# Secondary azoospermia after a successful natural pregnancy: a primary prospective study

## TL;DR

This study explores secondary azoospermia in men who previously had natural pregnancies, identifying factors like varicoceles and heart disease that may affect sperm retrieval.

## Contribution

The study is the first primary prospective investigation into secondary azoospermia as a cause of male infertility after natural conception.

## Key findings

- Younger age and a history of coronary artery disease predict negative outcomes in sperm retrieval.
- Varicoceles are common in patients with secondary azoospermia.
- The condition's causes are likely multifactorial.

## Abstract

To date, there is a lack of studies conducted on males with secondary azoospermia as a potential cause of male infertility who had previously fathered children through natural conception. The current study aims to investigate the potential causes of secondary azoospermia as a presentation of male infertility as well as the prognostic factors that can impact sperm retrieval rate (SRR) while undergoing microdissection testicular sperm extraction (microTESE).

Thirty two patients were recruited from the andrology outpatient clinic from August 2023 till January 2024. The mean age of the patients was sixty-two years old. All patients had varicoceles. Twenty seven patients (84%) had palpable varicocele grade 2 and 3 on both sides. Further multivariate logistic regression analysis of the significant factors in the univariate regression revealed that younger age (OR 0.7, 95% C.I. 0.7-1.0, p = 0.03) and having a history of coronary artery disease (CAD) were predictable factors for negative TESE outcome (OR 123.1, 95% C.I. 3.2-4748.5, P = 0.01).

It appears that the etiopathogenesis of secondary azoospermia are multifactorial. Varicocele and CAD are major factors to be considered. Future studies should be implemented deploying larger pools of patients suffering from the same condition to affirm the findings of this primary study.