I have been married for three years and do not have children. Could this be due to the injury? (Ngoc Hai, 35, Binh Duong)

Severe sports injuries to the lower abdomen and pelvic region that necessitate surgery can lead to infertility. This can occur due to direct damage to reproductive organs or complications following surgery, such as scar tissue or adhesions. These issues can affect the sperm ducts, nerves, and blood vessels that nourish the testes, particularly those passing through the groin and lower abdomen. Additionally, strong direct impacts to the testes themselves may cause rupture, torsion, or inflammation.

Infertility resulting from such injuries can manifest in one of three ways:

First, obstructive azoospermia occurs when the body produces sperm normally, but its pathway is blocked. This obstruction can be caused by the vas deferens being ruptured, crushed, or adhering to scar tissue after surgery. If both vas deferens are blocked, the ejaculate will not contain sperm.

Second, severe pelvic trauma often involves damage to the perineal region and urethra. Some pelvic surgeries can affect the bladder neck sphincter, causing sperm to flow backward into the bladder instead of being ejaculated externally, a condition known as retrograde ejaculation.

Third, injury or surgery can impact the nourishing blood vessels, leading to gradual testicular atrophy and a loss of sperm-producing capability. Alternatively, testicular rupture can damage the blood-testis barrier, prompting the body to produce antibodies that attack sperm, thereby suppressing sperm production.

Given your history of pelvic surgery and a recovery period exceeding two months, it indicates significant surgical intervention and extensive soft tissue damage, which carries a high risk of scar tissue forming and compressing the sperm ducts. Since you have been married for three years without conceiving, a diagnosis of infertility is possible. To help doctors pinpoint the exact cause, you will need several hormonal tests, including FSH, LH, and testosterone. Additionally, an ultrasound of the scrotum and groin is necessary to check for varicocele or any signs suggesting epididymal obstruction. A post-ejaculation urine test is also required to rule out retrograde ejaculation. Based on these results, an appropriate treatment plan can be devised.

If obstructive azoospermia is identified, doctors may perform techniques such as PESA (percutaneous epididymal sperm aspiration) or TESE (testicular sperm extraction). If the damage affects the testes, severely reducing sperm production, doctors might use micro-TESE (microsurgical testicular sperm extraction). This is currently considered the most advanced technique, enabling doctors to retrieve residual sperm from small areas within the testes. Subsequently, you can undergo in vitro fertilization by combining the extracted sperm with your wife's eggs to create embryos, making it possible to have children normally.

When you attend your appointment, it is advisable to bring your medical records from seven years ago. This will help doctors understand the exact nature of your surgery, including any interventions in the groin, bladder, or urethra, which is crucial for identifying the underlying cause. With current medical technologies, men experiencing azoospermia due to pelvic injuries can still father children using their own sperm through assisted reproductive techniques.

Dr. Nguyen Cong Minh

Reproductive Support Center

Tam Anh General Hospital - District 8