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Patient: I have come across your website whilst searching online from the UK.I am a 29 year old male, married for 2 years. My wife and i have been trying to conceive for over 2 years now with no success.A year ago I was diagnosed with Azoospermia due to unknown causes from several sperm samples.I had all necessary tests carried out by my urologist and all came back normal.FSH Levels – NormalGenetic Tests – NormalTestosterone – NormalTestes Size – NormalSemen Production – NormalRectal Ultrasound – NormalTesticle Ultrasound – NormalI then went onto undergo a testicular biopsy to see if any sperms could be extracted. None present.He was not able to give me a reason for the Azoospermia.All of this happened a year ago and my wife and I have not been back to him since.I also had a rectal ultrasound and they took some fluid from prostate for culture and all was normal.I did contract Chlamydia when I was 21 which was treated with a 7 day course of antibiotics.The main symptoms did go away post treatment however I really did not feel the same ever since that period of treatment ended. Even now 8 years on i still have a burning sensation when i urinate and ejaculate. Also ejaculation feels different and less intense if that makes sense..I have been back since to my local GUM clinic to do urine tests and the said i do not have Chlamydia anymore.I cant help but think that i wasnt treated properly in the first instance back when i was 21 and now i am paying the price.I am going back this week to test for Trichamoniasis, could this potentially be the cause of my infertility if it is detected?I have also have been noticing bad smelling urine and it is sometimes cloudy.My wife in the last 2 months has started to get creamy white discharge which is unusual for her. She has recently had a smear and her GP said that she has a strawberry cervix. Could this be all related?If the outcome is that I have long term Trichamonas, if treated with antibiotics, could my azoospermia be reversed?Sorry if this message is long windedYour advice is much appreciatedKind regards

 

 

Symptoms: Zero Sperm, years of burning when urinating, less intense ejaculation, pelvic pain, smell and sometimes cloudy urine

 

 

Doctor: Hello,Thanks for the query to ATD for an opinion,Firstly Azoospermia being a complete lack of sperm production i s seen in 5% of male infertility cases and can be really distressing for a couple, decreasing their chances of conception naturally. There can be two main causes for azoospermia—either decreased or no sperm production or there is a blockage in epididymis. I would like to give you a list of causes which should be evaluated :-Conditions That Cause AzoospermiaPrimary testicular failure, Klinefelter syndromeY chromosome microdeletionsGenetic infertility due to abnormal chromosomes (karyotype)Unexplained genetic infertilitySecondary testicular failure, Kallman syndromeUnexplained gonadotropin deficiencyHypothalamic/pituitary tumorHyperprolactinemiaCancer treatment (chemotherapy, radiation, surgery)Varicocele effectPituitary suppression, drug induced (anabolic steroids, alcohol, glucocorticoids)Testosterone supplementsCongenital adrenal hyperplasiaSevere illness (cancer, kidney or liver failure)Diabetes mellitusSickle cell anemiaHemachromatosisSperm autoimmunityPesticide/toxin exposure (including hot tubs and baths)Undescended testicles at birthObstruction, congenital absence of the vas deferens (CAVD)Ejaculatory duct obstructionEpididymitisScrotal trauma or surgeryYoung syndromeVasectomySo, considering the causes mentioned above if your concern is chlamydia infection which you contracted 8 years back as the cause of azoospermia following epididymitis possibly can be befitting, but you had taken a course for 7 days and was treated. But chlamydia can be easily contracted again if your partner was not treated for the same concomitantly and may have cross infected you again then.The fact that you are experiencing cloudy urine and bad smelling urine indicates that you harbour a urinary tract infection and that your wife ha creamy white vaginal discharge which indicates a possible candidiasis or chlamydia again. Ideally both should be tested and treated together to remove the cause and decrease chance of reinfection from each other.In cases of nonobstructive azoospermia in which sperm production is not normal, then it is assumed that obstruction does not exist. In a few cases, this condition is medically treatable (Kallman syndrome, hyperprolactinemia); in most instances however, the only hope for building a biological family is to use sperm retrieved from the testis with assisted reproduction in the form of IVF and ICSI. One of the most difficult aspects of nonobstructive azoospermia, is that while testis sperm retrieval in men with obstruction is not difficult, there is a failure to obtain sperm for ICSI in up to 50% of men with nonobstructive azoospermia. If however, after evaluation for the above mentioned causes, azoospermia is not reversed then the only option you would have is that of a donor sperm and InVitro Fertilisation.You may discuss the option with your infertility expert and take an informed decision,I hope i have answered your query in detail,Wishing you good health,Regards

 


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Dr. Jimmy Obaji M.D.

Dr. Jimmy Obaji M.D.

Dr. Jimmy Obaji completed his residency in Family Medicine at the University of Manitoba. He currently operates a walk-in-clinic in downtown Toronto.

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