Evaluation starts with WHO 2021-criteria CASA semen analysis (same-day results), a 3-marker hormonal panel, and scrotal Doppler ultrasound. Results determine whether cause is obstructive, non-obstructive, hormonal, or structural. Treatment: varicocele repair (60–70% semen improvement), TESA/micro-TESE for azoospermia, or hormonal therapy for secondary hypogonadism. Full English results and IVF coordination letter to your fertility clinic included.
Diagnostic Pathway
WHO 2021 CASA Semen Analysis
Computer-assisted sperm analysis (CASA) measuring count, total motility, progressive motility, morphology (Kruger strict criteria), and volume against WHO 2021 lower reference limits. Results in 2–3 hours. Written English interpretation of clinical significance of each abnormal parameter included.
| Parameter | WHO 2021 Lower Limit |
|---|---|
| Sperm concentration | 16 million/mL |
| Total motility | 42% |
| Progressive motility | 30% |
| Normal morphology | 4% (Kruger) |
| Semen volume | 1.4 mL |
Hormonal Panel (FSH, LH, Testosterone, Prolactin)
FSH is the critical azoospermia marker. Elevated FSH (>7.5 IU/L) + azoospermia = non-obstructive cause (lower sperm retrieval success). Normal FSH + azoospermia = likely obstructive (higher retrieval success). Testosterone and prolactin screen for treatable hormonal causes.
Scrotal Doppler Ultrasound
Detects clinical and subclinical varicocele (most common correctable cause of male infertility, 35–40% of infertile men), epididymal obstruction, and testicular atrophy. 20-minute, non-invasive.
Genetic Testing (Selected Cases)
Karyotype and Y-chromosome microdeletion for non-obstructive azoospermia. AZFc deletion — sperm retrieval sometimes successful. AZFa/AZFb deletion — sperm retrieval virtually impossible; genetic counselling essential before IVF.
Treatment Plan + IVF Coordination
English-language referral letter with CASA results, operative notes (if surgery), and clinical summary for global coordination with your IVF clinic.
Varicocele Repair (Microsurgical)
Most common correctable cause of male infertility. Microsurgical subinguinal ligation under ×20 microscope — gold standard technique. Semen parameters improve in 60–70% of patients at 6 months.
- 60–90 min under spinal or local anaesthesia + sedation
- Same-day discharge; office work at day 5–7
- Semen reassessment at 3 and 6 months
- Cost: $1,800–$2,600 all-in
TESA — Testicular Sperm Aspiration
Needle aspiration for obstructive azoospermia. 80–90% retrieval success in OA. Same-day, 20–30 minutes. Retrieved sperm cryopreserved for IVF/ICSI.
- Local anaesthesia + IV sedation
- Includes cryopreservation + IVF coordination letter
- Cost: $900–$1,400 all-in
Micro-TESE
For non-obstructive azoospermia (NOA). ×20 microsurgical exploration of testis to identify sperm-producing tubules. 40–60% retrieval success in NOA vs. ~30% for conventional TESE. Requires FSH + karyotype results before scheduling.
- 2–3 hours under general anaesthesia
- Cost: $2,400–$3,200 all-in