Epididymis is almost a twenty feet long tightly coiled duct inside the scrotum. It is thin walled and is responsible for collecting sperms from the seminiferous tubules. The sperms are manufactured in the seminiferous tubules. Epididymis is a crescent shaped duct and runs along the back of the testes. Epididymis is further changes to vas deferens when its walls become thick and straight. The sperms get matured and also become mobile when they are passing through the epididymis.
Can The Epididymis Get Blocked?
In some men, epididymis can get blocked and it is known as epididymal obstruction. In this case, the sperms cannot enter the vas deferens and therefore cannot get into the ejaculate either. This blockage or obstruction in the epididymis can happen at one or both sides. The blockage may be caused due to natural reasons or at the time of a hernia or hydrocele surgery. If there is an epididymal obstruction on one side, this may lead to a lower sperm count in the ejaculate and if there is an obstruction on both sides, then this may lead to azoospermia, meaning a zero sperm count in the ejaculate.
Diagnosis Of Epididymal Obstruction
During a physical examination, the physician can feel the epididymal obstruction. When ductal structures are examined during the physical exam, the epididymis can feel hardened and dilated. It cannot be felt generally under normal conditions. If it can be felt and feels hard to touch it may mean that there is a blockage there. If this is accompanied by a low or zero sperm count in the semen sample, you may need to take other tests to confirm the diagnosis and get the problem corrected by taking appropriate measures.
Treatment Of Epididymis Obstruction
If epididymis obstruction is confirmed, the physician may ask you to undergo a testicular biopsy. The specialists do the biopsy by taking a sample of the testes for investigation by either of the two methods- taking a piece through an incision made in the scrotum and testes or taking an aspiration through needle. If the biopsy indicates a good sperm count, it means that the issue is not sperm production but the delivery of the sperm into the seminal fluid is. The specialist will then rule out other blockages and a correction of the epididymal blockage is the next step. This can be achieved by doing the bypass of the blockage. This process is known as vasoepididymostomy.
- In case the epididymis obstruction cannot be cleared with this procedure, then there are other methods available.
- Sperm can be obtained from the scrotum. This is done in many ways.
- A needle can be used for this procedure for insertion in the testes
- An incision can be taken on the testes
- Microscopic epididymal sperm aspiration also known as MESA can be done to obtain sperm from the epididymis
- MESA(microscopic epididymal sperm aspiration) is generally considered advantageous over the procedures performed on testes. This is because-
- The sperms in the epididymis are more matured compared to those in testes
- They have a better mobility as compared to the ones in testes
- There are also more sperms in the epididymis as compared to the testes
- The sperms obtained through the MESA technique can be frozen and stored and can be used for many IVF cycles
These and the sperms obtained from the testes may also be used in the couples who are seeking assisted reproduction techniques like in vitro fertilization (IVF), intracytoplasmic sperm insertion (ICSI). In ICSI, the sperms are inserted in an egg directly
Though one may suffer from epididymis obstruction, it does not mean that one may become necessarily infertile.
There are ways and means to clear the obstruction and in the event that this is impossible, there are still techniques by which the sperms can be obtained from the testes or epididymis and frozen and stored for a later use in assisted reproduction techniques.