A couple is evaluated for male infertility. Semen analysis shows azoospermia on two occasions. Testicular volume is 6 mL bilaterally with soft consistency, vas deferens are palpable, and serum FSH is 22 IU/L (normal 2 to 8). The MOST likely diagnosis is:

• A Obstructive azoospermia due to congenital bilateral absence of vas deferens
• B Non-obstructive azoospermia due to primary testicular failure ✓
• C Ejaculatory duct obstruction
• D Retrograde ejaculation

Explanation

Small soft testes with markedly elevated FSH indicate germinal epithelial damage: the Sertoli cells fail to produce inhibin B, removing feedback inhibition on pituitary FSH. Obstructive azoospermia, including ejaculatory duct obstruction, shows normal FSH, normal testicular volume, and often low semen volume. Congenital absence of the vas would make the vasa impalpable, contradicting the examination here.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.