This study highlights the risk of misdiagnosing cryptozoospermia as non-obstructive azoospermia (NOA) and underlines the importance of extended semen analysis and specific clinical parameters to avoid mistakes. Between April 2021 and April 2024, men who were initially diagnosed with azoospermia at other centers were re-evaluated with detailed semen analysis. Compared to true NOA patients who underwent micro-TESE, nearly 20% of the men were actually reclassified as cryptozoospermic. These men typically had lower FSH levels, higher total testosterone, and larger testicular volume. They also showed higher rates of AZFc microdeletions and parental consanguinity. In the multivariate analysis, FSH levels below 18.6 mIU/mL and testicular volume above 11 mL were found to be independent predictors of cryptozoospermia.
This study shows that about one in five men diagnosed with NOA may in fact have rare sperm that can be detected with careful analysis. Therefore, it is essential to re-examine azoospermic patients who have low FSH and larger testes to prevent unnecessary interventions and to offer the most appropriate assisted reproductive treatment.