Understanding Male Infertility: Vas Deferens Obstruction and Azoospermia.

Azoospermia refers to the absence of sperm in the semen after ejaculation. A normal male typically has an ejaculate volume of about 2 to 5 cc. Azoospermia occurs when there are issues with sperm production in the testes or in the transportation process. It accounts for 20% of male infertility cases, and some men have azoospermia due to genetic abnormalities.
 

Symptoms of Azoospermia

Azoospermia often has no obvious symptoms, and it is usually discovered after a semen analysis following prolonged infertility. Symptoms may include smaller testicles and semen that is more transparent, less voluminous, and less viscous. Azoospermia shares similarities with oligospermia, and some patients may experience reduced libido.
 

Causes of Azoospermia

The main causes of azoospermia include the inability of the testes to produce sperm, obstruction of the vas deferens, and hormonal imbalances from the hypothalamus or pituitary gland. Vas deferens obstruction can be congenital (absence of the vas deferens) or acquired (obstruction of the epididymis or vas deferens). Patients with azoospermia can choose appropriate treatment options based on their specific causes and fertility plans.
 

Treatment for Azoospermia

Treatment for azoospermia primarily involves sperm retrieval from the testes, usually performed under local anesthesia, followed by procedures such as intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF). Patients at RSMC Fertility Center in the U.S. often opt for IVF combined with genetic screening (PGS/PGT-A) to maximize the chances of a successful pregnancy. Since repeated sperm retrieval procedures may lead to significant testicular atrophy and premature onset of male menopause, many azoospermia patients at RSMC choose to freeze any remaining sperm after their first successful treatment for future use.

Obstruction of the vas deferens prevents sperm from reaching the female uterus to fertilize the egg, resulting in infertility. Obstructive azoospermia accounts for 40% of all azoospermia cases. Causes of obstruction can be congenital or acquired. Congenital causes include congenital epididymal obstruction and bilateral absence of the vas deferens, while acquired causes include infections, trauma, excessive length of vas deferens defects, orchitis, epididymitis, and prostatitis. The obstruction can occur in the vas deferens, epididymis, or ejaculatory duct, and may be segmental or multiple.

Symptoms of Vas Deferens Obstruction

1. Absence of sperm or low sperm count in the semen.

2. Pain during ejaculation or weak ejaculation.

3. Abnormal findings upon palpation of the epididymis or vas deferens.

4. History of reproductive system infections.

5. Previous surgeries or injuries to the reproductive system.

Symptoms of vas deferens obstruction are often subtle, and many men may hesitate to seek help due to psychological factors. It is advisable to undergo a physical examination early on for fertility planning and health reasons.

Treatment for Vas Deferens Obstruction

Microsurgical reconstruction is an option, but it is only applicable for segmental obstructions and not for multiple obstructions. Patients with multiple obstructions can consider various procedures such as percutaneous epididymal sperm aspiration, microsurgical epididymal sperm aspiration, testicular biopsy for sperm retrieval, percutaneous testicular aspiration, or testicular tissue biopsy. Each treatment option has its pros and cons, and after a medical evaluation, we can help you schedule a free consultation with a U.S. physician to find the most suitable treatment for sperm retrieval.