physical differences

Some men have physical, or structural, differences that affect their reproductive organs, such as the sperm ducts, testicles or vas deferens. If you aren’t that familiar with the important reproductive parts of the male body, it may be helpful to review these first.

Unlike women, who often have no symptoms, men can often tell if something is amiss. Also, physical problems with a man’s reproductive organs can often be repaired with surgery or with other treatment measures.

• blockage
• hydrocele
• retrograde ejaculation
• undescended testes (cryptochidism)
• varicocele
• vasectomy

blockage

A common cause of infertility in men is any sort of obstruction in the sperm ducts, vas deferens or urethra that prevents the sperm from being ejaculated. Blockages can develop as a result of infections (including sexually transmitted diseases), and can sometimes be repaired to restore his fertility. While structural blockage may require surgery, a blockage caused by infection may clear up with antibiotics alone. If the structural blockage cannot be repaired, then a testicular biopsy can be done to retrieve sperm.

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hydrocele

A hydrocele is a small fluid-filled sac that surrounds a testicle and causes the scrotum – the sac of skin surrounding the testicles – to swell. This condition usually isn’t painful, and generally responds very well to surgery.

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retrograde ejaculation

When semen is ejaculated into the bladder instead of exiting through the penis during orgasm, a man has retrograde ejaculation. Men with this condition can still get erections and climax, but no or very little semen will actually be ejaculated out of his penis, leading to fertility problems. This condition is due to a malfunction in the valves that control the flow of urine versus semen through the urethra, and is associated with diabetes and the removal of the prostate gland.

Normally, when a man ejaculates the sperm travel from the testicles through the vas deferens to the urethra – which is also connected to the bladder – and out the penis. The muscle at the opening of the bladder tightens like a valve during ejaculation to prevent semen from entering the bladder as it passes through the urethra. With retrograde ejaculation, however, the tiny valve doesn’t tighten properly, allowing semen to enter the bladder instead of being ejected out the penis.

Retrograde ejaculation can sometimes be reversed with medications, or may require assisted reproductive technologies. Learn more about treatment for this condition.

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undescended testes (cryptochidism)

The scrotum, which houses a man’s testicles, hangs outside the body because the testes need to be a few degrees cooler than body temperature for normal sperm production to occur. Some baby boys are born with a testicle that hasn’t fully descended into the scrotum. This problem usually corrects itself within the first few weeks of the baby boy’s life. However, that baby boy may grow up to have fertility problems if his testes did not descend into the scrotum within the first month or so after birth. Surgery can repair undescended testes, but permanent damage may be incurred if the testes do not descend in childhood.

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varicocele

A varicocele is an enlargement of the veins in a man’s scrotum, the sac that holds the testicles. It’s similar to a varicose vein that can develop in your leg. There is quite a bit of debate among researchers about the relevance of a varicocele on fertility, but a popular theory is that the veins increase the temperature in the testicles. It gets too hot in the testicles, and the heat weakens sperm and impedes sperm production. A varicocele can be surgically repaired.

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vasectomy

If a man has had a vasectomy, of course there won’t be any sperm when he ejaculates because the vas deferens have been clamped, cut or sealed. If he changes his mind down the road, a medical procedure can try to reverse the vasectomy. The success of the reversal depends on how long ago the vasectomy was performed – if more than five years ago, the reversal may have a lower chance of successfully restoring sperm in the ejaculate. The outpatient procedure involves either suturing the vas deferens back together or stitching the vas deferens directly onto the epipidymis.

If the vasectomy was done more than five years prior to treatment or if the reversal fails, there are excellent techniques to retrieve the sperm from the epipidymis or testes for use in in vitro fertilization (IVF).

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