ArticleThe Journal of clinical endocrinology and metabolism2025
Unraveling a Subgroup of Men With Unexplained Male Infertility-Men With Normogonadotropic Nonobstructive Azoospermia.
Article in The Journal of clinical endocrinology and metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Anti-Müllerian Hormone as a Biomarker for Predicting Testicular Sperm Extraction Outcomes in Azoospermic Patients: A Comprehensive Systematic Review and Meta-Analysis.International journal of molecular sciences · 2025Pooled it
- Exploratory Evaluation of Combined Hormonal Indices in Non-Obstructive Azoospermia: Diagnostic Performance and Prediction of TESE Success.Journal of clinical medicine · 2026Article
- Identification of biomarkers related to amino acid metabolism in nonobstructive azoospermia by bioinformatics.Medicine · 2026Article
- Refining the Endocrine Stratification of Non-Obstructive Azoospermia: Commentary on the Global Andrology Forum Guidelines.The world journal of men's health · 2026Article
- Development and validation of a nomogram for predicting sperm retrieval success in patients with non-obstructive azoospermia undergoing testicular sperm aspiration.Translational andrology and urology · 2026Article
- GutFrontiers in cellular and infection microbiology · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
contextNonobstructive azoospermia (NOA) constitutes male infertility with complete absence of sperm in the ejaculate. NOA can originate in testicular malfunction or in endocrine dysregulation. Elevated follicle-stimulating hormone (FSH) levels are diagnostically valuable for NOA.
objectiveAn azoospermic patient cohort comprising 79 men and exhibiting no obstruction but normal FSH levels was identified. Focusing on this normogonadotropic nonobstructive azoospermic (NNOA) group, the study aimed to characterize these patients in depth.
methodsWhether the missing FSH upregulation in patients with NNOA is due to testicular or pituitary/hypothalamic malfunctions was examined by analyzing somatic, endocrine, and testicular parameters compared with 87 men with hypergonadotropic NOA and 88 normozoospermic men.
resultsTesticular phenotypes of patients with NNOA and NOA were compared in histologically stratified subgroups (most advanced germ cell type). Using flow cytometry, the samples were evaluated for testicular cell composition by ploidy analysis. Concerning the distinct histological classification (hypospermatogenesis, spermatogenic arrest, Sertoli cell only, tubular atrophy) NNOA men produced more elongated spermatids and showed higher sperm retrieval. Testicular tissue composition between patients with NNOA and patients with NOA only differed after meiosis.
conclusionThe missing FSH upregulation in NNOA might be due to a testicular malfunction, as both FSH and testosterone were normal and NNOA spermatogenesis differed only after meiosis. Two explanations are possible: NNOA represents a phenotype in which spermatogenesis fails-different from NOA-only at the postmeiotic level, leaving FSH regulation unaffected, or the same mechanism underlies both NNOA and NOA, but the groups are at different stages of progression of the same disorder.
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