Ejaculatory Duct Obstruction and Resection
Understanding a Common Barrier to Male Fertility
One to five percent of infertile men have a condition called ejaculatory duct obstruction (EDO). But having EDO does not mean you are destined to be infertile. Although unusual, EDO is a very treatable condition.
Board-certified urologist and men’s sexual health expert Paul Turek, M.D., has pioneered many minimally invasive techniques for the treatment of EDO. He is one of the world’s thought leaders on the diagnosis and treatment of this condition. Dr. Turek can treat EDO during a one-hour procedure called transurethral resection of the ejaculatory ducts (TURED). By clearing the obstruction, Dr. Turek can help you achieve your goals of fathering a biological child.
What Are the Ejaculatory Ducts?
During ejaculation, two ducts carry semen from the seminal vesicles to the urethra, where it exits the penis in the ejaculate. A blockage or obstruction can develop in one or both of the ejaculatory ducts, preventing sperm from getting into the ejaculate. Sometimes the ducts are blocked from birth (i.e., congenital) and in other cases they are acquired.
Dr. Turek has described several types of EDO. Complete or classic EDO is the obstruction of both ducts and presents with low ejaculate volumes in the setting of no sperm or azoospermia. Incomplete or partial EDO is the obstruction of one of the ducts or partial obstruction of both ducts. In this case ejaculated sperm are present but the volume, count and motility are typically all low. Functional EDO presents as classic ejaculatory duct obstruction without anatomical evidence of a physical blockage.
Table 1: Classification of Ejaculatory Duct Obstruction By Semen Analysis
|Incomplete or Partial||Complete||Functional|
|Ejaculate volume||Low or Low-normal||Low||Low|
|Sperm count||Low||Absent||Absent or low|
|Sperm motility||Low||Absent||Absent or low|
|Ejaculate fructose||Present||Absent||Absent or low|
How Is Ejaculatory Duct Obstruction Diagnosed?
Diagnosing EDO involves a complete sexual and medical history and physical examination of the testes and genitalia as well as lab testing that examines the semen analysis and reproductive hormones including follicle stimulating hormone (FSH) and testosterone levels.
Transrectal ultrasound (TRUS) is the workhorse medical tool used to help diagnose suspected cases of EDO. It can reveal dilated seminal vesicles, cysts blocking the ejaculatory ducts or calcifications in the ducts. But, as Dr. Turek’s research has shown, TRUS alone is not sufficient to make the diagnosis in many cases. He has found TRUS to be very good at suggesting that obstruction is present, similar to a taking a snapshot picture with a camera. However, it should be used in combination with other diagnostic techniques that provide a more “dynamic” image of the system to make a truly accurate diagnosis. These adjunctive techniques include seminal vesicle sperm aspiration, TRUS-guided seminal vesiculography, ejaculatory duct chromotubation and ejaculatory duct manometry.
Seminal vesicle sperm aspiration involves looking at the fluid within the seminal vesicle to confirm whether sperm is being made. The finding of high numbers of sperm in the seminal vesicle fluid suggests an obstruction. However, this technique does not help to identify the site of the blockage or differentiate between physical blockage and functional obstruction. The addition of chromotubation and ejaculatory duct pressure measurements (manometry) techniques greatly helps Dr. Turek accurately distinguish between EDO cases due to blockage that may be treated surgically from those that are dysfunctional and will not respond to surgery. This help him to avoid unnecessary surgery whenever possible.
Treating Ejaculatory Duct Obstruction
During TURED, the ducts are opened to allow for the normal flow of ejaculate. At least 75 percent of men who undergo TURED will have a marked improvement in semen quality and a 30 percent natural pregnancy rate can be expected.
If the obstruction cannot be repaired, sperm retrieval techniques can be considered and the sperm used for pregnancy with IVF-ICSI. Dr. Turek can review these options with you and help you decide how to proceed.
Contact The Turek Clinic
If you are experiencing symptoms of EDO and would like to discuss them with a trusted men’s sexual health provider, Dr. Turek invites you to visit The Turek Clinic. Contact us today to schedule an appointment.