Dear Dr. G,

My wife and I have been married for more than ten years, despite a very active sex life; sadly we never had children.

During the pandemic, as we are both working from home, we tried even harder. Sadly with no sign of my wife getting pregnant, I suspected the problem is that I am firing blanks.

I went to see the specialist who asked me to perform a sperm tests, indeed it turns out I have no sperm cells in my ejaculate. After some blood tests and scans, the specialist assured me my hope of fathering a child was still not dead.

The doctor tried to explain to me the problems I encounter was like if nature performed a vasectomy on me. I am really flabbergasted and intend to be the first in the New Year to put Dr. G on the spot.

Why is nature so unkind and perform a vasectomy on me? In fact, can you tell me how common is male factor infertility?

Isn’t this mainly a woman’s problem? What are the signs and symptoms of ejaculate not containing sperm; will this cause me any harm?

Lastly, the doctors mentioned the only hope I have to father a child was to undergo an operation and accept test tube babies. What operation will I need to face?

On that note, I wish you and all the readers a Happy New Year and hope you can help me to overcome the vasectomy nature has performed on me.

Vasectomized Vincent

In general, infertility is defined as the inability for couples to conceive after one year or more of active sex life without contraception. Although there are no exact statistics of the prevalence of infertility, the World Health Organization estimates 60 to 80 millions couples are affected, and this number is constantly rising.

The realisation of male-factor infertility has also become more apparent. Male infertility applies to a sexually mature men having difficulty to impregnate a healthy fertile female.

Contrary to common belief that infertility is predominantly a female problem, male infertility can account for up to 40% of all infertility. This can affect up to 7% of all male populations.

Starting from the late 20th century, the realisation of the declining quality of semen has become apparent. A study in 1992 revealed the number of sperms has declined by 1% per annum since 1938.

This is echoed by studies carried out in many countries showing the decline is not just in sperm counts, but also motility, morphology and seminal volumes in overall male populations.

One of the main causes is the blockage of the ejaculation apparatus that prevents the passage of sperms. Congenital bilateral absence of the vas deferens (CBAVD) is a well-recognized cause of male infertility, when the vasa deferentia of male reproductive organs fail to form properly during birth.

As most of the seminal fluids derive from the prostate, men who are missing their vas deferens are typically ejaculating “normally” but without sperm. This renders them having a condition known as obstructive azoospermia.

There are two main causes of CBAVD. The mutation of Cystic Fibrosis gene in men carrying the CFTR genes can result in either the absence of one or both sides of vas deferens.

The other genetic basis of the second group is less well understood, as no specific mutations are identified, but the congenital defects will still result in azoospermia. The complex genetic basis of the second subset of CBAVD may also result in the non-development of the kidney, known as renal agenesis.

Trans-abdominal or trans-rectal ultrasound scans are usually performed helping to determine the diagnosis of CBAVD. In addition, hormonal blood tests such as FSH are also important to determine the nature of azoospermia.

Almost all men with CBAVD are completely unaware of their shortcomings until encountering issues with male infertility. Therefore, many men who choose not to father a child can definitely live blissfully all their lives not knowing that nature has already lent them a helping hand.

Men with CBAVD can overcome infertility with the assistance of modern ART (Artificial Reproductive Technology). PESA (Percutaneous Epididymal Sperm Aspiration), MESA (Microscopic Epididymal Sperm Aspiration) and TESE (Testicular Exploration Sperm Extraction) are the three main surgical techniques used to retrieve the trapped sperm.

With the help of IVF (in-vitro fertilisation) the hope of having a baby is just a matter of time. The problems of male infertility is a long struggle for many men, as the society assumes all sexually mature men to be fertile, and the guilt of infertility to be shouldered solely by women.

Childbearing is clearly not just a matter of sex, multifactorial issues of overall well-being of couples. Sometimes, nature does play a trick, however nothing so complicated that cannot be overcome by knowledge and science. Many men with self-realisation often put themselves forward in the New Year for conviction and determination to be better men.

Benjamin Franklin famously said: “Be at war with your vices, at peace with your neighbours. And let every New Year find you a better man.”

When Men with CBAVD armed with the knowledge that nature has played a trick on him and performed a vasectomy by mistake, is putting Dr. G on the spot for an opinion.

His view is “Let the science be at war with your vices, so you can be at peace with yourself. Hope the New beginning will make you a better man and father!”

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