Blockage in Ejaculation Duct?

Q. My husband was just told he has stones in his ejaculation duct. We had noticed a problem when we were unable to conceive because no semen came out. He had an ultrasound, and the urologist found the stones. We were told some of them were embedded and therefore cannot be removed. We are trying to get a second opinion before we proceed with surgery. Can stones like this be removed? Will we have a better chance of conceiving after surgery?

A. It sounds like your doctor told your husband that no semen comes out because stones are blocking his ejaculatory duct. This is possible, though not common. Even if obstruction is present, stones in the ejaculatory duct are far less likely to be the cause. In a 1992 study by Larry Lishultz, an expert in male fertility at Baylor University in Texas, only two of 20 men with ejaculatory duct obstruction were found to have calcifications (they were not well-defined enough to identify as stones, so he called them “concretions”) in the ejaculatory duct. More common causes of ejaculatory duct obstructions are growths or malformations within the duct. These are easily identified by transrectal ultrasound and can be treated.

There are other, more common reasons for no semen coming out. The most common is a problem called retrograde ejaculation, which means that when your husband has an orgasm, the semen goes backwards into the bladder. Your doctor can test for this easily by checking your husband’s urine for sperm after an ejaculation.

The next most common cause is obstruction, but not necessarily in the ejaculatory duct. To check for obstruction, a transrectal ultrasound is used. Signs to look for are dilated ejaculatory ducts and dilated seminal vesicles, not stones. Although stones are usually not found in the ejaculatory duct, they are common in the prostate, and they don’t cause problems there unless perhaps they get infected. If your husband’s stones are in the prostate, it makes sense that your doctor cannot get all of them out, because most stones in the prostate are deep, and no one can remove them all without taking the entire prostate out.

The only true way to check for obstruction is to perform a vasogram. This is done by putting a special fluid into the ejaculatory duct and at the same time taking X-rays. The ejaculatory duct is a hollow tube, so the doctor can see exactly where the blockage is — if there is a blockage. Before your doctor does this or any other surgery, find out his qualifications. There are many good urologists who are not experienced in vasography. I am concerned about your husband; I think if you have any doubt after reading this, a second opinion might be in order.

As for your fertility, you will obviously need to deal with the problem of the absence of semen. However, there are many other factors involved in fertility of a couple. Once you have addressed the ejaculation problem, you might ask your doctors (including your own gynecologist) whether you should consider a more complete fertility workup, starting with a semen analysis for your husband.