Ejaculatory duct obstruction is definitely an uncommon reason for male infertility, representing about 1% of instances.
Most instances are bilateral because of the near proximity with the ostia of both ejaculatory ducts anatomically.
The situation may be congenital or obtained.
Sometimes, congenital isolated ejaculatory duct obstruction may be linked with CFTR mutations, and genetic screening is suitable.
Obtained cases might be due to prostatic nodule development or inspissated secretions in the ejaculatory ducts leading to calculi.
Utricular cysts may also obstruct the ejaculatory ducts.
Signs and symptoms from duct obstruction consist of infertility, reduced ejaculate volume, decreased ejaculatory force, hematospermia, discomfort with ejaculation, and dysuria.
Sometimes, patients with ejaculatory duct obstruction will have a palpable seminal vesicle or mass on rectal examination, or prostatic or epididymal tenderness, but generally they have regular physical examinations and regular hormonal profiles.
Clinically, duct obstruction should be considered in sufferers with azoospermia, lower ejaculate amount, absence of fructose within the ejaculate, and regular serum gonadotropin and testosterone amounts.
Transrectal ultrasonography (TRUS) has also led towards the identification of sufferers with seminal vesicle dilation or genitourinary cysts leading to oligospermia or azoospermia, decreased motility, and reduced ejaculatory amount.
Partial obstruction of the ejaculatory duct has also been recognized.
Impacted sufferers have low-volume ejaculate and variable semen high quality.
Unfortunately, semen quality might worsen after attempting corrective surgical treatment.
Seminal vesicle aspiration after ejaculation might help in diagnosing partial ejaculatory duct obstruction.
Immunologic infertility may outcome from a breach in the blood-testis barrier, exposing the mature spermatozoa towards the immune system with the formation of antisperm antibodies.
Antisperm antibodies might be existing in the blood or in reproductive tract secretions.
Danger factors for that formation of antisperm antibodies in males include trauma towards the testes, epididymitis, congenital absence with the vas deferens, or vasectomy.
It may also be triggered by dysregulation of regular immunosuppressive actions inside the male reproductive tract.
Antisperm antibodies are found in 5-10% of infertile couples but are also present in 1-2.
5% of fertile males.
Antisperm antibodies react with all the major regions of sperm and can impair sperm motility, sperm penetration via the cervical mucus, acrosome reaction, and sperm-oocyte interactions and fertilization.
High amounts of circulating antisperm antibodies might reduce successful outcomes from remedy by intercourse, IUI, or IVF.
Nevertheless, if intracytoplasmic sperm injection (ICSI) is used in conjunction with IVF, antisperm antibodies don't use a damaging effect about the final result with the process.