Post Date April, 15 2023
Mr. and Mrs. Li have been married for almost three years and have not had children yet. After a doctor's examination, the problem lay with Xiao Li. "Xiao Li's testicles are normal in size and development, and have no sexual function problems, except that there is no sperm in the semen.". The doctor analyzed that it was possible that the sperm delivery pipeline (spermatic duct) was blocked, preventing sperm from being discharged. It is recommended that Xiao Li undergo further examination to make a final diagnosis.
In cases of infertility, the most common is obstruction of the vas deferens. The method of detecting obstruction of the vas deferens can be determined based on specific medical conditions. The simplest and easiest method is testicular biopsy, which involves examining live testicular tissue.
"If the levels of follicle stimulating hormone and testosterone in the blood are normal, and the testicular biopsy is normal, it can be determined that the vas deferens are blocked or that there is congenital vasectomy.". Otherwise, it may be a problem with spermatogenic function.
You can also do an X-ray, that is, a vasectomy and seminal vesiculography. This imaging technique was used in clinical practice as early as 1913, but has not been well developed due to some side effects. In the past, when performing contrast surgery, it was necessary to first cut the skin of the scrotum, and then puncture the vas deferens with an injection needle. The contrast agent was injected into the direction of the seminal vesicle before taking an X-ray film. Based on the X-ray film, it was possible to determine whether there were any problems with the seminal vesicle, prostate, ejaculatory duct, vas deferens, and ampulla of the vas deferens. This type of surgery can cause significant damage, combined with the high concentration of viscous contrast media used at the time, which can promote obstruction of the vas deferens and may cause infection, causing secondary obstruction.
Later, people improved this method by using hydrophilic contrast agents, especially by puncturing the vas deferens directly through the scrotal skin without surgery, which reduced tissue damage and patient pain.
Practice has proven that this improved method improves safety and success rate. However, it is still necessary to conduct this examination in a qualified hospital. According to foreign data, infertility caused by obstruction of the seminal tract accounts for 3-10% of male infertility, with Shanghai Jiangyu Professor and others reporting 0.63%, and others reporting around 2%.
Causes of seminal tract obstruction:
① Congenital abnormality;
② Inflammation and tuberculosis;
③ Trauma;
④ Cysts or tumors;
⑤ External oppression, etc;
⑥ Young's syndrome, often associated with bronchiectasis.
"If the obstructed site is found, and the obstructed or occluded site is not long, and surgery is possible, microsurgery can be used to anastomose it.". For example, among the more than 30000 infertile patients admitted to the University of Hamburg in the Federal Republic of Germany over the years, 1000 people belong to this type of obstructive azoospermia, or obstruction of the seminal tract. Half of the eligible patients have undergone anastomosis surgery. In other cases, symptomatic treatment can be taken for conditions such as inflammation and tuberculosis.
