A couple is evaluated for infertility. Two semen analyses show complete azoospermia even after centrifugation. The man has bilateral testicular volumes of 6 mL each, and serum FSH is 26 IU/L (normal 1.5 to 12). Which statement is MOST accurate?

• A This is obstructive azoospermia; surgical sperm retrieval from the epididymis is expected to succeed
• B This is non-obstructive azoospermia due to testicular failure; karyotype including Y chromosome microdeletion testing is indicated ✓
• C The raised FSH confirms pituitary adenoma as the cause
• D Repeat semen analysis after 6 months of testosterone therapy is the next step

Explanation

Small testes with markedly elevated FSH indicate primary testicular failure with impaired spermatogenesis, defining non-obstructive azoospermia. Elevated FSH reflects loss of Sertoli cell inhibin B negative feedback. Obstruction gives normal FSH and normal testicular volumes, which kills distractor A. Testosterone therapy suppresses gonadotropins further and worsens spermatogenesis, so D is actively harmful. Karyotype and Y microdeletion analysis are standard because Klinefelter syndrome and AZF deletions are common causes.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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