Case Registration Form

Our Azoospermia Information Form is designed to assist individuals seeking advice on azoospermia treatment. Completing this form ensures a more accurate response to determine if Prolistem is suitable for you. Rest assured, your information is kept confidential, and our primary goal is to provide guidance and support to those facing the challenges of azoospermia

Personal Information:

Your Email

Country

WhatsApp Number

Your Age

Medical History

1. Do you know the type of azoospermia you have?

Based on your inputs, Prolistem has proven to be successful in similar cases where chances

You are eligible to undergo Prolistem treatment for six months. Prolistem is designed for primary testicular failure. If no sperm is found in the semen after completing the six months of treatment, it is recommended to consider sperm retrieval

Click here to Learn more about Prolistem:

You are not eligible for Prolistem treatment, as it is not designed to treat secondary testicular failure (hypogonadism)Bottom of Form

You are not eligible to undergo Prolistem treatment, Prolistem does not designed to treat obstructive azoospermia

2. Do you know the reason for your azoospermia?

3. What is your FSH (Follicle-stimulating hormone):

4. Write your recent FSH Level

5. What is your LH (Luteinizing hormone )

6. Write your recent LH Level

7. What is your Testosterone Level:

8. Write your recent Testosterone Level

9. Have you undergone a biopsy, TESE, or Micro-TESE in the past?

10. What was indicated in your biopsy report?

11. Do you plan to undergo sperm retrieval in the near future?

Genetic History

12. Do you know if your azoospermia is a result of a genetic issue?

Prolistem is not designed to treat azoospermia with genetic issues. In a few cases, such as Klinefelter syndrome, Prolistem can be used for six months, and sperm retrieval must be performed immediately after the treatment. Nevertheless, success chances with any genetic issues will be very low

13. If yes, please specify the genetic issue:

14. Do you have any family members with infertility issues (brother, cousin, etc.)?

Treatment History

15. What treatments have you used in the past for azoospermia?