Clinical Case Study Week 2

During a routine physical exam, a 27-year old man mentioned to his family doctor that he and his wife had been unable to conceive a child after nearly 2 years of trying. He added that his wife had taken the initiative of having a thorough gynaecological evaluation in an attempt to find out what was causing the problem. Her test findings revealed no physical conditions that could be linked to infertility. Upon palpating the patients testes, the doctor found nothing unusual. When he examined the scrotal sac above the testes, however, the doctor appeared perplexed. When heinformed his patient that the two tubular structures, one for each testis, appeared to be absent, and that they probably had been missing since birth. During a follow-up visit, the doctor told the patient that the examination of his ejaculate revealed azoopermia (no viable sperm). Explain how the result of the semenalysis relates to the patients physical exam findings. What are the missing structures. Does it seem peculiar that the patient is capable of producing an ejaculate? Why or why not?

Hint: Fertility specialists have made remarkable advancements during the past decade in treating couples with fertility problems. A semenalysis reveals the relative number of sperm (sperm count), sperm vitality, and chemical nature of the fluid medium in a sample ejaculate.

Clinical Case Study Answer

The tubular structures that are apparently absent in our patient are the ductus deferentia. This condition, known as congenital bilateral absence of the ductus deferentia, prevents the transport of spermatozoa from the testes to the ejaculatory ducts. This explains the absence of spermatozoa in the patients ejaculate. His ejaculate consists only of the secretions from the seminal vesicles (which in many cases are also absent or non-functional in this deformity) and the prostate. Until recently, this patients condition would have categorically prevented him from becoming a father. Microsurgical extraction of spermatozoa from the epididymides is now possible, however, and has allowed many afflicted men to father children.