Blockage of sperm transport or obstructive azoospermia is a fertility disorder, which leads to lower concentration of sperm (partial blockage of sperm transport) up to complete absence of motile sperm in semen (azoospermia due to total blockage of sperm transport). 10% to 15% of infertile men have blockage of sperm transport. Obstruction of semen ducts occurs in 70% of all azoospermia cases. Blockage can occur at any point of sperm outflow tract, starting from epididymis tubules over ejaculatory ducts and up to the urethra. Blockage of sperm transport can be due to congenital (stenosis or duct cysts) or acquired reasons. Among the latter ones specialists emphasize the infection, inflammation and benign tumors as especially frequent causes of sperm transport blockage.
Sperm motility score should be studied in the laboratory, equipped with modern magnification equipment. The normal motility score represents the percentage of sperms which actively move into the forward direction.
Patients with partial obstruction (blockage) may have mild or no symptoms. Nevertheless it is important to perform the timely diagnostics of this condition, since it leads to infertility and other health problems, such as
- Painful ejaculation
- Chronical perineal pain
- Retrograte ejaculation
- Urinary sphincter disorder
During a physiological palpation procedure, an experienced urology or andrology specialist can find post-operative scars, seals, bands, areas of thickening or cyst. In case some dubious areas are identified, a special transrectal ultrasound procedure is performed. It helps to diagnose the possible dilatation problem in epididymis and seminal vesicle . Among the other necessary diagnostic steps there are:
- Angiography - x-ray examination of the vas deferens;
- Studies of FSH and LH hormones in the blood. High levels of FSH suggests that the testicles do not produce sperm. In this case the restoration of patency of the vas deferens through a surgery is questionable.
- Testicular biopsy helps to determine the presence of sperm in the testis.
- These steps help not only to diagnose the blockage of sperm transport, but also to determine the root cause of the blockage of sperm transport.
Surgical management of the sperm transport blockage is the only way to restore fertility of a man. The surgery aimed at unblocking the sperm transport should be performed by an experienced microsurgery specialist, who will clear up the blockage under 10x25 power magnification. A special “Microknife” technology is usually implemented at German clinics to hemitransect the vas until the lumen is revealed. This kind of treatment is performed under general anesthesia and lasts about 25-50 minutes. After the surgical elimination of the blockage, the fertility function is restored in 70% of all cases. If the azoospermia still persists and a man still has low sperm count, the treatment with one of the assisted reproductive technique is indicated.
If the permeability of the seminal ducts is unrecoverable or microsurgical operation is contraindicated due to anatomical features, a man can apply to direct microsurgical aspiration of sperm from the epididymis (TESA) or extraction of sperm from the testicle (MESA), combined with artificial insemination (ICSI intracytoplasmic sperm injection). The spermatozoa aspirated from epididymis or testicles can be frozen (cryopreserved), to allow a second ICSI procedure, if another pregnancy is planned in the future.
Being a patient at one of the best German fertility centers, you can expect the highest level of urological service as well as individual and holistic approach. Don’t hesitate to call us for more information.