Post-Testicular Factors of Male Infertility – Causes & Treatment

By (gynecologist), (gynecologist), (embryologist), (invitra staff) and (biochemist).
Last Update: 09/26/2022

Male sterility due to a post-testicular factor refers to that which affects spermatozoa once they have been synthesized and leave the testicles.

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

Some of the reasons for seminal tract obstruction include infections, trauma, hypospadias, presence of antisperm antibodies and so on.

What are the causes of post-testicular factor infertility

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 contrary, it can be that there is ejaculation, but there are no spermatozoa in the semen, or their 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, we discuss the main reasons for post-testicular sterility.

Seminal duct obstruction

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

  • Epididymis
  • Vas deferens
  • 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. This is a permanent contraceptive method which prevents the presernce of sperm in the ejaculate.

Seminal Infections

Bacterial infections of the seminal ducts or the glands associated with 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 these, we recommend the following 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 continue reading 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 arises if the male is diagnosed with azoospermia, i.e. total absence of spermatozoa. In this case, there are two possibilities:

  • That the azoospermia is obstructive
  • That azoospermia is secretory

In obstructive azoospermia, the male produces spermatozoa in the testicles, but they cannot leave. 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.

Only a few sperm of poorquality are obtained, but it is the most applicable 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) to obtain embryos.

Epididymis Aspiration

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

The epididymis is the tube located behind the testicles where the spermatozoa are stored and complete their maturation. As such 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 Jon Ander Agirregoikoa M.D. (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.

Is there a difference between sterility and primary infertility?

By María Calomarde Rees M.D. (gynecologist).

Sterility and primary infertility are two different diagnoses that can follow a fertility study in women and men.

On the one hand, sterility is diagnosed in case of total inability to conceive. There are different causes of sterility, which can be observed in the case of dysfunction of the sexual organs or gamete defects. Among the causes of sterility, we have: abnormalities in the testicles, alterations in the FSH and LH hormones, absence of sperm or eggs and genetic abnormalities in the gametes.

On the other hand, we speak of primary infertility when it is impossible to conceive after one year of unprotected sexual intercourse without achieving pregnancy. Unlike sterility, primary infertility does not prevent pregnancy, but the couple may have to resort to assisted reproductive techniques to achieve pregnancy.

In case of primary infertility, we recommend a complete study of the couple, in order to reach a correct diagnosis, and guide the couple towards an adapted and personalized protocol.

How can I get pregnant if my husband suffers from erectile dysfunction?

By Marita Espejo Catena M.D., M.Sc., Ph.D. (gynecologist).

The inability to deposit sperm in the vagina during sexual intercourse has traditionally been one of the absolute causes of infertility.

Until the introduction of the most complex assisted reproduction techniques, the only option that could be contemplated was the use of a donor sperm sample.

With the development of in vitro fertilization (IVF) techniques, and especially with oocyte insemination by means of sperm microinjection (ICSI), the possibility of conceiving with a scarce number of spermatozoa is feasible.

In patients suffering from impotence that is not due to andrological medical treatment, nor psychological, an epididymal aspiration or testicular biopsy may be performed.

Epididymal aspiration consists of extracting the sperm stored in the epididymis using local anesthesia, where they acquire the ability to move after being generated in the seminal ducts.

Biopsy is reserved in cases of epididymal aspiration with negative results and requires access to mature sperm directly from the testicular tissue. Although it can be performed under local anesthesia, it can also be performed under anesthetic sedation, which allows the procedure to be performed at different points or on both testicles.

What are the symptoms of post-testicular factor infertility?

By Zaira Salvador B.Sc., M.Sc. (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.

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 reading the following article: Azoospermia – Can a Man Actually Have Zero Sperm Count?

We make a great effort to provide you with the highest quality information.

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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?', 'Is there a difference between sterility and primary infertility?', 'How can I get pregnant if my husband suffers from erectile dysfunction?' and 'What are the symptoms of post-testicular factor infertility?'.

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Authors and contributors

 Jon Ander  Agirregoikoa
Jon Ander Agirregoikoa
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 Jon Ander Agirregoikoa
License: 014809788
 Marita Espejo Catena
Marita Espejo Catena
M.D., M.Sc., Ph.D.
Graduated in Medicine and Surgery from the University of Valencia in 1992. Specialist in Gynaecology and Obstetrics. Doctor in Medicine from the University of Valencia in 2000. Master in Assisted Human Reproduction by the Rey Juan Carlos University and IVI in 2008. Currently, she is the director of Instituto FIVIR. More information about Marita Espejo Catena
License: 464616497
 Zaira Salvador
Zaira Salvador
B.Sc., M.Sc.
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
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

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