How to cite: Stocks, Blair T. “Redefining Azoospermia: New Diagnostic and Management Strategies.” October 2025. Accessed Nov 2025. https://grandroundsinurology.com/redefining-azoospermia-new-diagnostic-and-management-strategies/
Blair T. Stocks, MD, PhD, Assistant Professor, Division of Male Reproductive Medicine and Surgery, Baylor College of Medicine, Houston, Texas, explains the current limitations in managing azoospermia, particularly non-obstructive forms. Conventional microdissection testicular sperm extraction (mTESE) yields sperm in only 30 to 50 percent of cases and requires prolonged procedures, manual tissue search, and high out-of-pocket costs for patients.
Dr. Stocks reviews efforts to enhance sperm detection. These include extended sperm search with multiple embryologists and emerging AI-assisted microscopy. Imaging cytometry paired with convolutional neural networks can be used to identify sperm among millions of cellular events. By staining samples with sperm-specific markers, capturing thousands of images per second, and training models on validated sperm and debris, his team achieves strong specificity while confirming sperm identity through marker positivity.
Dr. Stocks also highlights research by colleagues exploring ultra–high-frequency ultrasound as a noninvasive means of evaluating testicular tubule size. Preclinical work in animal models and early patient studies suggest this technology can distinguish fertile, cryptozoospermic, and azoospermic states based on tissue density mapping. Pilot case studies show promise in guiding mTESE by identifying testicular regions more likely to contain sperm. This same technology could have applications for erectile dysfunction, Peyronie’s disease, and early cardiovascular risk detection.
Dr. Stocks argues that artificial intelligence, advanced imaging cytometry, and high-resolution ultrasound may together redefine azoospermia diagnostics and optimize patient selection for surgical sperm retrieval.
ABOUT THE AUTHOR
Blair T. Stocks, MD, PhD, is an Assistant Professor in the Division of Male Reproductive Medicine and Surgery within the Scott Department of Urology at Baylor College of Medicine in Houston, Texas. Dr. Stocks’ clinical interest is male infertility and men’s health. He runs an active basic science laboratory focused on the mechanisms of male infertility.
Dr. Stocks earned his Bachelor of Science in Biomedical Engineering from the University of Virginia in Charlottesville. He earned his medical degree and PhD in Cellular Immunology from Vanderbilt University in Nashville, Tennessee. Dr. Stocks then completed an internship in General Surgery, a residency in Urology, and a fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine.
Dr. Stocks is a member of the Alpha Omega Alpha Honor Medical Society, American Urological Association, Sexual Medicine Society of North America, and the American Society for Reproductive Medicine. He has published numerous articles in male’s fertility and men’s health. Dr. Stocks has been recognized for his contributions to the field, including the Student Research Award for the Society of Pediatric Research, Young Innovator Award from the American Society of Transplantation, Young Investigator Award from the American Association of Immunologists, and the SSMR’s Men’s Health Traveling Fellowship Winner, among others.
