shortest AGD which appeared to drive much of the mea-
sured AGD difference between nonobstructive azoosper-
mic men and those with normal sperm production.
Certain limitations warrant mention. Working in a
referral center for male infertility, it was not always possi-
ble to blind observers to the men’s diagnoses, which theo-
retically may have led to observer bias. Because most of
the men with obstruction underwent vasectomy, the etiol-
ogy of azoospermia was not a diagnostic dilemma. It is
possible that men undergoing vasectomy are a population
distinct from men who have obstruction for other reasons
(e.g. CBAVD, idiopathic epididymal obstruction). Indeed,
men with CF (cystic ±brosis) have been shown to have
impaired testosterone production (Boas
et al.
, 1996).
Unfortunately, the limited numbers of men remaining
after strati±cation by obstructive diagnosis precluded
subanalyses. However, future work should validate the
utility of AGD in predicting azoospermia from all etiolo-
gies. While the measurements are similar to those from
our earlier studies, slight differences do exist as the cur-
rent report examines a distinct subpopulation (Eisenberg
et al.
, 2011, 2012).
Moreover, it is interesting to note that the men with
obstructive azoospermia were taller than the men with
nonobstructive azoospermia. This may have resulted by
chance alone, however, it may also re²ect subtle develop-
mental differences between the groups. In addition, there
were a limited number of noncaucasian men, preventing
racial subanalyses. Moreover, the current method of AGD
measurement in adult men has not been studied, and
thus its accuracy and reproducibility were dif±cult to
assess by means other than comparison of measurements
by investigators (Eisenberg
et al.
, 2011, 2012). However,
we have previously shown good correlation and reproduc-
ibility of our methods. Nevertheless, our study represents
the ±rst analysis of anogenital distance in azoospermic
adult men and suggests a clinical utility for the measure-
ment. As such, AGD may predict normal male genital
development and sperm production and could therefore
provide a novel metric to assess reproductive potential in
men. Moreover, it may give the practitioner additional
prognostic information when counseling azoospermic
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2012 The Authors
International Journal of Andrology
2012 European Academy of Andrology