Aspermia – Symptoms, Treatment, Causes, Diagnosis, Complications

Aspermia is a condition wherein the males do not produce semen. This is different from azoospermia, which is the absence of sperm cells in the male semen. Aspermia is widely associated with male infertility. In this condition, males usually reach orgasm and experience the sensation of ejaculation, but do not actually ejaculate semen, meaning there is no semen released from the body. Normally, in males who are fertile, there is constant production of sperm cells by the testes. These cells then are stored in the epididymis and released every time the male reaches orgasm and experiences ejaculation. During this process, a volume of sperm cells released by the epididymis moves across the vas deferens, which acts as a bridge between the testicles and the prostate gland. Inside the prostate gland, the sperm cells are incorporated with secretions coming from the prostate gland, the semininal vesicles and from the Cowper’s gland, which becomes the semen that is released during periods of ejaculation from the penis.

Aspermia Causes

There are two noted causes of aspermia: retrograde ejaculation and ejaculatory duct obstruction.

Retrograde ejaculation

In this condition, the semen streams into the bladder rather than outside the body via the urethra and out of the body by the penis. This condition is a result of bladder sphincter malfunction which results from weak muscles and impaired nerve supply in the sphincter muscles.

Aspermia caused by retrograde ejaculation usually occur as a result of:

1. Prostate or testicular surgery
2. Damaged nerve as a result of a disease
3. May also be correlated to diseases such as diabetes, spinal cord injury, and multiple sclerosis.
4. It can also result from regular intake of medications like tamsulosin which is used to treat prostate tumors, antihypertensive drugs, antidepressants and antipsychotic drugs.

Ejaculatory duct obstruction

This is the other leading cause of aspermia. The following are probable causes of this condition contributing to aspermia:

1. Congenital cyst found inside the ejaculatory ducts.
2. Conditions such as inflammation of the prostate gland, or tuberculosis of the prostate gland may also cause ejaculatory duct obstruction.
3. Infection with a sexually transmitted disease like Chlamydia is also a likely cause.

Aspermia Symptoms

Aspermia is rare compared to other conditions causing male infertility. There are only few, but they are very apparent signs and symptoms of this condition. The following are the noted symptoms of aspermia:

1. Absence of semen upon ejaculation, usually referred to as dry orgasms
2. Hazy urine after reaching the peak of intercourse. This is the result of leakage of semen in the bladder possibly due to an obstruction.
3. Pelvic pain after ejaculation
4. Oligospermia or the very little amount of semen is released
5. Unable to father a child or male infertility because there is no semen entering the vagina during intercourse.

Diagnosis

The diagnosis of aspermia is dependent on the factors that leads to the disorder. Upon consultation, the doctor will advise the patient to take the following tests to confirm aspermia to provide adequate and proper treatment procedures.

1. Patient history: An elaborate patient history is very important in understanding the conditions underlying the disorder.
2. Physical Examination: This procedure involves the evaluation of the genitalia and testicles to ensure that all of the important parts are present especially the tubules or the vas deferens.
3. Post-ejaculate urine analysis: This is done to check if semen is present in the urine, which confirms retrograde ejaculation as the cause of aspermia.
4. Blood tests: This includes tests for a follicle-stimulating hormone and testosterone. A decreased in the level of testosterone results in very low amounts of semen.
5. Radioimmunoassay (RIA): This test is utilized to check levels of sexual hormones in the blood. In aspermia, results show that testosterone and follicle-stimulating hormone levels are decreased and there is an apparent increase in the level of luteinizing hormone.
6. Wright-Giemma stain: This test is done to check sperm morphology among aspermia patients.
7. Microscopic examination of the sperm: This is important in the diagnosis of aspermia.
8. Chemical analysis of the semen: This test will show that there is a decrease in the concentration of fructose in the semen and that the pH is also low.
9. Imaging studies: This includes a transrectal ultrasound and magnetic resonance imaging. This is done to see if there are damages in the structure of the prostate gland and the seminal vesicles.

Aspermia Treatment

The treatment of aspermia is the aimed at the eradication of the causes of the disorder. Conservative therapy is given, but if this does not correct the problem, operation may be recommended.

If the cause of the condition is drug-related, medications causing the problem should be stopped.

Oral therapy

This helps the bladder neck to constrict during ejaculation, thereby allowing semen to flow directly into the urethra. These drugs will help restore the function of the damaged nerve that causes the condition. These include:

1. Pseudoephedrine (Sudafed plus): 120mg taken before ejaculation
2. Imipramine (Tofranil): 25-50 mg taken daily for the span of one month
3. Phenylephrine (Neo-Synephrine): Nasally sprayed 1-2 hours before ejaculation
4. Ephedrine (Ventolin): 30-60 mg taken 1-2 hours prior to ejaculation
5. Inhalers (Apulent and Proventil): taken 1-2 hours prior to ejaculation
6. Chlorpheniramine (Atarax): taken 2x daily for the span of 1 month
7. Bromopheniramine (Vistaril): taken 2x daily for the span of 1 month

Assisted reproduction

This procedure is done when the affected males want to father a child. There are several ways achieve this procedure. This includes the following:

1. Intrauterine insemination: Semen collected in the urinary bladder is introduced in the partner’s uterus. This procedure has been successful in most patients.
2. In Vitro fertilization: This procedure is done if the sperm has decreased motility and decreased numbers of sperm.
3. Bladder sperm harvest: This procedure is done when urine pH does not go up despite the use of medications to increase the pH since exposure of sperm cells to urine results in death of sperm cells.

Surgery

Surgical procedure is done if, and only if, the condition cannot be treated with medications and other adjunctive therapy.

1. Transurethral resection of the ejaculatory duct (TURED): This invasive procedure is done to correct ejaculatory duct obstruction if this is the one causing aspermia. This procedure leads to normal pregnancies but causes several complications. This can cause damage to the valves found in the orifice of the ejaculatory ducts and lead to the urethra causing urine to retreat inside the seminal vesicles.
2. Recanalization of ejaculatory ducts: This is another procedure done to correct aspermia caused by ejaculatory duct obstruction. This is done by transrectal or transurethral insertion of balloon catheter. The balloon catheter will dilate the obstructed ejaculatory duct to allow semen to flow freely. The rate of success for this procedure is not yet known and it also causes complications.

Aspermia Complications

Aspermia, once treated and detected early, will not result in any complications. Early detection and treatment of underlying causes is the key to prevent complications.

The most notable complication of aspermia is male infertility. Despite infertility, affected males can still father a child and live normally since their semen can be collected and stored in a sperm bank for future use via assisted reproduction.