Dear Dr G,

We are a thirty-year-old couple who are deeply troubled by our fertility issues.

My wife and I have been married for more than two years, and it has been our dream to have a dragon child to complement our Zodiac signs.

In fact, my father and my grandfather were both born in the dragon years, and I am left with the burden of carrying the family dragon line.

We both work very hard in the last twelve months, having regular sex to get pregnant.

We are somewhat puzzled when there is no outcome despite both of us being fit and healthy.

My wife has given in to pressures from our parents just before Chinese New Year to avoid well-meaning relatives.

We went for a check-up with the specialist at the end of last year.

While my wife was given her all-clear, I was asked to do my sperm tests.

I was shocked when I found out I had been firing blanks all this while.

I am very surprised as I am perfectly normal with my libido, erection and ejaculation.

Despite climaxing normally, I was told my firing had all been blanks.

The doctors have asked us to embark on a test-tube baby treatment as soon as possible.

On these auspicious days of the Chinese New Year, I would like to put Dr. G on the spot for this curious situation I am in.

First, how is it possible that I ejaculate normally and there are no sperms in it?

What exactly is azoospermia, and why is it affecting me?

Lastly, the doctor suggested the only way to go forward is to do a small operation on my balls to retrieve sperm for test tube babies. Is that necessary?

I really hope to celebrate the end of this year with my offspring.

Are my blank firings dashing all the hope for Paternal Dragon Dreams?

Regards

Under normal circumstances, the sperms, which travel through the reproductive tract to the prostate, are formed and mature in the testicles. The sperm will mix with the seminal and prostatic secretions that make up the semen. With or without the sperms, the secretion forms a thick, white ejaculation that comes out of the penis. When the semen is deprived of sperm, men can continue to ejaculate “normally” and are oblivious to the fact they are “firing blanks” until the semen analysis is carried out.

Azoospermia is a medical condition characterised by a man having normal sexual functions and ejaculation. However, the semen contains no sperm. This fertility condition affects up to 1% of the male population in general, but the prevalence can be as high as 20% during investigations for infertility in couples. Although the diagnosis of azoospermia is devastating for most men, many forms of the condition are amenable to medical treatment to restore fertility. Obviously, the undesirable outcome, or lack of it, is male-factor infertility.

Azoospermia is generally classified into obstructive and non-obstructive in origin. The two different types can further be subclassified into congenital and acquired azoospermia. Obstructive azoospermia constitutes 40% of azoospermia due to defects of the vas deferens or epididymis, resulting in occlusion of the passage of sperms from the testicles. The common reason for such physical obstruction is vasectomy when the intended intervention for contraception causes men to fire blanks. Other forms of acquired obstructive azoospermia may include testicular trauma and infections resulting in tubal occlusions, such as chlamydia and gonorrhoea, causing the scarring of the vas.

Genetic mutations are also known to result in obstructive azoospermia. Men with cystic fibrosis or carrying such genetic mutation may have a defective connection of the vas, causing congenital bilateral absence of the vas deference. Other inborn deformities, such as congenital prostatic cysts, are also well recognised, rendering sperm passage obstruction.

The non-obstructive form of azoospermia can be caused by defective testicles with the inability to produce or allow the maturation of sperms. This can be due to undescended testicles or spermatogenic arrest. Other acquired destruction of spermatogenesis includes childhood mumps, cancer, diabetes, varicocele, and radiation that destroy normal sperm production, causing azoospermia.

The most basic way to diagnose azoospermia is through semen analysis. Blood investigations and the biopsy of the testicles can also assist in the definitive diagnosis of obstructive or non-obstructive azoospermia. The investigations can also identify the presence of sperms that can potentially be used for the fertilisation of embryos. The biopsy and extraction of sperm are usually done concurrently. The samples are retrieved using a small needle to harvest the sperms directly from the scrotum (Per Cutaneous Sperm Aspiration). In addition, a small procedure to explore the reproductive tracts with the assistance of a microscope (Microscopic Epididymal Sperm Extraction) can also have the added benefit of getting healthy sperm for the purpose of IVF and Test-tube babies.

For infertile men often inspired by their own fathers and aspire to walk the path, the diagnosis of azoospermia effectively crushed the lifetime dream of fatherhood. In the last few decades, the advancement in research for male infertility and refinement of sperm retrieval has contributed so much to the art of ART (Artificial Reproductive Technology), overcoming the obstacles of azoospermia. The renowned Italian Philosopher, Astronomer and Mathematician whose theories anticipated modern science once said: “Time is the Father of Truth.” When men discover they have been firing blanks and having their paternal dreams dashed, are putting Dr G on the spot for advice, his view is “Time is of absolute essence to discover the father of truth”, as early intervention has much better out-cum to let ART of Science to give the helping hand to nature, especially time is running out for this round of Dragon Babies. On that note, wishing all a prosperous and fruitful Dragon Year!!

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