Male infertility occurs due to one or more of three primary reasons. Firstly, a low sperm count (Oligospermia) can lead to difficulty in conceiving. Secondly, there can be problems with the transportation of sperm after production in the testes to the vagina. Such sperm transport disorders are responsible for 10-20% of male infertility cases. The third problem is when there is production of abnormal sperm (Teratospermia).
What is the Route the Sperm Must Follow?
Sperm is produced in the two egg-shaped glands, known as the testes. The testes are seated in the scrotal sac at the base of the penis. It takes around 70 days for the sperm to be produced and mature. The sperm is then passed from the testes to the epididymis, where the sperm gains motility (the ability to swim). After roughly 10 days in the epididymis, the sperm is ready to move out at the next orgasm.
During an orgasm, the muscle contractions push the sperm along with some fluid from the testes to the vas deferens. This is the duct that conveys the sperm to the urethra. The mixture of sperm and fluid, known as semen, is released into the urethra. The semen travels via the urethra to the tip of the penis and is released. This release at the time of orgasm is known as ejaculation.
What Problems Arise in Sperm Transportation?
Blockages in the different ducts that carry the sperm from the testes to the urethra can cause problems for sperm transportation. The three main categories of problems arising in sperm transportation can be classified under the categories of congenital disorders, acquired disorders and functional obstruction.
These are birth disorders that affect male fertility. They include incomplete development of the sperm ducts, atresia of duct (natural blockage), and no seminal vesicles present to store sperm. Any other structural disorders of the male reproductive system present from birth fall under this category.
These are caused due to a disease or infection of the reproductive system. Inflammation can lead to scarring. Sperm transportation can be affected by scars in the ducts leading to no place for sperm to travel. Motility is also affected by the severing of sperm transportation ducts during hernia repair. Other blocks may be created as a side effect of surgery for another organ.
These are disorders which can stop sperm movement, thereby causing male infertility. These include conditions such as nerve damage caused in an accident, surgery which has had an adverse effect on the ability of the ducts to transport sperm, and injury to the spinal cord affecting muscular motion. The nervous system can also be affected by tranquillizers, anti-depressant medication, and blood pressure medication.
What Signs or Symptoms are Associated with Blockage of Sperm Ducts?
Sperm duct blockages are responsible for a sizeable number of male infertility cases. However in most cases there are no obvious signs or symptoms pointing to this condition. Should the blockage be caused by an infection, there may be abnormal penis discharge with a peculiar smell.
Inflammation of the penis along with discomfort during passing urine or ejaculation is also reported in some cases. The volume of semen ejaculated when there is a blockage may also be less. A semen analysis, and transrectal ultrasound are required to check whether there is any blockage in the sperm transport system. The blocks can be present in either the seminal vesicles or the ejaculatory ducts.
Treatment Options to Improve Sperm Transportation
Most obstructions in the sperm transportation route can be reversed with specialized surgery. The only condition which does not have a surgical cure is the complete absence of the vas deferens. Transurethral resection of ejaculatory duct (TURED) surgery, vasoepididymostomy, and microsurgical vasovasostomies may be performed to unblock the sperm transportation ducts.
Treatment will be suggested based on diagnostic tests that reveal the actual nature of the problem.
The surgical procedures are usually done under general anaesthesia and may take a couple of hours to perform. Recovery time differs based on the treatment procedure performed and can be anything from days to a fortnight. The patients are advised to avoid any strenuous physical activities during the recovery period.
Post-operative care will include a course of prescribed antibiotics to ward off any possible infection, as well as the wearing of scrotal supporters. Should the fever or nausea persist beyond a couple of days after the surgery, ensure that the health care provider is informed. Any pain or bleeding seen in the region will merit a trip to the hospital immediately.
Male infertility caused due to sperm transport blockage is corrected in 50-70% cases post-surgery. Most patients are able to return to work within a week of the surgery being performed. Normal lifestyle may be resumed three weeks after the surgical procedure, as long as no secondary infection occurs.
Reviewed by Afsaneh Khetrapal BSc (Hons)