Infertility cases which involve only the male partner amount to 20% of the causes for infertility. Male infertility causes are broadly categorized as: impaired production of the sperm and impaired delivery of sperm. Impaired production of sperm is because of low sperm count, impaired shape and the movement of the sperm, varicocele, testosterone deficiency, genetic defects, infections and undescended testicles. Impaired delivery of sperm is due to cystic fibrosis, presence of anti-sperm antibodies, hypospadias, blockage of ejaculatory ducts or blockage of epididymis, retrograde ejaculation and other sexual issues.
Blockage of Ejaculatory Duct
The blockage of the ejaculatory duct or blockage of epididymis accounts for 1-5% of the male infertility causes. The ejaculatory duct comprises of two parts: the epididymi (two coiled tubes) and the vas deferens (a muscular tube to carry the sperms). The function of the epididymi is to carry the sperms from the testes (where sperms are produced) to the vas deferens to ejaculate. However, when there is a blockage in the ejaculatory duct or epididymis, the sperm will not be ejaculated, though they are produced in the testes.
Causes for Blockage
The following causes contribute to the blockage of epididymis or ejaculatory ducts:
- Congenital anomalies of the vas deferens - The blockage of the ejaculatory duct can be unilateral or bilateral (one side or both sides). Blockage happens when there is the absence of the vas deferens at birth or when other parts of the epididymi are missing. In such cases, the sperm produced by the testes will not pass through the epididymis to ejaculate.
- Surgeries - Surgeries such as hernia or hydrocele repairs can scar a tissue in the epididymis causing a blockage. Even surgeries to remove cysts on the prostate gland or tumors in the genital tract can block the ejaculatory duct.
- STD Infections - Infections in the reproductive tract because of sexually transmitted diseases can also cause blockage to the epididymis. STD infections block the tail of the epididymis or cause inflammation in other parts of the genital tract, thus preventing the sperm to ejaculate.
- Infection in the prostate - The prostate is a gland that lies just below the male urinary bladder. Infection in the prostate gland causes inflammation and blockage to the ejaculatory duct, as the ejaculatory duct passes through the prostate gland.
- Traumatic injury - A traumatic injury caused to the genital tract can cause a scar or blockage to the epididymis.
- Cysts - The presence of cysts or even stones in the ejaculatory duct causes blockage.
Treatment
Treatment for the blockage of ejaculatory duct or the blockage of an epididymis is done through a small surgery. These kinds of surgeries are simple procedures done on an outpatient basis under general or local anesthesia.
To treat the blockage of ejaculatory duct, a surgery (called transurethral resection) is done to enable the ejaculation of semen naturally. A small cut or opening is made on the testes to isolate the ejaculatory duct, where the blockage is identified and removed. The success rate of this surgery is high with the restoration of sperm flow into the semen. However, the pregnancy rate is relatively low between 20-30% following this surgery.
To treat the blockage of the epididymis, a surgery called vasoepididymostomy is performed. The success rate of this surgery, however, depends upon the skill of the surgeon and the findings made at the time of surgery.
