Dear Dr G,

My wife and I have an active sexual life and enjoy great intimacy.

However, as the festive season approaches, we are stressed out over the expected barrage of questions from well-meaning relatives about having children.

We have been trying since marriage but have not been successful.

My wife is slightly older than me and her gynaecologist has assured us that nothing is wrong with her physiologically.

I was asked to see a urologist completely shocked when I was told I have azoospermia – not producing any sperm.

I would like to put Dr. G on the spot for clarification of my “seedless” sex.

I have a strong sex drive, no erectile dysfunction and don’t suffer from premature ejaculation.

Can you explain why I am producing copious semen, but firing blanks?

What is azoospermia and is it curable? Will I ever be able to father a child?

Yours truly,

Azoospermia Anwar

Scientific data reveals that 30% of infertility issues are due to male factors and another 50% due to women. The remaining 20% are the result of complications with both partners.

Societal and cultural attitudes tend to unfairly place the burden of fertility on women but it would be naive to assume infertility is exclusively female in origin. As a result delays in the male seeking treatment compromises successful conception as couples are working on a tight timeline due to the female “fertility clock”.

Azoospermia is a condition where a man does not have any measurable sperm in his semen, which affects about 1% of the entire male population and in 20% of men with infertility issues. As the vast majority of the semen derives from the prostate and seminal vesicles, men who have azoospermia – just like men after a vasectomy – would be unable to tell that their semen does not have sperm.

It is not uncommon for men to assume that when the apparatus is functioning, the reproductive system is fine too.

But in reality, the male sexual libido is controlled by testosterone and the erection is dependent on the integrity of the blood vessels and nerves to the penis.

In other words, the reproductive system is an independent entity.

Causes of Azoospermia can be broadly divided into obstructive or non-obstructive in nature. Obstruction of the sperm ducts can occur after previous trauma or vasectomy. In some cases, a previous infection of chlamydia or gonorrhoea could cause obstructive azoospermia.

It can also be a genetic condition such as congenital bilateral aplasia of vas deferens (CBAVD), a condition closely linked with cystic fibrosis.

Non-obstructed causes of Azoospermia are generally conditions that render the cessation of spermatogenesis such as previous chemotherapy, mumps or radiation. The increase of temperature in the scrotum caused by dilated veins, as varicocele, can also severely impair spermatogenesis.

Lastly, some reports suggest that radiation from mobile phones in trouser pockets may not be too sperm-friendly.

Artificial reproductive technology (ART) has brought optimism to many for nearly five decades with procedures such as percutaneous epididymal sperm aspiration (Pesa), Microscopic epididymal sperm aspiration (Mesa) or testicular exploration sperm extraction (Tese).

These entail a small operation on the scrotum and most men would consider such intervention as a small price to pay for parenthood! This has brought hope to millions of prospective fathers.