Epididymal Obstruction

Sperm is produced in the seminiferous tubules and is transferred to the epididymis. This is a tube coiled inside of the scrotum. This duct is actually about twenty feet long, but is coiled very tightly and runs behind the testes, forming a duct. This duct is a passage for sperm to travel down as they grow and mature before they are expelled. When this duct becomes blocked, it is referred to as an epididymal obstruction.
Epididymal obstructions prevent the sperm from ever making it to the ejaculate. Obstructions can occur on one side or both sides. One sided blockages normally cause a man to have a low sperm count. A two sided blockage can cause the sperm count to be as low as zero. This condition is referred to as azoospermia.
An epididymal obstruction can sometimes be felt in a simple physical exam. Blockages can cause the epididymis to become swollen and hard. Azoospermia can be caused by the sperm not being produced or not being delivered due to an epididymal obstruction. An infertility specialist will determine which is the cause if you are experiencing azoospermia. If any sperm are being produced, then they can be manually retrieved and can be used for conception through in-vitro fertilization or intracytoplasmic sperm insertion, so a zero sperm count does not always mean that you can not father a child.
Blockages of the epididymis can usually be surgically repaired. Success rates may depend on the cause of the blockage. Some blockages are naturally occurring, some can be caused by hernia or from the repair of a hydocele.
Your infertility specialist may need to take a tissue sample from the testis to determine if sperm production is happening. If it is, then a blockage may be diagnosed. After that, you may consider surgery to bypass the blockage. This surgery is called vasoepididymostomy. This bypass connects the vas deferens to the epididymis.
Many men choose sperm retrieval for use in in-vitro fertilization or intracytopolasmic sperm insertion over surgery. Sperm can be retrieved with a needle or incision into the testis. Another option is to retrieve the sperm directly from the epididymis through a Microscopic Epididymal Sperm Aspiration (MESA). This is a common choice because the sperm are more mature when taken from the epididymis. There is also more sperm to be retrieved from the epididymis than the testis. Sperm can be harvested and frozen for future in-vitro fertilization attempts.
About the Author: Dr. Eric Daiter, the medical director of The NJ Center for Fertility and Reproductive Medicine, LLC, a leading NEW JERSEY INFERTILITY CENTER that offers a complete range of MALE INFERTILITY AND FEMALE INFERTILITY TREATMENT. For more information on The NJ Center for Fertility and Reproductive Medicine and Eric Daiter please visit www.drericdaitermd.com.

Spermatogenesis

A certain series of events needs to occur for sperm cells to mature into viable sperm ready for fertilization. This process is controlled by the man’s endocrine system and is referred to as spermatogenesis.

Spermatogenesis is controlled by the hypothalamus in the brain. This is a very small section of the brain that helps maintain and regulate metabolic processes. The hypothalamus secretes gonadotropin-releasing hormone (GnRH).

Gonadotropin-releasing hormone stimulates the release of luteinizing hormone (LH) from the pituitary gland. The pituitary gland is located at the base of the brain and is part of the endocrine system. Luteinizing hormone stimulates the Leydig cells in the testicles to produce testosterone.

The sperm cells mature when testosterone combines with follicle stimulating hormone (FSH). Follicle stimulating hormone is critical in spermatogenesis because it aids in the production of androgen-binding proteins necessary for maturation.

All of these processes need to work properly for spermatogenesis to occur, so it is no surprise that many men have problems with infertility. Nearly half of all infertility cases are male-factor.

Many things can interfere with spermatogenesis. Alcohol use, high stress, poor diet, medications, lifestyle, disease and illness are only a few of the things that can interfere with sperm cell maturation. The process of spermatogenesis takes about seventy two days. Therefore, sperm cells can be affected for a long time after an illness or other disruptive trigger.

Because of the sensitive nature of spermatogenesis, multiple semen analysis may be necessary to diagnose a problem. It can take some time to get an accurate idea of what the problem is. Most people are familiar with sperm count.

Sperm count refers to the number of millions of sperm per milliliter of ejaculate. A normal range is between forty million and three hundred million sperm. Sperm count is considered low if it is under twenty million. But, keep in mind that in many cases, low sperm count is temporary and reversible.

Obstructions in the male reproductive system can cause a sperm count to be zero. This is referred to as azoospermia. In these cases, infertility treatments can help. There are several ways for sperm to be retrieved from the testes and reproductive tract. Once the sperm is retrieved, then it can be inserted into an egg outside of the body in the lab through a process called intracytoplasmic sperm injection (ICSI). Another option is in vitro fertilization (IVF), where the sperm and egg are combined in a laboratory and fertilization is allowed to occur. Your Reproductive Endocrinologist will help you decide which method has the greatest chance of success for you.

This information is provided by Dr. Eric Daiter MD.


About the Author: Dr. Eric Daiter, the medical director of The NJ Center for Fertility and Reproductive Medicine, LLC, a leading NEW JERSEY INFERTILITY CENTER. Dr. Eric Daiter offers a complete range of MALE INFERTILITY AND FEMALE INFERTILITY TREATMENT. For more information on The NJ Center for Fertility and Reproductive Medicine and Eric Daiter please visit www.drericdaitermd.com.