After sperm is generated in the testicles, it travels a certain distance and finally reaches its destination – the vagina. The tubes that transport sperm and the warehouses that store sperm in the testicles are very fragile and easily damaged. Blockage of the tubes or leaks in the warehouses will cause infertility. Vas deferens obstruction accounts for 5% of male infertility cases. Most patients are caused by acquired damage and infection, and a few cases are congenital underdevelopment. Sperm are produced and mature in the testes and stored in the epididymis (the epididymis is a coiled seminiferous tube several meters long). The sperm reaches the vas deferens through the seminiferous tubules of the epididymis. The vas deferens is between the epididymis and the prostate. The sperm mixes with the seminal plasma secreted by the prostate to form semen.
Many reasons can cause obstruction of the vas deferens and cause male infertility:
①Congenital abnormality. The vas deferens is congenitally underdeveloped or underdeveloped, and does not communicate with the epididymis. It is often accompanied by underdevelopment of the seminal vesicles, resulting in low semen volume and no sperm.
②Inflammatory stenosis. Various pathogenic bacteria inflame the vas deferens, causing scarring and occlusion of the lumen. Severe cases may cause azoospermia.
③Tumor: Obstruction of the lumen caused by tumor compression of the vas deferens itself or adjacent organs can also cause One of the causes of azoospermia.
④ Trauma or surgical injury, such as hernia repair, causing luminal obstruction. Vasectomy is one of the main methods of male sterilization, which is to artificially block the lumen of the tube to prevent the discharge of sperm to achieve the purpose of birth control.
In infertility caused by obstruction of the vas deferens, the testicular spermatogenic function is normal, but sperm cannot be found in the semen. Various imaging studies are often required, such as vas deferens seminal vesicle imaging, vas deferens epididymography and urethral imaging. Angiography, etc., can be used to identify the location of obstruction.
Male urinary system examination, which is similar to female gynecological examination, is necessary to diagnose the cause of infertility. The examination can discover the cause of the couple\’s disease and provide corresponding treatment, such as antibiotics and anti-inflammatoryMedicines and surgeries. Today\’s microsurgery has come a long way in improving male fertility. The movement of sperm must rely on the motor function of the vas deferens. There are many causes of scarring, adhesions, thickening, and even obstruction of the vas deferens.
The most common causes of vas deferens obstruction are injury, inflammation, and infection. If the disease that causes the vas deferens to be blocked is treated promptly, it is still possible to have children. Some sexually transmitted diseases may have no clinical symptoms in male patients, but can still form scar adhesions; gonorrhea and mycoplasma infection are the most common sexually transmitted diseases among men in the United States, and are also the most common causes of scar adhesions. Male gonorrhea patients often feel pain when the infection is not serious, while most female patients are asymptomatic; however, both couples with mycoplasma infection may have no clinical symptoms.
Mycobacterium tuberculosis can also invade the male reproductive system and destroy the seminiferous tubules and vas deferens in the epididymis. In addition, tuberculosis of the reproductive system can also be transmitted to women through sexual intercourse, causing female infertility. Mycoplasma, chlamydia and other microorganisms are related to urethritis and can sometimes block the vas deferens, damage sperm, and destroy the quality of seminal plasma. Because little is known about the biological properties of these microorganisms, treatments are often ineffective. The prostate infected by viruses and bacteria mainly changes the composition of seminal plasma. Bacteria tend to stay in the prostate. Sometimes bacteria overflow into the seminal plasma and kill sperm. Prostatitis can also cause obstruction of the vas deferens, change the composition of seminal plasma, make the seminal plasma thick and accumulate sperm. Although prostatitis is difficult to treat, most infections can be controlled with antibiotics.
Surgery can also cause obstruction of the vas deferens, sometimes years after surgery. Due to the close relationship between the anatomical location and the spermatic cord during hernia repair and cryptorchidism reduction, the vas deferens and blood vessels are easily damaged. If the artery is damaged, it can cause testicular necrosis. Microsurgery can usually be used to repair the vas deferens, but any surgery has the possibility of scarring and adhesion.
Vas deferens obstruction caused by testicular torsion is rare. After testicular torsion, the blood supply is interrupted, the testicles swell rapidly, and there is severe pain. Testicular torsion is an emergency. If the torsion is not reset within 6 hours, the testicle will become necrotic. After testicular torsion, a urology specialist can quickly reset the testicle and fix the tissue with sutures to prevent torsion from happening again. It used to be thought that in men who lost one testicle due to torsion, their fertility could be compensated by the other testicle. In fact, this is not the case. Most of these patients are absolutely infertile. The mechanism is: the body\’s immune response caused by injury acts on both the spermatogenic cells of the affected testis and the spermatogenic cells of the unaffected testis.
For infertility caused by obstruction of the vas deferens, surgery may be selected to recanalize the vas deferens depending on the disease condition, such as anastomosis between the vas deferens and epididymis caput, or anastomosis after resection of the vas deferens obstruction site Technique etc. Some men who have had a vasectomy and want to have children again can restore their fertility through vasectomy recanalization surgery. microsurgical techniquesThe development has obviously promoted the success rate of surgery. If the obstruction is caused by inflammation, anti-inflammatory treatment should be carried out as soon as possible, which may help the inflammatory edema subside and restore smoothness.
Men who have had a vasectomy may need recanalization in certain circumstances. Recanalization is possible, but it is best to tell the doctor who is performing the ligation. Because he is the only one who is familiar with his surgical operation and the special medical history involved.
Unfortunately, 50% of men who undergo vasectomy will develop autoimmunity to their sperm after surgery. For this reason, despite the success of the operation, the pregnancy rate of the female spouse after surgery is only 30%. Steroid hormones can effectively suppress the anti-sperm antibodies produced by the immune system, which is beneficial to improving the pregnancy rate of the spouse.
Recanalization is far more complicated than ligation. Ligation can be performed in an outpatient setting, and the operation takes about half an hour; while recanalization requires hospitalization and is performed under general anesthesia. The operation takes about two hours and the hospital stay is four to five days. Laser surgery has become more and more popular because it does not require hospitalization or general anesthesia, but can be performed in the outpatient department under local anesthesia, and can recanalize tissues without suturing.
The pregnancy rate of female spouses after recanalization is 30% to 35%, and 60% to 80% of patients can obtain healthy sperm. After a period of accumulation, artificial insemination technology can To achieve the purpose of making the female spouse pregnant.
This article is provided by Baidu Reading and is excerpted from \”The Clear \”Conception\” Plan\” Author: Sun Jianqiu and Xie Yingbiao