Episode 3: Obstructive Azoospermia

Roughly 1% of all men shoot blanks. News of azoospermia can be shatter a man’s dreams of becoming a father. We traveled to Beverly Hills, CA to meet with Dr. Philip Werthman, a renowned surgeon who has seen incredible success rates in helping men with azoospermia restore their fertility. In this segment, we discuss plumbing problems that can lead to azoospermia and options for how to best correct them.

Types of Azoospermia

Doctors break the diagnosis of azoospermia into two categories. Non-obstructive meaning the testicle has a hard time producing sperm and Obstructive meaning that the testicle is making sperm but there is a blockage somewhere that prevents them from getting out. Dr. Werthman further divided obstructive azoosermia into two groups. Congenital meaning something that you are born with versus Aquired which means that the condition was caused by either an infection or medical procedure. Below we’ve outlined some of the main forms of obstructive azoospermia that Dr. Werthman reviewed with us during our interview.

Blockages of the Vas Deferens

Many of the plumbing problems occur with the vas deferens which is the main tube that transports sperm out of the testicle. The most common form of blockage to the vas deferens is a vasectomy which is a procedure where a doctor intentionally ties off the vas preventing sperm from leaving the testicle. This procedure is an incredibly painless and effective form of permanent birth control. Other things that cause blockages of the vas deferens include being a carrier the cystic fibrosis gene or having a history of hernia repair.

CF gene carriers

Some men who carry the CF gene have a congenital absence of the vas or a natural vasectomy. A skilled urologist should be able to identify an absence of the vas at a physical exam because it is large enough for them to feel. The most common form of treatment is an epididymal sperm retrieval which often yields hundreds of thousands or even millions of healthy sperm to be used with ART techniques. Genetic counseling is recommended for patients with this condition to help minimize the chances of passing the gene on to offspring.

Hernia repair

Another reason that men may experience blockages of the vas deferens is in cases where they’ve had hernia repair surgery, either as a child or using mesh as an adult. In these cases it may be possible to perform a surgery similar to a vasectomy reversal to restore functioning of the vas or perform a sperm retrieval.

Ejaculatory duct infections

The ejaculatory ducts are small tubes near the prostate which allow the majority of the seminal fluid to join the sperm on their way out of the body. Sometimes these tiny ducts (they are about a mm wide) can get blocked by infections or cysts in the prostate. A big key that can clue you and your urologist that you may have an ejaculatory duct obstruction is by noting a very small volume of seminal fluid. If only are able to get a few drops of semen during each ejaculation, there may be a blockage upstream. Most commonly a trans-rectal ultrasound is an imaging technique that can confirm the blockage and potential problems with the prostate. Often treating ejaculatory duct problems means treating the prostate. Sometimes this is a simple as taking antibiotics other times it may require surgical removal of cysts. If there is a suspected prostate issue, it is a good idea to find out what’s going on as prostate health is a key part of long-term health in men.

Epididymus blockages

Finally, the blockages may occur in the epididymus which is a thin coil of tube inside the testicle where newly developed sperm are stored. These blockages are often the most difficult to diagnose because the epididymus is really to small for most forms of imaging. In some cases, an infection will cause inflammation which will show up on a scrotal ultrasound but not always. As is the case with other infections, the situation may be resolved with antibiotics. But it may be necessary to perform a sperm retrieval.

Watch our full interview with Dr. Werthman on Obstructive Azoospermia

Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
Sara SDx

Author: Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.

5 thoughts on “Episode 3: Obstructive Azoospermia”

  1. Hi sara
    I had a hynia surgery when I was still a child…many yrs later after marriage I have still not been able to conceive. test result shows azospermia which is as a result of blockage (bilateral varicosele). This is six months after the surgery and the test result is still the same. Although the operated part is still swollen. Please I want to know what your advise is and if there is hope for me? My test result shows
    Colour: greyish white
    Viscosity: watery
    Ph 8.0
    Motile cells:0%
    Non Motile cells: 100%
    Volume : 3ml
    Odour : seminal
    Semen count : 3.0 x 10^6 cells/ml

    1. I’m confused. A varicocele is not a blockage — it is enlarged viens. Did you have surgery for the blockage or for treating the varicocele.
      Hernia surgery can cause blockages separate from varicoceles. Both can cause issues with sperm.

  2. Hi sir!
    I was diagnosed with nil sperm (azoospermia) and after that doctor told me to do blood test in wich all the hormones are in the normal range.I.e FSH,lh etc they suggested me to do testicular biopsy.
    Sir what u suggest should I go for biopsy or not please guide me.
    Jawad Ahmed.

    1. Sorry for the delay in getting back to you. I was on vacation for the holidays and didn’t have internet connection k
      FSH in the normal range is a pretty good sign.

      Did they test for Y chromosome microdeletion? XXY? CF carrier?

      Have you had a physical exam to check for blockages? Maybe some imaging tests — like a scrotal ultrasound.
      Do you have a urologist that has specialized in male fertility?

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