Azoospermia Form Consultation Form Please answer the following questions about your case. Once you complete this form, we will contact you by email if this treatment is right for you or not. Do you have Non-Obstructive Azoospermia or Obstructive Azoospermia? *Non-Obstructive Azoospermia Obstructive Azoospermia I don't knowCan you write your FSH level? *What is your LH levels? *What is your Testosterone levels? *Do you know what type of Azoospermia you have? *Sertoli cells only syndromeMaturation arrestI don't knowDid your DNA test indicate any microdeletion in Y chromosome?YesNoYou can use Prolistem treatment even you have microdeletion in chromosome Y, but in this case you need to consider testicular sperm extraction after the treatment. Microdeletion in chromosome Y lower the chances to find sperm in the semen.Do you know the reason for your Azoospermia?(Azoospermia could be for many reasons that we know and most of them we don't know)Have you had testicular sperm extraction (TESE) for IVF done before? *(if yes can you give more details)What is your sperm count analysis results (recently)? *Very few spermZero spermI don't knowpick one!What kind of treatments you tried in the past?Do you have any heart disease, high blood pressure or diabetes? *No, I am healthyYesPeople with the following conditions should not take Prolistem® Stage I and Stage II treatments: heart failure, heart disease, fluid retention, high blood pressure (hypertension), diabetes, kidney disease and liver disease.Do you have any additional information that we should know?How did you find us? *Google AdsSearch engine (Google, Bing...)YoutubeFacebookFertility magazineFertility forumFriendsWhat is your age? *What country do you live in?Prolistem can be ship worldwideEmail What is your e-mail address? *Request Informations
