DEAR DOCTOR: I can’t have babies naturally, what my options?

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I am 39 years old. I went for semen analysis two weeks ago and the results showed that my semen had no sperm.

I am 39 years old. I went for semen analysis two weeks ago and the results showed that my semen had no sperm.

What next? Please advise me.

The condition where there are no sperms in the semen is called azoospermia. It means that there are no sperms at all, or the sperms present are too few to be picked by the measuring instruments. For you to get this diagnosis, you need to have done two (2) semen analysis tests at a good laboratory, preferably at a fertility centre.

There are two types: obstructive and non-obstructive azoospermia. Obstructive azoospermia means that sperms are being made in the testicles, but they do not get outside because of a blockage or obstruction along the tubes.

This can happen due to infection of the reproductive tract causing swelling and/or scarring that blocks the tubes; some people are born missing a part of the tubing; presence of cysts along the reproductive system, causing blockage; complications of surgery done on or around the reproductive organs causing scarring and blockage; and also vasectomy. Some people have retrograde ejaculation, where the sperm goes backwards into the urinary bladder after ejaculation, instead of through the urethra to the outside.

Non-obstructive azoospermia means that there is no, or there is defective or reduced sperm production by the testicles. It can be due to abnormalities in the testicles or in the hormones that control sperm production. This can also be due to a problem with the genes (e.g. Klinefelter syndrome, deletion of the Y-chromosome, etc), varicocele (swollen blood vessels within the testicles), testicular cancer, chemotherapy or radiotherapy treatments, and use of anabolic steroids. Other causes of azoospermia include injury to the testicles, undescended testicles and excessive alcohol consumption.

You need to see a fertility specialist who will find out the cause of the azoospermia. If it is treatable, it will be treated e.g. clearing infection, unblocking any obstruction, removal of varicoceles or cysts, or correcting hormonal issues. If there are a few sperms produced, then it might also be possible to retrieve them and use them to bring about conception.

I recently started feeling pain in my right testicle. I went for a check-up after which it was found that I have testicular hydrocele.

This means there is some fluid in my scrotum, and surgery was recommended. What is the cause of this disease and is it in any way related to cancer. Is there any other treatment apart from surgery?

A hydrocele is a build-up of fluid within the scrotum, surrounding the testicles. It causes scrotal swelling and is usually painless. Most of the time, the cause is unknown, though in a few cases, it may be related to infections within the reproductive system, recent surgery, injury to the groin area, hernia, and in rare cases, it may be associated with testicular cancer or kidney cancer.

A scrotal ultrasound scan will show the hydrocele, and if there are any other growths or tumours in the testicles, or any signs of infection. A urine analysis would also assist in diagnosing an infection if present, which should then be treated.

If the hydrocele does not change in size, or if it grows smaller, then there is no need for surgery. This is because, a lot of the time, the hydrocele causes no other problems other than discomfort. If the hydrocele continues to grow in size, or it is causing a lot of pain or discomfort, then surgery is done (hydrocelectomy). Unfortunately, there is no other treatment for a hydrocele.

I am in my early twenties. My periods are irregular and when I get them the pain is unbearable. Apart from that, I have noticed traces of blood after intercourse.

Regular periods come every 21 to 42 days and last for two to eight days. Some people experience pain during their periods, which is normal. Irregular periods are usually a result of an imbalance of the hormones that regulate the menstrual cycle, that is, oestrogen and progesterone.  It could also be due to polycystic ovarian syndrome, use of hormonal contraceptives, thyroid disease, stress, significant change in body weight (weight gain or loss) and excessive exercise. Sometimes, irregular periods could be due to problems within the uterus like uterine polyps, fibroids, or severe scar tissue formation within the uterus (Asherman’s syndrome).

Mild bleeding after intercourse could be due to friction, and is not a cause of concern. It can be easily resolved by using lubricant. Other causes of bleeding include vaginal or cervical infection, pelvic inflammatory disease, vaginal dryness and/or tears, cervical or uterine polyps (non-cancerous growths) and very rarely, cervical cancer.

It is advisable for you to visit a gynaecologist due to both concerns, so that you can have a physical examination done, a Pap smear and also a pelvic ultrasound scan. The doctor may also advise you to have your hormone levels checked. In most cases, irregular periods are not treated, unless they cause a lot of concern, or there is an underlying problem, or if one would like to get pregnant. The bleeding will also be treated depending on its cause.

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