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Aspermia: a Review of Etiology and Treatment Donghua Xie1,2, Boris Klopukh1,2, Guy M Nehrenz1 and Edward Gheiler1,2*

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Aspermia: a Review of Etiology and Treatment Donghua Xie1,2, Boris Klopukh1,2, Guy M Nehrenz1 and Edward Gheiler1,2* ISSN: 2469-5742 Xie et al. Int Arch Urol Complic 2017, 3:023 DOI: 10.23937/2469-5742/1510023 Volume 3 | Issue 1 International Archives of Open Access Urology and Complications REVIEW ARTICLE Aspermia: A Review of Etiology and Treatment Donghua Xie1,2, Boris Klopukh1,2, Guy M Nehrenz1 and Edward Gheiler1,2* 1Nova Southeastern University, Fort Lauderdale, USA 2Urological Research Network, Hialeah, USA *Corresponding author: Edward Gheiler, MD, FACS, Urological Research Network, 2140 W. 68th Street, 200 Hialeah, FL 33016, Tel: 305-822-7227, Fax: 305-827-6333, USA, E-mail: [email protected] and obstructive aspermia. Hormonal levels may be Abstract impaired in case of spermatogenesis alteration, which is Aspermia is the complete lack of semen with ejaculation, not necessary for some cases of aspermia. In a study of which is associated with infertility. Many different causes were reported such as infection, congenital disorder, medication, 126 males with aspermia who underwent genitography retrograde ejaculation, iatrogenic aspemia, and so on. The and biopsy of the testes, a correlation was revealed main treatments based on these etiologies include anti-in- between the blood follitropine content and the degree fection, discontinuing medication, artificial inseminization, in- of spermatogenesis inhibition in testicular aspermia. tracytoplasmic sperm injection (ICSI), in vitro fertilization, and reconstructive surgery. Some outcomes were promising even Testosterone excreted in the urine and circulating in though the case number was limited in most studies. For men blood plasma is reduced by more than three times in whose infertility is linked to genetic conditions, it is very difficult cases of testicular aspermia, while the plasma estradiol to predict the potential effects on their offspring. It is strongly level increases 1.5 times. Obstructive aspermia accounts recommended that assisted reproductive techniques should for 12.7% and testicular aspermia for 87.3% of all cases not be started until genetic screening results. of aspermia [6]. Keywords Infection Aspermia, Infertility, Etiology, Treatment Aspermia can be associated with TORCH infection [7], Introduction brucellosis [8,9], and tuberculosis [10]. One study was to reveal causal relations between infection of the uri- Aspermia is the complete lack of semen with ejacula- no-genital tract by intracellular parasites, the so-called tion, due to due to either an inability to transport semen TORCH-infections, and the decrease of spermatogene- (anejaculation) or to ejaculate in an antegrade direction sis. For observation 182 men of reproductive age (from [1,2], which is associated with infertility. Two major caus- 22 to 38 years) were selected who had oligozoospermia es of aspermia are retrograde ejaculation, ejaculatory duct or aspermia, without any complaints or clinical symp- obstruction [2-4], and sexual dysfunction [5]. In a 9-year toms indicating infection of the urino-genital tract. Out prospective monocentre study on 1737 patients to study of those, 51 revealed-aspermia. Examinations were the causes of male infertility, the main cause of aspermia carried out for Chlamydia trachomatis (Ch.t), Herpes was severe sexual dysfunction (71.7% of aspermia pa- simplex virus (HSV), Ureaplasma urealiticum (U.u.), Cy- tients). Despite of these, there are still many other causes tomegalovirus (CMV), and Mycoplasma hominis (M.h.). we want to explore. We also want to review the outcome In the group with oligozoospermia, cases of infections of different treatments. by Chlamydia (41.5%) and Herpes virus (51.3%) were Etiology frequent, but Ureaplasma (56, 5%) was more frequent than any infections. Cytomegalovirus occurred in the Hormonal level change least number of cases. Similar picture was observed in Aspermia could be divided into testicular aspermia Group II as well. In Group II spermatogenesis remained Citation: Xie D, Klopukh B, Nehrenz GM, Gheiler E (2017) Aspermia: A Review of Etiology and Treatment. Int Arch Urol Complic 3:023. doi.org/10.23937/2469-5742/1510023 Received: October 25, 2016: Accepted: February 15, 2017: Published: February 18, 2017 Copyright: © 2017 Xie D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Xie et al. Int Arch Urol Complic 2017, 3:023 • Page 1 of 8 • DOI: 10.23937/2469-5742/1510023 ISSN: 2469-5742 without any changes [7]. Epididymoorchitis is the most Radiation frequent genitourinary complication of brucellosis. In Aspermia can be associated with radiation, either one study, epididymoorchitis was detected in 17 out of from cancer treatment or accidental exposure [25-32]. 