Objective: It is now very important to investigate azoospermia because the introduction of the intracytoplasmic sperm injection technique during the last decade has allowed many infertile men to achieve their dreams of fatherhood. The purpose of this study was to define the characteristics of infertile men with azoospermia, and to analyse the clinical and laboratory features and the causes of infertility in Tunisia. The authors also discuss various aspects that they consider to be very important in the diagnosis of male fertility. Material and Methods: This retrospective study analysed the parameters of physical examination, laboratory tests, semen analysis, radiographic examinations, testicular biopsy, karyotype and AZF microdeletions. Results: Based on the results of endocrinological and cytogenetic examinations, the aetiology of azoospermia was considered to be secretory in 43 cases of azoospermia. Physical examination revealed a high percentage of hypotrophic/atrophic testes (43.9). Serum follicle stimulating hormone levels were high in 58.5 of cases. The overall incidence of chromosomal abnormalities was 31.4. The most frequent anomaly was Klinefelter syndrome (9 cases). Seven out of 28 patients (25) with nonobstructive azoospermia had AZF deletions. None of the patients with excretory azoospermia and severe oligospermia had an abnormal karyotype or AZF microdeletions. 48.8 of patients presented a varicocele, 13.9 had cryptorchidism and 13.0 had a history of genital tract infection. Conclusion: In line with the literature, genetic abmormalities are the main causes of severe forms of impaired spermatogenesis in the Tunisian population.
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