Status of Azoospermia in Saudi Arabia: A Retrospective Narrative Mini-Review

Abstract

The total lack of spermatozoa in the ejaculate is known as Azoospermia. It is the most severe and significant contributor to male infertility. Therefore, the purpose of this study is to assess the status of Azoospermia and its etiologic factors that contribute to male infertility in Saudi Arabia. This study included all published studies written in English that were published in Saudi Arabia. Online searches via PubMed and Google Scholar were conducted from their inception to 15 January 2023. A total of 624 studies were found and reviewed, of which only 57 were eligible for the review. Studies were eligible if they provided the prevalence of infertility in Saudi Arabia. A total of 57 articles reported cases diagnosed with male infertility were identified with a sample size of (n = 9441), and only nine studies reported patients diagnosed with Azoospermia. Retrospectively, from our review, the reported cases of Azoospermia in Saudi Arabia are (n = 1030) between 1989-2022. The Klinefelter syndrome was reported in 46 cases and only 9 cases with Y-chromosome microdeletion. A total of 6 studies reported cases of non‐obstructive Azoospermia (NOA) (n = 843). Among NOA cases, three studies reported sperm retrieval rates (SRR) were 43.9%, 44.3%, and 47.2%, respectively; the most common histology pattern was Sertoli cell-only (SCO) (n = 120). A total of 3 studies reported cases of obstructive Azoospermia (OA) (n = 187); the most common cause of OA was a history of a genital infection (n = 90). After the microsurgical intervention, two studies reported overall patency rates of 37.3% and 59%, respectively, and three studies reported overall paternity rates of 6%, 10.4 and 36%, respectively. Azoospermia reporting is low in Saudi Arabia. Estimates of male infertility are crucial in helping governments and healthcare decision-makers implement the right social and economic policies. A nationwide azoospermia registry in Saudi Arabia is recommended.