Physical Abnormalities

A structural problem with male reproductive organs can sometimes be repaired with surgery or with drugs.

Blockage

Any sort of obstruction in the sperm ducts, vas deferens, or urethra can prevent the sperm from being ejaculated. Damaged sperm ducts may be caused by genetic conditions, surgeries, injuries or infections that damage the duct system. Treatment with an antibiotic may cure an infection and possibly restore fertility. A structural blockage may require surgery. If the structural blockage cannot be repaired, then a testicular biopsy can be done to retrieve sperm.

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Retrograde Ejaculation

This condition, also called ‘dry orgasm’, occurs when semen is ejaculated into the bladder instead of through the penis. As a result, you may ejaculate little to no semen. While this condition is not harmful to you, it can cause male infertility. Retrograde ejaculation can be caused by certain medications, surgeries, or health conditions such as diabetes or multiple sclerosis that affect the nerves and muscles that control the opening to the bladder. Symptoms of retrograde ejaculation include ‘dry orgasms’, and cloudy urine after orgasm. After a physical examination and examining your urine for semen, your doctor may prescribe medications that can help keep the entrance to your bladder closed during ejaculation. If medication does not allow you to ejaculate enough semen to achieve pregnancy with your partner, you may require assisted reproductive technologies (ART) including intrauterine insemination (IUI), or in vitro fertilization (IVF) with or without intracytoplasmic insemination (ISCI) depending on your case.

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Undescended Testes (Cryptorchidism)

Most men with one undescended testis are fertile but with a reduced sperm count. If both testes are undescended by adulthood there is a very poor prognosis for fertility. Surgery to repair the undescended testes can be performed at a very young age, and fertility is not reduced if surgery is performed anywhere between the ages of 4 and 14 years.

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Varicocele

Varicose (enlarged) veins in the testicle cause varicocele. There is much debate about the relevance of a varicocele on fertility. Varicoceles often result in one smaller testis. While the other testis can sometimes compensate, over time reduced testosterone production, reduced sperm production and raised FSH hormones may result, which can reduce fertility. Varicocele can be surgically repaired to attempt to restore fertility.

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Vasectomy

A common reason for the absence of sperm in the ejaculate is a previous vasectomy. Men can elect to have a medical procedure done to reverse the vasectomy. The success of the procedure depends upon how long ago the vasectomy was performed. Vasectomies that were performed more than five years prior to the reversal may have a lower chance of successfully restoring sperm in the ejaculate. The outpatient procedure involves either suturing the patient’s vas deferens back together or stitching the vas directly onto the epipidymis.

If the vasectomy was done more than five years prior to treatment or if the reversal fails, there are excellent techniques to retrieve the sperm from the epipidymis or testes for use in in vitro fertilization (IVF).

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