Anti-inflammatory and varicocele treatment in nonobstructive azoospermia

A 34-year-old male patient with nonobstructive azoospermia and childlessness for more than 2 years is presented. As even severely damaged testes often harbour cryptic areas with remaining spermatogenesis, such cases might be suitable for spermatid extraction from bilateral testicular biopsies. Taking into account that testicular biopsies bear the risk of permanent testosterone insufficiency, less invasive andrological treatment modalities were considered. Under the assumption of frequent silent testicular inflammatory reactions, the nonsteroidal anti-inflammatory drug ibuprofen was administered. Additionally, a concomitant left-sided varicocele was removed by retrograde sclerotherapy. Within 1 year, the spermiogram showed spermatozoa at a concentration of 0.6-1.2 million ml(-1). This allowed ejaculate samples to be stored for cryopreservation to enable in vitro fertilization with intracytoplasmic injection of spermatozoa. Our successfully performed anti-inflammatory and varicocele treatment underlines the value of conservative andrological therapies. Despite the modern possibilities of assisted reproductive procedures the clinical andrologist should be aware of a careful andrological examination and of less invasive therapeutic options such as anti-inflammatory treatment and varicocele repair.