/dmac016.

Dasgupta S, Le TS, Rambhatla A, Shah R, Agarwal A. Medical treatment prior to micro-TESE. Asian J Androl. 2025;27(3):342-354. doi:10.4103/aja202492.

Sun Y, Yao C, Liu G, Li Z, Yang X, Chen Q, et al. Letrozole and Infertility Among Males With Spermatogenic Failure: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(6):e2618422. doi:10.1001/jamanetworkopen.2026.18422.

Cao TN, Hoai BN, Huu VD, Jannini EA. Association of testicular histopathology with sperm retrieval success rates in men with idiopathic non-obstructive azoospermia. Aging Male. 2025;28(1):2436850. doi:10.1080/13685538.2024.2436850.

Jensen CFS, et al. Microdissection testicular sperm extraction versus multiple needle-pass percutaneous testicular sperm aspiration in men with nonobstructive azoospermia: a randomized clinical trial. Eur Urol. 2022;82(4):377-384. doi:10.1016/j.eururo.2022.04.030.

Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, et al. Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(6):733-757. doi:10.1093/humupd/dmz028.

Negri F, Pozzi E, Corsini C, Raffo M, Belladelli F, Bertini A, et al. Short-term hormonal changes following microdissection testicular sperm extraction among men with non-obstructive azoospermia: findings from a large longitudinal prospective multicentric study. World J Mens Health. 2025;43(3):702-709. doi:10.5534/wjmh.240184.

Alkandari MH, Bouhadana D, Zini A. Is a contralateral testicular exploration required at microdissection testicular sperm extraction for men with nonobstructive azoospermia, cryptozoospermia or severe oligozoospermia? Andrologia. 2021;53(11):e14208. doi:10.1111/and.14208.

Özmen S, Tola EN. Microdissection testicular sperm extraction in male partner with non-obstructive azoospermia: fresh or frozen-thawed sperm for intracytoplasmic sperm injection? J Obstet Gynaecol Res. 2025;51(5):e16298. doi:10.1111/jog.16298.

Jiao ZY, Liu MR, et al. Sperm retrieval rate and patient factors in azoospermia factor c microdeletion azoospermia: a systematic review. BJU Int. 2024;134(1):6-12. doi:10.1111/bju.16205.

Momtazi-Mar L, Naelitz BD, Mucci A, Cannarella R, Lundy SD. Surgical sperm retrieval in patients with nonmosaic Klinefelter syndrome (47,XXY) may be safely delayed until adulthood: a systematic review and meta-analysis. Fertil Steril. 2025;124(6):1223-1234. doi:10.1016/j.fertnstert.2025.07.021.

Li H, Chen LP, Yang J, Li MC, Chen RB, Lan RZ, et al. Predictive value of FSH, testicular volume, and histopathological findings for the sperm retrieval rate of microdissection TESE in nonobstructive azoospermia: a meta-analysis. Asian J Androl. 2018;20(1):30-36. doi:10.4103/aja.aja_5_17.

Association of higher serum follicle-stimulating hormone levels with successful microdissection testicular sperm extraction outcomes in nonobstructive azoospermic men with reduced testicular volumes. Asian J Androl. 2025. PMID: 39716744.

Puia D, et al. Anti-Müllerian hormone as a biomarker for predicting testicular sperm extraction outcomes in azoospermic patients: a comprehensive systematic review and meta-analysis. Int J Mol Sci. 2025;26:11643. doi:10.3390/ijms262311643.

Zhang F, Dai M, Yang X, Cheng Y, Ye L, Huang W, et al. Predictors of successful salvage microdissection testicular sperm extraction (mTESE) after failed initial TESE in patients with non-obstructive azoospermia: a systematic review and meta-analysis. Andrology. 2024;12(1):30-44. doi:10.1111/andr.13448.

Ghalayini IF, Alazab R, Halalsheh O, Al-Mohtaseb AH, Al-Ghazo MA. Repeated microdissection testicular sperm extraction in patients with non-obstructive azoospermia: Outcome and predictive factors. Arab J Urol. 2022;20(3):137-143. doi:10.1080/2090598x.2022.2028066.

Oates RD, Silber S, Brown LG, Page DC. Clinical characterization of 42 oligospermic or azoospermic men with microdeletion of the AZFc region of the Y chromosome, and of 18 children conceived via ICSI. Hum Reprod. 2002;17(11):2813-2824.

Majzoub A, Viana MC, Achermann APP, Ferreira IT, Laursen RJ, Humaidan P, et al. Non-Obstructive Azoospermia and Intracytoplasmic Sperm Injection: Unveiling the Chances of Success and Possible Consequences for Offspring. J Clin Med. 2024;13(16):4939. doi:10.3390/jcm13164939.

Corona G, Pizzocaro A, Lanfranco F, Garolla A, Pelliccione F, Vignozzi L, et al. Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2017;23(3):265-275. doi:10.1093/humupd/dmx008.

Eliveld J, van Wely M, Meißner A, Repping S, van der Veen F, van Pelt AMM. The risk of TESE-induced hypogonadism: a systematic review and meta-analysis. Hum Reprod Update. 2018;24(4):442-454. doi:10.1093/humupd/dmy015.

Wang X, et al. Genetic and epigenetic insights into non-obstructive azoospermia. Reprod Biol Endocrinol. 2025;23:159. doi:10.1186/s12958-025-01497-7.

Kandil H, Arafa M, Kaya C, Wyns C, Le TV, Hamoda T, et al. Artificial intelligence in non-obstructive azoospermia: state of the art in sperm retrieval. World J Mens Health. 2026;44:e26. doi:10.5534/wjmh.250367.

Hermann BP, Sukhwani M, Winkler F, Pascarella JN, Peters KA, Sheng Y, et al. Spermatogonial stem cell transplantation into rhesus testes regenerates spermatogenesis producing functional sperm. Cell Stem Cell. 2012;11(5):715-726. doi:10.1016/j.stem.2012.07.017.

Abdelaal NE, Tanga BM, Abdelgawad M, Allam S, Fathi M, Saadeldin IM, et al. Cellular therapy via spermatogonial stem cells for treating impaired spermatogenesis, non-obstructive azoospermia. Cells. 2021;10(7):1779. doi:10.3390/cells10071779.

Goossens E, et al. First successful transplant of human immature testicular tissue after gonadotoxic therapy during childhood: complete spermatogenesis in intra-testicular grafts. medRxiv. 2026. Preprint. doi:10.64898/2026.03.04.26347483.

Sato T, Katagiri K, Gohbara A, Inoue K, Ogonuki N, Ogura A, et al. In vitro production of functional sperm in cultured neonatal mouse testes. Nature. 2011;471(7339):504-507. doi:10.1038/nature09850.