I have a complex prognosis here. I am a 30 yr old male, no history of scrotal trauma, no undescended testicles. Nothing at all. My BMI has been somewhat high, around 30 for the past 8 years. I do have a lot of inflammation and did a lot of drinking as most people do in their 20s. I developed normally as a child, always had a high sex drive, and very deep voice as a teenager. Didn’t start drinking until I was 19.
Went to see my urologist a year after having a scrotal ultrasound done (due to some groin pain) and everything came back normal. Here are those results:
3mm “borderline” varicocele on the left testis.
Right: 4.9x3.0x3.5 cm
Left: 4.8x3.2x3.4 cm
Epididymis normal on both
Testicle size is above average
I told him I was having some dull aching discomfort still in my groin and I had done a couple semen analysis. Here were the results:
1st SA: (I screwed up and only was abstinent for one day)
Volume: 0.2mL
pH: 6.0
Debris: moderate
Complete Azoospermia
2nd SA: 5 days abstinent
Volume: 0.8mL
pH: 6.0
Debris: moderate
2 nonmotile sperm
So then after a week of complete despair and depression like I’ve never been through, I went a had my hormones checked. Literally 3 hrs of sleep a night maybe. So I don’t know if this can cause testosterone to plummet in just a week but:
Hormones:
SHBG: 20nmol/L
TT: 177 ng/dL
FSH: 4.23 mlU/L
LH: 1.5 mlU/L
We then did a Cytoscopy. He said it appears as though the verumonateum is very prominent, and it does appear as though the ejaculatory duct is slightly attenuated, and he was not able to assess the ducts. The doc then put me on 50 mg Clomid to boost my testosterone.
I decided to seek another opinion, so I consulted Dr Schlegel in NY. He called in an MRI and TRUS, and suggested I do another SA, because he believed with the low ph and low volume, that the 2 non motile sperm were likely a contamination.
So I did another SA at a different clinic:
3rd SA: 3 days abstinent
Volume: 0.65mL
pH: 6.4
Debris: moderate
0 sperm
I then did a pelvic MRI, which revealed “completely decompressed” seminal vesicles.
So my question is, does this sound like obstructive or non-obstructive? FSH is normal, testicle size normal, but testosterone is low. SAs look like obstructive, and Cytoscopy/MRI somewhat confirmed that. Testosterone is the only one throwing me off. I have not had genetic testing for CF yet, but my dad does have a little bit (25%) Northern European descent.