Roughly 1% of all men shoot blanks. News of azoospermia can be shatter a man’s dreams of becoming a father. We traveled to Beverly Hills, CA to meet with Dr. Philip Werthman, a renowned surgeon who has seen incredible success rates in helping men with azoospermia restore their fertility. In this segment, we discuss plumbing problems that can lead to azoospermia and options for how to best correct them.
Types of Azoospermia
Doctors break the diagnosis of azoospermia into two categories. Non-obstructive meaning the testicle has a hard time producing sperm and Obstructive meaning that the testicle is making sperm but there is a blockage somewhere that prevents them from getting out. Dr. Werthman further divided obstructive azoosermia into two groups. Congenital meaning something that you are born with versus Aquired which means that the condition was caused by either an infection or medical procedure. Below we’ve outlined some of the main forms of obstructive azoospermia that Dr. Werthman reviewed with us during our interview.
Blockages of the Vas Deferens
Many of the plumbing problems occur with the vas deferens which is the main tube that transports sperm out of the testicle. The most common form of blockage to the vas deferens is a vasectomy which is a procedure where a doctor intentionally ties off the vas preventing sperm from leaving the testicle. This procedure is an incredibly painless and effective form of permanent birth control. Other things that cause blockages of the vas deferens include being a carrier the cystic fibrosis gene or having a history of hernia repair.
CF gene carriers
Some men who carry the CF gene have a congenital absence of the vas or a natural vasectomy. A skilled urologist should be able to identify an absence of the vas at a physical exam because it is large enough for them to feel. The most common form of treatment is an epididymal sperm retrieval which often yields hundreds of thousands or even millions of healthy sperm to be used with ART techniques. Genetic counseling is recommended for patients with this condition to help minimize the chances of passing the gene on to offspring.
Another reason that men may experience blockages of the vas deferens is in cases where they’ve had hernia repair surgery, either as a child or using mesh as an adult. In these cases it may be possible to perform a surgery similar to a vasectomy reversal to restore functioning of the vas or perform a sperm retrieval.
Ejaculatory duct infections
The ejaculatory ducts are small tubes near the prostate which allow the majority of the seminal fluid to join the sperm on their way out of the body. Sometimes these tiny ducts (they are about a mm wide) can get blocked by infections or cysts in the prostate. A big key that can clue you and your urologist that you may have an ejaculatory duct obstruction is by noting a very small volume of seminal fluid. If only are able to get a few drops of semen during each ejaculation, there may be a blockage upstream. Most commonly a trans-rectal ultrasound is an imaging technique that can confirm the blockage and potential problems with the prostate. Often treating ejaculatory duct problems means treating the prostate. Sometimes this is a simple as taking antibiotics other times it may require surgical removal of cysts. If there is a suspected prostate issue, it is a good idea to find out what’s going on as prostate health is a key part of long-term health in men.
Finally, the blockages may occur in the epididymus which is a thin coil of tube inside the testicle where newly developed sperm are stored. These blockages are often the most difficult to diagnose because the epididymus is really to small for most forms of imaging. In some cases, an infection will cause inflammation which will show up on a scrotal ultrasound but not always. As is the case with other infections, the situation may be resolved with antibiotics. But it may be necessary to perform a sperm retrieval.