Table 1. Comparison of the different guidelines on the medical and surgical management of NOA.
| AUA/ASRM | EAU | EAA | |
|---|---|---|---|
| Hormonal therapy before cTESE/mTESE | Limited data to support hormonal therapy prior to SSR (Schlegel et al., 2021 [8]) | No routine therapy recommended (Salonia et al., 2022 [7]) | No recommendation |
| NOA due to exogenous testosterone | No recommendation | Withdrawal of testosterone for 6 to 12 months, if no sperm in semen, hCG with or without FSH or clomiphene can be prescribed | No recommendation |
| Exogenous testosterone for patients with NOA and low testosterone | Testosterone therapy should not be prescribed as a clinical principle (Schlegel et al, 2021 [8]) | Avoid testosterone therapy for male infertility (Salonia et al, 2022 [7]) | No recommendation |
| Sperm retrieval in Klinefelter syndrome | Spermatogenesis found upon mTESE in up to 50%–60% of patients | Spermatogenesis found upon mTESE in up to 50% of patients | No recommendation |
| Microsurgical varicocelectomy for clinical varicocele and NOA | Couples should be informed of the absence of definitive evidence supporting VR prior to SSR for NOA (Schlegel et al, 2021 [8]) | VR in NOA can result in the appearance of sperm in the ejaculate (Minhas et al, 2021 [37]). Evidence is not robust as it is based on observational studies |
No recommendation |
| Microsurgical varicocelectomy for subclinical varicocele and NOA | Recommend against repair of subclinical varicocele | Recommend against repair of subclinical varicocele | No recommendation |
| FNA before mTESE | mTESE has a two times more likely successful outcome | No recommendation in view of the limited evidence | No recommendation |
| Predictors of successful SSR | No recommendation | No preoperative biochemical and clinical variables clinical variables may be considered sufficient and reliable predictors of positive sperm retrieval at surgery in patients with NOA | No recommendation |
AUA: American Urological Association, ASRM: American Society for Reproductive Medicine, EAU: European Association of Urology, EAA: European Academy of Andrology, mTESE: microdissection testicular sperm extraction, cTESE: conventional testicular sperm extraction, SSR: surgical sperm retrieval, FSH: follicle-stimulating hormone, hCG: human chorionic gonadotrophin, VR: varicocele repair. NOA: non-obstructive azoospermia, FNA: fine-needle aspiration.