Obstructive azoospermia (OA), also called post-testicular azoospermia, is a cause of male infertility whereby no sperm are seen in a semen sample due to ejaculatory duct obstruction (EOD), responsible for allowing exit to the exterior.
It is the least severe type of azoospermia, and the one involving the lowest degree of infertility. Learn about your options to have a baby with obstructive azoospermia hereunder.
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Most common causes
The causes of ejaculatory duct obstruction (EOD) are varied.
The following are the main ones:
- Vasectomy: the seminal ducts are voluntarily blocked as a birth control method.
- Surgical complications that caused a cut or blockage in the ejaculatory ducts.
- Some congenital or genetic abnormalities can cause to failure in ejaculatory duct development. Bilateral cryptorchidism is an example.
- Diseases like mumps or meningitis before puberty can block the ejaculatory ducts.
- Inflammation, cysts or trauma, whether they occur in the testes, epididymis, prostate, urethra, or vasa deferentia.
Related post: What Are the Causes of Azoospermia?
Diagnosis
Patients with obstructive azoospermia have normal hormone levels and testicular size.
For this reason, to verify that it is a case of obstructive azoospermia, the man has to undergo a series of seminal analyses and check whether his testes are able to produce sperm through a testicular biopsy.
A thorough palpation of the testicle can help the specialist to determine if there is spermatogenesis (sperm production) or not, although rendering a correct diagnosis before doing a biopsy is not possible.
The next step is to discover the exact location of the blockage. By doing this, we can determine the site where sperm can be collected from. The sample collected can be used in a fertility treatment to achieve a pregnancy.
Treatment
The only treatment for obstructive azoospermia that can fix it is surgery. It basically involves reconnecting the conducts again to allow the passage of sperm again.
If surgery works, most males are able to expel spermatozoa again after a few months. Thus, they will have the chance of conceiving naturally, that is, without needing assisted reproduction to conceive a child.
As for natural treatments, there is no remedy that can work, as an obstruction cannot be repaired with a natural or medical therapy. Aside from a few exceptional cases, obstructive azoospermia requires surgery in almost all cases.
Pregnancy with obstructive azoospermia
As regards the chances of pregnancy, obstructive azoospermia is the less severe than non-obstructive or secretory azoospermia. In fact, there exist varios reproductive options for a man with obstructive azoospermia to be able to have genetic children, since spermatogenesis occurs.
As explained in the previous section, surgery is the first option in all cases of obstructive azoospermia. If achieving pregnancy is not possible after surgery, the most adequate fertility treatment will be determined.
What follows is a list of the potential alternatives available. However, should these options be unsuccessful, sperm donation is another possibility. To learn more about it, read: What Is Sperm Donation?
Testicular biopsy
A testicular biopsy is one of the main options for a man with obstructive azoospermia to have children. With a testicular biopsy, retrieving sperm that are capable of fertilizing the egg and result in a viable embryo is possible. The resulting embryo will be then transferred to the maternal womb, so that it is hopefully able to implant and cause pregnancy in the intended mother.
For fertilization to be possible in these cases, the technique used is IVF with ICSI (intracytoplasmic sperm injection). With this method, success can be achieved with just a single sperm cell. Given that with a testicular biopsy, neither retrieving a large amount of spermatozoa nor high-quality sperm is possible, ICSI is the only feasible option.
If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
Sperm aspiration
Another possible option, only viable in case the blockage is found in the vasa deferentia and not in the epididymis, is microsurgical epididymal sperm aspiration. It works similarly to a testicular biopsy: after retrieving sperm with this method, they are microinjected into the egg cell through ICSI technique.
A final option, although it is less common, it is also possible for a man with obstructive azoospermia to have biological children using ICSI with sperm collected via testicular sperm extraction. As in the case of epididymal sperm retrieval, it involves injecting a needle in the testicle, aspirating part of its content, and search for live sperm to be microinjected into the egg cell.
FAQs from users
Why does vasectomy cause azoospermia?
A vasectomy is a surgical procedure whereby the vasa deferentia are cut and tied. This causes sperm not to be expelled along with the semen during ejaculation, that is, it causes obstructive azoospermia.
Can cystic fibrosis cause obstructive azoospermia?
Cystic fibrosis is a genetic pathology that can affect the adequate development of sexual organs. For this reason, it can cause babies to be born without one or both seminal ducts.
Is a natural pregnancy possible with obstructive azoospermia?
Yes, it is possible in cases where a surgical procedure allows the passage of sperm through the vasa deferentia and epididymis again.
In any case, even though surgery can allow the passage of sperm, it is possible that sperm quality is insufficient as to fertilize the egg. For this reason, sometimes, in spite of having fixed the obstruction surgically, conceiving via assisted reproduction is still required.
Suggested for you
As already explained, a testicular biopsy can help both in the diagnosis and treatment of obstructive azoospermia. See this for more: What Is a Testicular Biopsy? – Purpose & Procedure.
You may also enjoy some further information reading this: What Are Your Chances of Achieving Pregnancy with Azoospermia?
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References
Baker K, Sabanegh E Jr. Obstructive azoospermia: reconstructive techniques and results. Clinics (Sao Paulo). 2013;68 Suppl 1:61-73.
de Souza DAS, Faucz FR, Pereira-Ferrari L, Sotomaior VS, Raskin S. Congenital bilateral absence of the vas deferens as an atypical form of cystic fibrosis: reproductive implications and genetic counseling. Andrology. 2018 Jan;6(1):127-135.
Morita T, Komatsubara M, Kameda T, Morikawa A, Kubo T, Fujisaki A, Kurokawa S, Kawata H, Tanaka A. A new simple technique of epididymal sperm collection for obstructive azoospermia. Asian J Androl. 2016 Jan-Feb;18(1):149-50.
Ramasamy R, Lipshultz LI. Cystic fibrosis transmembrane regulator mutation and congenital bilateral absence of the vas deferens: a bad combination for successful intracytoplasmic sperm injection outcomes. Fertil Steril. 2014 May;101(5):1246.
Văduva CC, Constantinescu C, Radu MM, Văduva AR, Pănuş A, Ţenovici M, DiŢescu D, Albu DF. Pregnancy resulting from IMSI after testicular biopsy in a patient with obstructive azoospermia. Rom J Morphol Embryol. 2016;57(2 Suppl):879-883.
van Wely M, Barbey N, Meissner A, Repping S, Silber SJ. Live birth rates after MESA or TESE in men with obstructive azoospermia: is there a difference? Hum Reprod. 2015 Apr;30(4):761-6.
Wosnitzer MS, Goldstein M. Obstructive azoospermia. Urol Clin North Am. 2014 Feb;41(1):83-95.
FAQs from users: 'Why does vasectomy cause azoospermia?', 'Can cystic fibrosis cause obstructive azoospermia?' and 'Is a natural pregnancy possible with obstructive azoospermia?'.
