Post-Testicular Factors of Male Infertility – Causes & Treatment

By MD (gynecologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 02/25/2019

Male sterility due to a post-testicular factor refers to all agents that affect spermatozoa once they have been synthesized and leave the testicle.

Usually, the main cause of this type of infertility is some type of obstruction in the seminal ducts that prevents the sperm from leaving an ejaculation.

Causes

Post-testicular causes of male infertility are those related to the transport and expulsion of sperm and/or semen.

The absence of ejaculation is known as anejaculation. In this case, the male is not able to expel any semen, which is the fluid that transports the spermatozoa.

On the other hand, it can happen that there is ejaculation, but that there are no spermatozoa in the semen or that its concentration is very low. These alterations are known as azoospermia and oligozoospermia, respectively.

In both cases, achieving a natural pregnancy will be very complicated or impossible.

Below, the main reasons for post-testicular sterility.

Seminal Duct Obstruction

Seminal or sperm ducts are those that lead sperm from the testicles to the outside of the male reproductive tract and are composed of:

  • Epididymis
  • Deferential ducts
  • Urethra

Any trauma or infection in any of these or adjacent parts can lead to an obstruction that prevents the passage of sperm.

Another abnormality that could be included within this group is the congenital bilateral absence of the vas deferens, a genetic alteration found in the vast majority of patients with cystic fibrosis that causes obstructive azoospermia.

Finally, it is important to mention the most common cause of sperm duct blockage in adulthood: vasectomy.

Seminal Infections

Bacterial infections of the seminal ducts or the adnexal glands of the male reproductive tract can cause scarring and obstruction.

Next, we are going to name the most common pathologies:

  • Prostatitis:infection and inflammation of the prostate.
  • Epididymitis:, infection and inflammation of the epididymis.
  • Deferentitis:infection and inflammation of the vas deferens.
  • Urethritis:infection and inflammation of the urethra.

If you want to read more about this, we recommend you enter the next post: Sperm Infections and Temporary Infertility.

Sexual Impotence

Sexual impotence or erectile dysfunction refers to a man's inability to maintain an erect penis long enough to enjoy sexual intercourse and ejaculate.

Evidently, if the man cannot have sexual intercourse with ejaculation, the possibility of pregnancy in the woman will be null.

For more information on this topic, you can read more here: Male Sexual Dysfunction – Causes & Treatment.

Retrograde Ejaculation

Retrograde ejaculation is an alteration of the male reproductive tract consisting of the inability to expel semen through the urethra.

As a result, semen ends up in the bladder when the man ejaculates, making it possible to find sperm in the urine.

Possible causes of retrograde ejaculation are diabetes, the treatment of hypertension and surgery on the prostate, gallbladder or urethra.

If you are interested in reading more about this, you can click here: What Is Retrograde Ejaculation? – Causes & Treatment.

Treatment to achieve pregnancy

The first sign that may indicate an alteration in the seminal ducts is the low sperm count in the seminogram test. This oligospermia can easily be solved with in vitro fertilization (IVF).

The problem is when the male is diagnosed with azoospermia, i.e. total absence of spermatozoa. In this case, two things can happen:

  • That the azoospermia is obstructive
  • That azoospermia is secretive

In obstructive azoospermia, the male does produce spermatozoa in the testicles, but they cannot come out. Therefore, it will be necessary to collect them with techniques such as testicular biopsy or aspiration of the epididymis.

Testicular Biopsy

A testicle biopsy is a surgical procedure in which small cuts are made and small fragments are removed from the testicle to look for sperm under a microscope.

Very few sperm of not very good quality are obtained, but it is the most indicated technique when men present sterility of post-testicular origin.

The sperm obtained are then used to fertilise the eggs by means of intracytoplasmic sperm injection (ICSI) and to obtain embryos.

Epididymis Aspiration

Aspiration of spermatozoa directly from the epididymis is an alternative to testicular biopsy.

The epididymis is the tube located at the back of the testicles where the spermatozoa are stored and complete their maturation, so it is possible to obtain better sperm quality with this technique.

Do you need donor sperm for your fertility treatment cycle? Then we recommend that you get your Fertility Report now to find the most suitable clinic for you. Our thorough selection criteria when it comes to recommending clinics plus your particular needs equal the best fertility center for you. You will receive in your inbox a detailed report with the clinics that we recommend for your particular treatment, as well as the conditions that they offer for each program.

FAQs from users

What are spermatic or ejaculatory ducts?

By Dr. Jon Ander Agirregoikoa MD (gynecologist).

The sperm ducts are made up of the epididymis, the vas deferens, the ejaculatory ducts and the man's urethra. They constitute a set of ducts whose function is to liberate the spermatozoa to the outside by means of ejaculation.

What are the symptoms of post-testicular factor infertility?

By Zaira Salvador BSc, MSc (embryologist).

Depending on the cause of the post-testicular sterility, the male may or may not present some symptoms, such as pain, swelling, redness of the testicular area, etc.

On the other hand, the man may also notice that he ejaculates very little semen. This is known as hypospermia.

Suggested for you

If you have semen quality problems and want to have a child, you can read the following article for more information: Treatments for Male Infertility.

If you have an azoospermia problem, we recommend you read the following article: Azoospermia – Can a Man Actually Have Zero Sperm Count?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Brugo-Olmedo S, Chillik C, Kopelman S. Definición y causas de la infertilidad. Revista colombiana de obstetricia y ginecología 2003; 54(4):227-248.

Krausz C. Male infertility: pathogenesis and clinical diagnosis. Best Pract Res Clin Endocrinol Metab. 2011;25(2):271-85.

Gregory M, Cyr DG. The blood-epididymis barrier and inflammation. Spermatogenesis. 2014;4(2):e979619.

FAQs from users: 'What are spermatic or ejaculatory ducts?' and 'What are the symptoms of post-testicular factor infertility?'.

Authors and contributors

Dr. Jon Ander  Agirregoikoa
Dr. Jon Ander Agirregoikoa
MD
gynecologist
Graduated in medicine from the "Pays Basque" University, with a specialization in obstetrics and gynaecology. He has several years of experience in the field of assisted human reproduction and is co-director and co-founder of the ART clinics. He also combines his medical activity with teaching at the "Pays Basque" University. More information about Dr. Jon Ander Agirregoikoa
License: 014809788
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Marie Tusseau
Marie Tusseau
inviTRA Staff
Editorial Director of Babygest magazine in French and English More information about Marie Tusseau

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