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The Infertile Male
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Thoraya Ammar, C. Jason Wilkins, Dean C.Y. Huang, Paul S. Sidhu
Congenital causes of ejaculatory duct obstruction include duct atresia or stenosis as well as compression by midline prostatic cystic lesions, for example, cysts of the prostatic utricle (previously named Müllerian duct cysts), cystic dilatation of the prostatic utricle (PU), and ejaculatory duct cysts [22]. Cystic obstruction of the ejaculatory tracts is usually congenital.
Evaluation and Management of Male Infertility
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
The finding of dilated seminal vesicles, dilated ejaculatory ducts, and/or midline prostatic cystic structures on transrectal ultrasonography (TRUS) is suggestive of complete or partial ejaculatory duct obstruction [8]. Normal seminal vesicles are less than 2.0 cm in anteroposterior diameter [9]. Patients with complete ejaculatory duct obstruction produce low-volume, fructose-negative, acidic, azoospermic ejaculates and may have dilated seminal vesicles identified by ultrasound. Patients with CBAVD may also have these findings because they often have absent or atrophic seminal vesicles. Patients with partial ejaculatory duct obstruction often present with low-volume, diminished sperm concentration and/or poor motility. Cysts at the ejaculatory ducts may be identified by ultrasonography and are occasionally amenable to transurethral resection (“unroofing”), which may allow sperm to present in the ejaculate.
History and Physical Examination: Male Infertility
Published in Nicolás Garrido, Rocio Rivera, A Practical Guide to Sperm Analysis, 2017
Jared L. Moss, Mary Kate Keeter, Robert E. Brannigan
Patients should also be assessed for known risk factors associated with decreased fertility, including but not limited to, recurrent urinary tract infections (UTIs), prostatitis, epididymo-orchitis, postpubertal mumps, and sexually transmitted diseases. Infections involving the genitourinary tract in men may result in obstruction. Obstruction can occur at the level of an ejaculatory duct, vas deferens, or epididymis. Ejaculatory duct obstruction may present with an insidious sign such as isolated low-volume ejaculate.
A case of persistent haematospermia secondary to seminal vesicle calculi in an ageing male
Published in The Aging Male, 2020
Mahmood Vazirian-Zadeh, Adam Jones, Yih Chyn Phan, Wasim Mahmalji
Treatment requires removal of the calculus. Traditionally, SV calculi were treated with open seminal vesiculectomy or seminal vesiculotomy [10]; however, this technique is associated with high morbidity including organ dysfunction. This is in part due to anatomical consideration, given that the SV is located deep in the pelvis and an open approach will require substantial dissection which is associated with long operative time, intraperitoneal rupture, and haemorrhage [2]. As laparoscopic surgery has developed and now utilised routinely, laparoscopic seminal vesiculectomy is now possible as reported by Yun et al. [11]. Mello et al. [16] have published a step-by-step procedure on how a laparoscopic vesiculectomy could be performed. With advances in optics, seminal vesiculoscopy is now possible. Ozgök et al. [1] performed the world’s first ever seminal vesiculoscopy in 2005. In this case, the patient was treated by means of transurethral seminal vesiculoscopy (TRU-SVS). This is a highly specialised technique that utilises a 6 F endoscope to gain access and directly visualise the SVs and extract the calculi. It is also worth mentioning that this technique has also been utilised in some cases for the investigation of persistent haematospermia or ejaculatory duct obstruction [17].
Prediction of male infertility by the World Health Organization laboratory manual for assessment of semen analysis: A systematic review
Published in Arab Journal of Urology, 2018
Amir S. Patel, Joon Yau Leong, Ranjith Ramasamy
The most common reason for severe asthenospermia (0% motility) is epididymal or ejaculatory duct obstruction. Individuals with genital tract obstruction appear to be at an increased risk for anti-sperm antibodies (ASA), which are autoimmune antibodies against sperm cells. Elevated ASA titres have been found in 81% of men with obstruction as compared to 10% of men with other causes of infertility [35[36]–37]. Once these antibodies are generated due to inoculation of the sperm antigens to the immune system, ASA will impair sperm motility, passage through the female reproductive tract, and will also affect the capacity for sperm to properly interact with the oocyte during fertilisation [38].
Current updates and future perspectives in the evaluation of azoospermia: A systematic review
Published in Arab Journal of Urology, 2021
Nahid Punjani, Caroline Kang, Dolores J. Lamb, Peter N. Schlegel
The presence of abnormal semen parameters can prompt further clinical evaluation in infertile men. For example, a man with ejaculatory duct obstruction may have a semen sample characterised by azoospermia, low volume (typically <1 mL), acidic pH (due to the lack of fluid from the seminal vesicles that normally has a basic pH), and lacking fructose (produced by the seminal vesicles and may be absent if significant blockage of the seminal vesicles is present). On the other hand, a man with NOA will typically present with completely normal seminal fluid in terms of volume, pH, fructose levels, but with azoospermia.