134 (12.7%) male patients with brucellosis. Sperm anal- Doses of irradiation greater than 0.35 Gy cause asper- ysis was performed on 14 patients. Five patients had mia which may be reversible. The time taken for recov- aspermia and eight had oligospermia [8]. The infection ery increases with larger doses, however, with doses in associated aspermia could be caused by mechanical ob- excess of 2 Gy aspermia may be permanent. At high ra- struction of the ejaculatory ducts, or the development diation doses (> 20 Gy) Leydig cell function will also be of anti-sperm antibody [11], without a decrease of sper- affected [28]. In males, fractionated irradiation of the matogenesis. testes may be more harmful than acute, at least up to Spinal cord injury total doses of about 600 cGy (rad) [32]. Aspermia can be associated with spinal cord injury. The One study concludes with a recommendation of com- inability to ejaculate, i.e. anejaculation, affects the vast bined chemotherapy and involved field radiation for majority of men after spinal cord injury [12]. The aspermia children who have not fulfilled their growth potential, to from the spinal cord injury can also be a result of ejacu- achieve high cure rates, while minimizing morbidity [26]. lation dyssynergia [13]. In one study, seminal vesicle aspi- Chemotherapy ration was performed immediately before electroejacula- tion or penile vibratory stimulation in men with aspermia Chemotherapy can also contribute to aspermia [30]. secondary to spinal cord injury. The large number of se- Anejaculation or retrograde ejaculation from the che- nescent sperm within the seminal vesicles appears to be a motherapy may account for the aspermia. primary cause of poor sperm quality in spinal cord injured Congenital and developmental disorders men [14]. Approximately 13.7% of infertile men with aspermia Diabetes and 4.6% with oligospermia have a coexistent chromo- In one study, 21 consecutive patients complaining some abnormality. It could be a deletion in Y chromo- of nonejaculatory intercourse were studied. A juvenile some [33-35], breakpoint interruption on the long arm diabetic patient was discovered to have nonemission of Chromosome 18 [36], X/autosome translocation [37], but not retrograde ejaculation [15]. However, diabetes 45, X/46, X, r (Y) karyotype [38,39], Klinefelter’s syn- drome [40,41], cystic fibrosis [42-44], and Sertoli-cell-on- has been reported in another study to lead to retrograde ly syndrome [45,46]. Besides a decrease in spermato- ejaculation (RE) [16]. genesis, it is unclear if other mechanisms present for the Medication aspermia. Aspermia can be associated with certain anti-hyper- Klinefelter’s syndrome: The incidence of Klinefelter tensive medications with sympathicolytic activity such as syndrome in the general population is 0.1-0.2%, some Guanethidine. Results of studies show that this is probably 3% among infertile patients, and approximately 11% in not due to retrospermia, but rather to an interruption of patients with aspermia [40]. In one study, the results sperm transport during emission [17]. Aspermia can also of an analysis of seminal fluid, chromosomal formula, be caused by progesterone antagonists such as Mifepri- and testicular tissue performed on 32 men (including stone (RU486) [18], anabolic steroids [19], alpha-adren- 2 prepubertal boys) with Klinefelter’s syndrome are ergic receptor blocking compound (alpha ABC) (for treat- presented. Aspermia was noted in 11 cases [41]. In very ment of chronic non-suppurative prostatitis and benign rare cases, these patients might manifest focal residual prostatic hyperplasia with lower urinary tract symptoms) of spermatogenesis [40]. [20], phenoxybenzamine (PBZ) [21], anticoagulant abuse Cystic fibrosis: Aspermia caused by absence of the vas [22], and exposure to EDB (ethylene dibromide) (often in deferens is well known in cystic fibrosis. Genetic screening workers in citrus fumigation stations and a warehouse for cystic fibrosis revealed a compound heterozygote for used as a holding site before shipment) [23]. CFTR mutations delta F 508 and R 117 H [42]. In one study, Alcohol delayed menarche in five of seven female patients and infertility in the asymptomatic male patient (two of whom Drinking alcohol can lead to aspermia. One study found were found to have aspermia) could have led to earlier that in men who were heavy drinkers had seminiferous diagnosis. Teenagers and young adults with long-standing tubules filled mostly with spermatids that had undergone pulmonary or digestive symptoms, unexplained cirrhosis, degeneration, resulting in aspermia [24]. Impotence, de- aspermia, or a sibling with cystic fibrosis should be sweat- creased libido, and dysfunctional nervous system are com- tested
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