Medicine of the Future in America

Azoospermia – Evaluations and treatments: OBSTRUCTIVE AZOOSPERMIA

Before serving their role in fertilizing oocytes, spermatozoa must exit the testis and pass through a complex excurrent ductal system, which includes the efferent ductules, epididymis and vas deferens leading to the ejaculatory duct. Pathological conditions in any part of the excurrent ductal system obviously may have a significant impact on spermatozoa transport, resulting in subfertility or infertility.
Typically, azoospermia is evident when complete obstruction occurs bilaterally. It should, however, be noted that the finding of some sperm in the ejaculate does not rule out the presence of obstruction. In fact, partial obstruction of the excurrent ductal system, which is an underdiagnosed clinical entity, can occur, leading to impaired quantity as well as quality of sperm in semen. Proper diagnosis and treatment of obstruction can result in improved semen parameters. buy ampicillin
By far the most common cause of excurrent ductal obstruction is previous vasectomy. In addition, various inflammatory conditions , particularly those involving the epididymides, are among the prevalent etiologies of excurrent ductal obstruction. Other conditions that can lead to obstructive or, as some investigators preferred, secretory azoospermia (the inability to release sperm to ejaculate) are summarized in Table 3.

TABLE 3 Common causes of obstructive or secretory azoospermia

Congenital
Congenital absence of vas deferens Ejaculatory duct obstruction or cysts
Obstruction at prostatic utricle
Malformation of excurrent ductal system
Inflammatory conditions
Epididymo-orchitis
Vasitis
Prostatitis
Neurogenic
Anejaculation or retrograde ejaculation
Iatrogenic
Vasectomy
Postradiation ductal fibrosis
Vasal or epididymal injury from surgeries
Bladder neck injury
Drugs or medical therapy
Trauma
Neurological injuries
Excurrent ductal injuries
This entry was posted in Azoospermia and tagged Assisted reproduction, Azoospermia, IntracytopLasmic sperm injection, Male infertility, Microsurgery, Oligospermia.
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