Evaluation starts with WHO 2021-criteria CASA semen analysis, a 3-marker hormonal panel, and scrotal Doppler ultrasound. Results determine whether the cause is obstructive or non-obstructive, hormonal, or structural. Treatment options include varicocele repair (surgical), medical therapy (gonadotropins for hypogonadotropic hypogonadism), or surgical sperm retrieval (TESA/TESE) for azoospermia. Dr. Kwon coordinates results with your IVF clinic in English.
Diagnostic Pathway
CASA Semen Analysis (WHO 2021)
Computer-assisted sperm analysis measuring count, total motility, progressive motility, morphology (Kruger strict criteria), and volume. Results in 2–3 hours. Interpreted against WHO 2021 lower reference limits — Dr. Kwon provides written interpretation in English including clinical significance of each parameter.
| Parameter | WHO 2021 Lower Limit |
|---|---|
| Sperm concentration | 16 million/mL |
| Total motility (PR + NP) | 42% |
| Progressive motility (PR) | 30% |
| Normal morphology | 4% (Kruger) |
| Semen volume | 1.4 mL |
Hormonal Panel (FSH, LH, Testosterone, Prolactin)
FSH is the most critical marker for azoospermia evaluation. Elevated FSH (>7.5 IU/L) with azoospermia indicates non-obstructive cause (testicular failure) — lower success rates for sperm retrieval. Normal FSH with azoospermia suggests obstructive cause — higher retrieval success. Testosterone and prolactin screen for treatable endocrine causes.
Scrotal Doppler Ultrasound
Detects clinical and subclinical varicocele (the most common correctable cause of male infertility, present in 35–40% of infertile men), epididymal obstruction, testicular atrophy, and structural anomalies. Takes 20 minutes.
Genetic Testing (Selected Cases)
Karyotype and Y-chromosome microdeletion testing recommended for non-obstructive azoospermia (NOA). AZFc deletion — sperm retrieval sometimes successful. AZFa or AZFb deletion — sperm retrieval virtually never successful; genetic counselling before IVF critical.
Treatment Plan + IVF Coordination
Based on findings: varicocele repair, medical therapy, sperm retrieval for IVF/ICSI, or donor sperm counselling. Full English-language referral letter and operative notes provided for coordination with your IVF clinic globally.
Varicocele Repair (Microsurgical)
Varicocele is the most common correctable cause of male factor infertility. Microsurgical subinguinal ligation is the gold standard. Semen parameters improve in 60–70% of patients at 6 months post-repair.
- Surgery 60–90 min under spinal or local anaesthesia
- Same-day discharge; office work at 5–7 days
- Semen reassessment at 3 and 6 months
- MenPower cost: $1,800–$2,600 all-in
TESA — Testicular Sperm Aspiration
Needle aspiration of sperm from the testis under local anesthesia + sedation. Used for obstructive azoospermia (blocked vas or epididymis). 80–90% sperm retrieval success. Same-day procedure.
- 20–30 minutes under local + sedation
- Retrieved sperm cryopreserved for IVF/ICSI
- MenPower cost: $900–$1,400 (includes cryopreservation)
Micro-TESE — Microsurgical Testicular Sperm Extraction
For non-obstructive azoospermia. Microsurgical exploration of testis under ×20 magnification to identify and extract sperm-producing tubules. 40–60% retrieval success in NOA (vs. ~30% for conventional TESE).
- 2–3 hour procedure under general anaesthesia
- FSH and karyotype results required before scheduling
- MenPower cost: $2,400–$3,200
