Hamoda Taha, Shah Rupin, Mostafa Taymour, Pinggera Germar-Michael, Atmoko Widi, Rambhatla Amarnath, Al Hashimi Manaf, Çayan Selahittin, Colpi Giovanni Maria, Alipour Hiva, Ko Edmund, Zini Armand, Dimitriadis Fotios, Rashed Ayman, Park Hyun Jun, Saleh Ramadan, Toprak Tuncay, Ryzhkov Aleksei, Kadıoğlu Ateş, Kandil Hussein, Kalkanli Arif, El-Sakka Ahmed I, Calik Gokhan, Falcone Marco, Elbardisi Haitham, Arafa Mohamed, Ho Christopher Chee Kong, Martinez Marlon Pedrozo, Binsaleh Saleh, Motawi Ahmad Tarek, Gherabi Nazim, Tsujimura Akira, Taniguchi Hisanori, Kosgi Raghavender, Calogero Aldo E, Shatylko Taras, Kim Dongsuk, Thomas Charalampos, Tadros Nicholas N, Andreadakis Sotiris, Musa Muhammad Ujudud, Konstantinidis Charalampos, Preto Mirko, Le Tan V, Khalafalla Kareim Mohamed, Cannarella Rossella, Bowa Kasonde, Balagobi Balasingam, Katz Darren Jonathan, Nguyen Quang, Tanwar Raman, Borges Junior Edson, Agarwal Ashok
Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Urology, Minia University, Minia, Egypt.
World J Mens Health. 2025 May 12. doi: 10.5534/wjmh.250037.
Non-obstructive azoospermia (NOA), defined as the absence of sperm in the ejaculate due to testicular failure, is observed in 5% to 15% of infertile men and accounts for two-thirds of azoospermia cases. The management of NOA is marked by significant controversy and global variation in diagnostic and therapeutic approaches, highlighting the crucial need for well-designed and standardized clinical practice guidelines. We present comprehensive graded clinical practice recommendations and statements for diagnosing and treating NOA, aiming to establish standardized strategies that can globally help guide practitioners in their practice.
A comprehensive literature review was conducted to gather evidence on the epidemiological, diagnostic, and therapeutic aspects of NOA. The Global Andrology Forum (GAF) recommendations were developed through the collaboration of a global panel of experts using the Delphi method and surveys to achieve consensus. Statements were graded according to the Oxford Centre for Evidence-Based Medicine "GRADE" classification as either "Strong" or "Weak." Statements receiving at least 80% expert consensus were graded as "Strong," while others were categorized as "Weak."
The GAF has formulated a total of 49 recommendations and statements on the diagnosis and treatment of NOA, including 21 for diagnosis and 28 for treatment. The recommendations and statements were evaluated and graded by a panel of 48 GAF experts from 25 countries worldwide. The majority of experts (60.5%) had more than 10 years of clinical experience in managing NOA.
The GAF guidelines address discrepancies in NOA management across diverse clinical settings and provide comprehensive graded recommendations to guide clinicians in its diagnosis and treatment. Developed and graded by a large worldwide panel of experts, the current guidelines present simplified, high-standard strategies that can be seamlessly integrated into the daily global practice, offering practitioners a clear framework for managing NOA.
