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Medical Edge Newspaper Column from Mayo Clinic
GET A SECOND SPERM TEST BEFORE CONSIDERING SURGERY
DEAR MAYO CLINIC: I am a patient with azoospermia. My doctor recommended
me for semen analysis, which showed no sperm. This is my problem. Please
give me advice on how to overcome my condition. — Pakistan
ANSWER: Because there are different kinds of azoospermia (absence
of sperm in the ejaculate), and you don’t indicate the kind you have,
your question is difficult to answer. We can tell you about two types
of azoospermia, each of which has a different cause and treatment.
Obstructive azoospermia occurs when there is a blockage in, or absence
of, the tubes that deliver sperm from the testicle. While there is no
cure, surgical correction may be possible. If the tubes are absent, sperm
can be collected from the epididymis (the sperm storage tube in each testicle)
and kept for later reproductive use.
The other condition is non-obstructive azoospermia, and there is no cure
for it yet. NOA often indicates that spermatogenesis — the process by
which sperm are produced — is failing. A comprehensive physical examination
of the genitals, a thorough medical history (for example, some medications,
including chemotherapy, can cause temporary or permanent azoospermia),
and hormone analysis can aid in its diagnosis.
Keep in mind that NOA does not always mean that there are no sperm produced
in the testicle. If sperm are present, they can be surgically extracted
from the testicle and used to fertilize a mature egg through intracytoplasmic
sperm injection, or ICSI, a sophisticated technique in which individual
sperm cells are directly injected into eggs.
Since semen analysis is easy to perform and relatively inexpensive, it
may be worth repeating the test. Here’s why: Correct laboratory technique
is critical to obtaining accurate results in semen analysis. For example,
the semen sample should be centrifuged; otherwise, small numbers of sperm
could be missed. Even small numbers of sperm can be used for ICSI, negating
the need to perform surgery on the testicle.
Alan Thornhill, Ph.D., Reproductive Endocrinology and Infertility; and
Lance Mynderse M.D., Urology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Male Infertility
Appointment
Information
More
Information on Azoospermia
DEAR MAYO CLINIC: I seem to be kind of an oddity in this area.
None of the doctors here have ever seen someone with Klippel-Trenaunay
syndrome. I am a 53-year-old male, and my right leg and hip are affected.
Please tell me more about this condition. — Maine
Answer: Klippel-Trenaunay Syndrome is a rare blood vessel abnormality
that is present at birth. It is usually identified by three basic features:
1) malformation of various capillaries and other blood vessels; 2) port-wine
discoloration or staining of the skin; and 3) hemihypertrophy, which means
the arm and leg on one side of the body are larger, weaker and deformed
due to the blood vessel abnormalities.
Some people who have KTS experience only mild symptoms, for which they
can compensate fairly easily. For them, the condition is largely a nuisance
— not a source of continual distress or impairment. Others, however, may
be severely affected — sometimes losing the use of one of their limbs.
There is no cure for KTS. The first line of therapy is to treat it with
compression. Discuss wearing compression hose or stockings with a physician
who is familiar with KTS. If your symptoms are severe, surgical interventions
may be an option. But because it is rare, you will have to go to a university
or large medical center to find a specialist with the experience to evaluate
your condition and perform the surgery.
The cause of KTS is not known. Recent National Institutes of Health-sponsored
research — jointly led by Mayo Clinic and the Cleveland Clinic — has identified
two chromosomal abnormalities associated with KTS. This kind of genetic
understanding is a first step in developing corrective or preventive treatments.
If you haven’t done so already, consider contacting the KTS support group
(www.k-t.org). As with any disorder, support groups can provide practical
coping advice, medical referrals and emotional support.
Thom Rooke, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
Additional Resources:
Cardiovascular Disease
Appointment
Information
Information
on Klippel-Trenaunay Syndrome
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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