因射精障礙導致之男性不孕症 病例報告及文獻回顧

楊欣庭  唐靖

國泰綜合醫院 外科部 泌尿科

Male infertility secondary to anejaculation: A case report and review of literature

Hsin-Ting Yang, Chin Tang

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Abstract

We present a case of a 38-year-old male with hyperthyroidism presented to our outpatient urologic clinic for erectile dysfunction and infertility. He had been attempting conception with his wife for years but unfortunately never able to do so. Upon further questioning, he stated that he never ejaculated nor reaching climax once in his life, regardless of during masturbation or intercourse. He denied loss of libido, trauma history, cardiovascular diseases, or other psychological issues.

Physical examination revealed no abnormality of the external genitalia. The erection hardness scale was graded as 3. A testicular ultrasound revealed a mild left varicocele and a left epididymal cyst. Semen analysis was recommended but could not be performed due to anejaculation. Hormone tests were all within normal limits. Considering the patient's desire for fertility, he requested surgical intervention, and admission for the procedure was arranged.

Under the diagnosis of male infertility secondary to anejaculation, micro-testicular sperm extraction (TESE), micro-surgical epididymal sperm aspiration (MESA), and testis biopsy were performed. During the procedure, epididymal aspiration was unsuccessful. However, dilated seminiferous tubules were observed in the upper left quadrant of the left testis. Motile sperm was subsequently identified under a microscope at the fertility center. There were no post-operative complications. The testis biopsy revealed normal spermatogenesis with mature spermatozoa present in many seminiferous tubules, and no malignancy was found. the patient and his wife pursued ICSI after the procedure.

Anejaculatory infertility presents a significant challenge for physicians. While various causes of anejaculation have been identified, the condition cannot be reversed. However, in many cases, minimally invasive treatments are available, enabling patients to pursue their desire for children. In this case, we aimed to share our experience and management, emphasizing the importance of timely recognition and effective management strategies for patients with such disease as well as fertility concerns.