Many factors contribute to male infertility, including genetic defects, varicoceles, abnormal sperm production and environmental factors. For a detailed review on all these factors and more, click here.
Two conditions that frequently get confused are azoospermia and aspermia.
Azoospermia will be diagnosed if no sperm cells are detected in a sperm sample. It is usually due to a blockage in the male reproductive tract (obstructive azoospermia) or a testicular deficiency (non-obstructive azoospermia).
Aspermia is more colloquially known as ‘dry ejaculate’ and refers to a complete lack of semen expulsion. It is essentially an ejaculatory disorder and is broadly classified as either anejaculation, where the semen does not pass from the seminal vesicles, prostate and ejaculatory ducts into the urethra; or retrograde ejaculation, where the semen passes backwards into the bladder instead of moving in an antegrade direction. Treatment will depend on which type of aspermia is diagnosed.
Anejaculation, the inability to transport semen, has various aetiologies. These include ejaculatory duct obstruction, pelvic trauma/surgery/radiation, neurological conditions, diabetes and stress. The most common treatment approach for men who have anejaculation with an intact ejaculatory reflex is penile vibratory stimulation, which is successful in restoring antegrade ejaculation in 65-83% of cases. Alternative options are prostatic massage and electroejaculation. These methods are all types of sperm retrieval and will be used in preparation for Assisted Reproductive Techniques (ARTs).
Retrograde ejaculation, an inability to ejaculate in the antegrade direction, will often be diagnosed if sperm is detected in the urine. Semen enters the bladder, instead of emerging through the penis during orgasm. Retrograde ejaculation is responsible for 0.4-2% of all cases of male infertility and is most often due to previous medications or surgical procedures that have caused the muscle of the bladder neck to relax. Neurological conditions and diabetes can also affect this area, resulting in retrograde ejaculation. This form of aspermia responds well to drug treatment; specifically, sympathomimetic drugs (stimulate the sympathetic nervous system), which are able to restore ejaculation in 50-100% of cases, with minimal, if any, side effects.
The outlook for men with azoospermia and aspermia
The reality is that azoospermia and aspermia both significantly reduce the likelihood of a man fathering a child. Whilst one is classified as a condition of abnormal sperm production and the other as an ejaculatory disorder, the treatment options for both can be similar. For non-obstructive azoospermia and anejaculation the favoured treatment approach is sperm retrieval followed by ARTs. Unfortunately ARTs are costly and can be emotionally stressful. They also involve the female partner undergoing artificial hormone stimulation and egg retrieval. Men who have obstructive azoospermia may respond well to surgical blockage removal, avoiding the need to go through sperm retrieval and ART; and men who exhibit retrograde ejaculation may respond well to medication.
The main thing is to establish exactly what is causing infertility and devise an appropriate treatment plan accordingly.
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- Jungwirth A, et al. European Association of Urology (EAU) guidelines on male infertility. Arnhem, The Netherlands: European Association of Urology, 2015. Available at https://uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf [Accessed 31 March 2019].
- Mehta, A, and M Sigman. “Management of the Dry Ejaculate: a Systematic Review of Aspermia and Retrograde Ejaculation.” Fertility and Sterility, vol. 104, no. 5, Nov. 2015, pp. 1074–1081, doi:10.1016/j.fertnstert.2015.09.024.