Dear Dr G,

I email you with a heavy heart as I found our childlessness is my fault.

My wife and I have been married for five years and despite a very active sex life, there has been no outcome of any offspring.

For the last few years, during the festivities, my wife has been shouldering the burden of not bearing a child.

I didn’t even know there was such a thing as male-factor infertility, until we went to the doctors who asked for semen analysis.

As it turns out I have no sperm in my ejaculate.

Don’t get me wrong, I am perfectly normal in the bedroom. In fact, I considered our sex life to be at the top end of normal. I just don’t understand how it can be fruitless.

The doctor tried to explain to me the problem may either be due to blockages in the sperm ducts or destruction of the sperm producing cells.

I really would like to put Dr G on the spot for clarifications of my seedless outcome.

Can you tell me how common male factor infertility is?

How to differentiate between the obstructive and non-obstructive problem?

Why is this happening to me?

The doctors mentioned the only hope I have to father a child is to undergo an operation and accept test tube babies. What operation will I need to face?

Regards

Seedless Samuel

In general, infertility is defined as the inability for couples to conceive after one year or more of active sex life without contraception. The World Health Organisation (WHO) estimates 60 to 80 million couples are affected, and this number is often considered the tip of the iceberg. Male infertility applies to a sexually mature man having difficulty to impregnate a healthy fertile female.

Contrary to common belief that infertility is not predominantly a female problem, male infertility can account for up to 40% of all cases of infertility.

Starting from the late 20th century, the realisation of the declining quality of semen has become apparent.

A study in 1992 revealed the number of sperm cells has declined by 1% per annum since 1938.

This is echoed by studies carried out in many countries showing the decline is not just in sperm counts, but also motility, morphology and seminal volumes in overall male populations.

Some publications revealed azoospermia, or the absence of sperms in ejaculate, can affect up to 3% of all male populations.

The causes of azoospermia can be divided into either acquired or congenital in nature; this can further be differentiated into obstructive and non-obstructive in nature. The commonest acquired obstructive azoospermia is vasectomy.

Apart from the surgery, sexually transmitted infections or trauma to the genitalia can also result in the scarring of the sperm delivering systems causing azoospermia.

On the other hand, non-obstructive azoospermia can also be acquired or congenital. Infections such as mumps can destroy the sperm producing cells in the testicles, and men born with genetically derived spermatogenesis arrests can also end up with male-factor infertility.

The hope for fathering a child for a man with non-obstructive azoospermia is very slim.

One of the main causes is the blockage of the ejaculation apparatus that prevents the passage of sperms.

Congenital bilateral absence of the vas deferens (CBAVD) occurs when the vasa deferentia of male reproductive organs fail to form properly during birth.

As most of the seminal fluids derive from the prostate, men who are missing their vas deferens are typically ejaculating “normally” but the trapped sperms render them having obstructive azoospermia.

The main cause of CBAVD is the mutation of Cystic Fibrosis (CFTR) genes resulting in the absence of one or both sides of vas deferens.

Trans-abdominal or trans-rectal ultrasound scans are usually performed to determine the diagnosis of CBAVD.

Hormonal blood tests such as FSH are also important to determine the nature of azoospermia.

Almost all men with CBAVD are completely unaware of their shortcomings until the investigation for infertility.

Therefore, many men who choose not to father a child can definitely live blissfully all their lives not knowing that nature has already lent them a helping hand.

Men with obstructive azoospermia can overcome infertility with ART (Artificial Reproductive Technology).

PESA (Percutaneous Epididymal Sperm Aspiration), MESA (Microscopic Epididymal Sperm Aspiration) and TESE (Testicular Exploration Sperm Extraction). These are the three main surgical techniques to retrieve the trapped sperms.

Following the sperm retrieval, the creation of embryos with IVF (in-vitro fertilisation) and subsequent baby delivery is usually a matter of time.

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