Evaluation and treatment of ejaculatory duct obstruction in the infertile male.

OBJECTIVE

To evaluate the role of ejaculatory duct obstruction as a cause for male factor infertility and review the treatment of this condition.

DESIGN

A retrospective study was carried out involving male patients diagnosed as having ejaculatory duct obstruction as a contributing cause for their subfertility.

SETTING

Patients were evaluated and treated through a university-based male infertility clinic.

PATIENTS, PARTICIPANTS: Patients were evaluated for the presence of ejaculatory duct obstruction if they suffered from decreased ejaculate volume, sperm density, and sperm motility but had normal physical examinations and otherwise normal laboratory evaluations.

INTERVENTIONS

Patients were treated by transurethral resection of the ejaculatory ducts.

MAIN OUTCOME MEASURES

Results of semen analysis and pregnancy rates.

RESULTS

An alteration in semen quality was achieved in 79% of patients after transurethral resection. An increase in sperm density or motility was achieved in 50%, whereas 29% showed an increase in ejaculate volume only. Pregnancy rate postoperatively was 29%.

CONCLUSIONS

Ejaculatory duct obstruction as a cause of male infertility is more common than was previously recognized, especially among nonazoospermic patients. In properly selected patients, transurethral resection of the ejaculatory ducts can result in marked improvement in semen quality with subsequent pregnancy.