Ask a doctor on the topic of Urology

Groin pain OAT and leukocytes now azoospermia

October 12, 2016 | 20,00 EUR | answered by Dr. David Meyer

Dear Dr. med.,

A brief overview of the history: my husband had a left-sided undescended testicle "corrected" with medication at around 1.5 years of age (the testicle was partially not in the scrotum until primary school age, pendulum testicle? and is significantly smaller). In addition, in 2005 he had a mesh implanted after a right inguinal hernia. In 2015, he started feeling worsening pain in the right inguinal area and went to a urologist, who discovered a varicocele (sperm analysis 1 and antibiotic treatment for elevated leukocyte levels). After prolonged complaints in the groin (with further investigation through CT, MRI, orthopedists,...), my husband visited the urologist again (sperm analysis 2), who diagnosed azoospermia over the phone and referred him to an andrologist, stating that the varicocele had disappeared. At a follow-up appointment, my husband was sent home without any comments (after a brief testicular ultrasound) and all of our questions remain unanswered.

Please see attached data from both sperm analyses.

Could it be possible that due to inflammation and/or granuloma (or increased hardening of the right groin due to scarring), no sperm can be transported into the ejaculate anymore? We are puzzled by the "coincidence" that the worsening of the pain correlates with a deterioration of the sperm analysis... As we have been struggling with infertility for a year now, it would be beneficial if any inflammation (if not already present) does not further chronicize. At this point, we are not even sure which specialist to turn to.

Thank you very much in advance!

Dr. David Meyer

Dear questioner,

Your question may have remained unanswered for a long time because in this case, a "diagnosis from a distance" may not seem very sensible. I would need to personally examine the groin and testicles and see the existing findings. I will assume a complete azoospermia in this case.

For the above reasons, I do not want to speculate too much. There are many reasons for azoospermia and infertility. In fact, post-inflammatory factors, or even accidental severance of the vas deferens during inguinal hernia surgery, are possible reasons for unilateral azoospermia. If there is also an atrophic testicle on the left side due to undescended testicles in childhood (cryptorchidism), then that sounds quite plausible. However, in cases of unilateral cryptorchidism, 87% of men still have children.
You also mentioned hormone therapy as a child. According to recent studies, this can also be harmful to later fertility.

However, it is not clear what the cause and progression of the inflammation you mentioned is. Unfortunately, I cannot find the uploaded files here either.

I would advise you to visit a urologist again, maybe even a different one, and undergo a thorough examination, including a repeat semen analysis. If there has been an unfulfilled desire for children for 2 years, and a sperm analysis is recommended by the gynecologist, the health insurance usually covers all subsequent examinations.

I hope I have been able to help you somewhat.

Best regards,
Dr. Meyer
Urologist