Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction,
stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with
guidelines and offering expert recommendations.
Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from
July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries
were analyzed descriptively, with a Delphi process used for expert recommendations.
Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia
definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating
hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by
66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy,
distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation
relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of
finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate.
Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended
guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international
consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.