A couple is evaluated for 3 years of primary infertility. Semen analysis shows azoospermia. Physical examination reveals a left-sided grade III varicocele with absent right testis. Serum FSH is elevated at 22 mIU/mL, and testosterone is low-normal. What is the most likely cause of azoospermia?

• A Obstructive azoospermia due to vasal agenesis
• B Obstructive azoospermia due to epididymal blockage from the varicocele
• C Hypogonadotropic hypogonadism
• D Non-obstructive azoospermia due to primary testicular failure ✓

Explanation

Elevated FSH with low-normal testosterone indicates primary testicular failure, which causes non-obstructive azoospermia. In obstructive azoospermia, FSH and testosterone are normal. Hypogonadotropic hypogonadism would show low FSH and low testosterone. A varicocele can contribute to testicular dysfunction but does not cause obstructive azoospermia; it impairs spermatogenesis through increased testicular temperature and oxidative stress.

Reference: Campbell-Walsh-Wein Urology, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.