Dear Dr. G,I am a 32-year-old man who has been married for three years. My wife and I enjoy an active healthy appetite and great intimacy.In recent months, we have been trying for a baby and it has been very disappointing.As my wife is slightly older than me, it is natural for the extended family (and myself too) to point the finger at her.My wife went to see her gynaecologist, who assured her nothing was wrong with her reproductive organs. She has been asking me to go and see a urologist, but I am rather apprehensive and scared.I recently built up my courage to get a sperm test and was completely shocked to be told I have no sperm.How can that be? I have a strong sexual desire and no erectile dysfunction. I don’t think I suffer from premature ejaculation either. I am worried and confused.I would like to put Dr. G on the spot for clarification of my “seedless” sex.Can you explain why am I producing copious semen, but firing blanks?What exactly is “Azoospermia”? Why do I suffer from this condition?Is it curable? Will I be able to father a child?I am so shock and really eager to get the answers.Yours truly,(In)Fertile Fred The World Health Organisation defines infertility as a “disease of the reproductive system characterised by the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse”. It is estimated between 3% and 7% of couples have infertility. This sad fact renders many couples being involuntarily childless, ranging from 12% to 28%. Although it is a well-known fact that women gets less fertile with advancing age, the causes of infertility are not exclusively female in origin. It is frustrating when the assumption of the causes of infertility seem to be exclusively female in origin. Many would be surprised to learn that scientific data revealed 30% of infertility issues are due to male factors and another 50% due to women. The remaining 20% are result from complications with both partners. As a result of such naivety, the delay in the seeking treatment would compromise the success of conception as couples are working on a tight “timeline” due to the female “fertile biological clock”. Azoopsermia is a medical condition of a man not having any measurable sperm in his semen. This affects about 1% of the male population and around 20% of all men presented with issues of infertility. As the vast majority of the semen derives from the prostate and seminal vesicles, men who have azoospermia would have normal sex drives, erectile ability, producing copious amount of semen, but all amount to literally a “seedless” reproductive exercise. In fact, just like in men after a vasectomy, they would be oblivious to the fact their semen contains no sperm. The causes of Azoospermia can be broadly divided into obstructive or non-obstructive in nature. Obstruction of the sperm ducts can occur after previous trauma or vasectomy. In some cases, the “naughty past” of a man that he is not so proud of (such as previous infections of chlamydia or gonorrhea) would come back to haunt them in obstructive azoospermia. Obstruction of the sperm ducts can also be associated with genetic conditions such as Congenital Bilateral Aplasia of Vas deferens (CBAVD) that is closely linked with Cystic Fibrosis. Non-obstructed causes of Azoospermia can also occur. These are generally conditions that render the cessation of spermatogenesis such as previous chemotherapy, mumps, or radiation. The increase of temperature in the scrotum caused by dilated veins, as varicocele, can also severely impair spermatogenesis. Lastly, some reports demonstrated radiation derived from mobile phones in the trouser pockets may not be too “sperm-friendly”. So, keep the “crown jewels” away from those hand sets, boys! It is not uncommon for men to make the assumption that while the “machinery” of sexual health is optimal, the reproductive apparatus should also be at its best. In reality, the sexual libido in a man is controlled by his circulating testosterone and his erection is exerted by the integrity of the blood vessels and nerves to the penis. In other words, the reproductive system is an independent entity. Therefore, many years of “trying” may just be sheer “pleasure” with no outcome for men who are suffering from Azoospermia. In the space age of the 21st century, ART (Artificial Reproductive Technology) has brought optimism to many. Procedures such as PESA (Percutaneous Epididymal Sperm Aspiration); MESA (Microscopic Epididymal Sperm Aspiration) or TESE (Testicular Exploration Sperm Extraction) will be carried out with the intention to search for those healthy sperms in hiding. Though, such pursuit for the sperms will mean a small operation on the scrotum, most men would agree to this small price to pay for parenthood! In many instances, this has brought hope to millions, who were deemed impossible in that quest for parenthood. Martin Luther King once said: “We must accept finite disappointment, but never lose infinite hope!” Societal and cultural attitudes have always placed the burden of fertility on women, based on the principles of a finite biological clock. Increasing numbers of men who are building up the courage to admit the possibility of deficiency in fertility is a sign of a paradigm shift. This may be a symbol of hope for “mankind” and definitely infinite hope for couples living in the “darkness” of childlessness. When assumedly fertile men possibly firing blanks with seedless efforts put Dr G on the spot, his response is that the only way to find out is to get the specimen bottle out and get tested. After all, how difficult can it be? 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