Epididymal Obstruction
The epididymis is a long coiled tube located on the back of the testis; it collects and stores sperm. An epididymal blockage or obstruction can form (sometimes alongside epididymal congestion), preventing sperm from getting into the ejaculate. Fortunately, it’s completely treatable and we can help. Maze Health specializes in epididymal obstruction for patients in Westchester, New York City, Connecticut, and New Jersey.
Can an Epididymal Obstruction or Blockage Be Treated?
An epididymal obstruction is a potentially treatable cause of male infertility and can be a reason for low sperm count or even azoospermia (zero sperm count). The epididymis is where sperm mature and gain movement, and if it becomes blocked, sperm may be unable to enter the vas deferens and ultimately the ejaculate. Whether a blockage affects one side or both sides can influence how it shows up on semen testing, ranging from reduced sperm counts to complete azoospermia. Understanding the anatomy and how sperm travel is an important first step in evaluating options and determining the best path forward.
The epididymis is a thin-walled, tightly coiled duct within the scrotum that collects and stores sperm from the sperm-producing (seminiferous) tubules of the testes, where sperm develop. It is crescent- or moon-shaped and runs longitudinally along the back of the testis. Its walls become thicker and straighter as it becomes the vas deferens, which is the thicker tube that carries sperm all the way to the prostate and seminal vesicles. Believe it or not, when uncoiled, the epididymis is over 20 feet in length. While sperm are passing through the epididymis, they mature and gain movement. When normal flow is disrupted, pressure can build within this tightly coiled structure, leading to epididymal congestion and, in some cases, obstruction that interferes with sperm transport.
In some men, the epididymis becomes blocked, preventing sperm from entering the vas deferens and getting into the ejaculate. A blockage can occur on one side or on both sides. If a man has an epididymal obstruction on one side, he may suffer a lowered sperm count. If a man has epididymal obstructions on both sides, this will lead to azoospermia (zero sperm count).
What Causes an Epididymal Blockage?
An epididymal blockage can occur when the epididymis becomes scarred or damaged, preventing sperm from traveling normally into the vas deferens and the ejaculate. Common causes include infection, which can lead to permanent scarring, and prior scrotal surgery or procedures that can disrupt the delicate ducts of the epididymis. In some cases, trauma, emergency surgery such as treatment for testicular torsion, or even pressure changes after a vasectomy can contribute to blockage. Understanding the underlying cause is important because it helps guide the most appropriate treatment and fertility options.
There are several causes for blockage of the epididymis. Infection is a major cause because the epididymis is the most prone of all scrotal structures to become infected. Infection can result from sexually transmitted infections or, particularly in older men, bacterial infections. When infection occurs, the epididymis can become permanently scarred down and blocked — one reason it’s very important to treat any infection of the epididymis as soon as possible.
Surgery in the scrotum can also cause blockage. This may include hydrocele repair (a buildup of fluid around the testicle). It can also include spermatocele repair. A spermatocele is an outpouching of the epididymal tube — which is almost like a weakness in the wall of a tire — that fills with fluid and can feel like a cyst. It’s important to know that the fluid collection itself rarely blocks sperm flow; however, the repair of a spermatocele has a high chance of blocking sperm travel through the epididymis. It is very, very, very rare for a cystic structure in the epididymis to represent cancer, so if one is discovered, it should be evaluated by ultrasound and, if found to be a simple cystic structure, monitored rather than operated on.
Other surgical causes include surgery for trauma, where the epididymis can be damaged when the scrotum is explored for injury in childhood or adulthood. Treatment of testicular torsion can also rarely cause blockage. Torsion is a surgical emergency because a twisted testis can lose blood supply and be permanently destroyed; if treated in time, the twisted testis and the one on the other side are sewn to the scrotal wall to prevent twisting (orchidopexy). Rarely, this can lead to blockage of the epididymis on one or both sides.
Finally, vasectomy can contribute to epididymal blockage. When the vas deferens is cut to prevent sperm from passing through, the testicular side was traditionally closed, although the standard of care now is an open-ended vasectomy. When pressure builds in the thin-walled epididymis, epididymal congestion can occur, sometimes causing the duct to “blow out” and later scar down. This is an important consideration for men who want children after vasectomy and are considering vasectomy reversal.
Diagnosis and Treatment of Epididymal Obstruction
When a semen analysis shows no sperm in the ejaculate, one possible cause is an epididymal obstruction, a blockage that prevents sperm from traveling out despite normal sperm production. In many cases, an experienced specialist can suspect an obstruction during a physical exam because the epididymis may feel dilated and hardened, rather than flat and difficult to feel as it typically is. If an epididymal obstruction is suspected, additional testing may be recommended to confirm the diagnosis and identify the most effective next step. Treatment can include surgical repair (when appropriate) or sperm retrieval options that allow conception through IVF with ICSI, helping many couples move forward with a clear plan.
During diagnosis, your doctor can sometimes actually feel an epididymal obstruction during a physical exam. When examining the ductal structures, the epididymis may feel dilated and hardened, which can suggest epididymal congestion or an underlying obstruction. Normally, it is generally flat in the middle and cannot be felt, so if the epididymis is enlarged and firm, it may indicate a blockage. If an epididymal obstruction is suspected in a man with no sperm in the ejaculate, he may need additional testing to further evaluate the issue and determine whether there are steps that can help correct the problem.
If, after testing, your doctor suspects an epididymal obstruction, the next step may be a testicular biopsy, depending on your medical history. A small piece of testis tissue is taken either through an incision in the scrotum and testicle or with a needle. If good sperm production is found, it becomes clear that sperm production is not the issue; the problem is delivery of sperm into the ejaculate. If other blockages are ruled out, a surgical bypass may be performed, called a vasoepididymostomy, where the vas deferens is reconnected to the epididymis. Because this is a highly specialized microsurgical procedure, it’s important that it be performed by a skilled specialist experienced in this type of surgery.
If the obstruction cannot be repaired, there are still options. Sperm can often be retrieved directly from the scrotum in several ways, including with a needle into the testis or through an incision in the testis. Most commonly, Microscopic Epididymal Sperm Aspiration (MESA) is performed to retrieve sperm from the epididymis. MESA has two key advantages over retrieving sperm from the testis: the sperm are typically more mature and often have better motility, and there are usually significantly more sperm in the epididymis because sperm have already been collected and delivered there. In many cases, sperm retrieved through MESA can be frozen and used across multiple IVF cycles.
Sperm retrieved from the testis or epididymis may then be used to attempt conception through in vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI), where eggs are retrieved from the woman and sperm are injected directly into an egg. Fortunately, an epididymal obstruction does not mean untreatable infertility. A male infertility specialist can review the full range of treatment and retrieval options and help guide the approach that offers the greatest likelihood of success.
About Dr. Werner and Maze
About Dr. Werner
With over 25 years in clinical practice, Dr. Michael Werner is a board-certified urologist specializing in sexual and reproductive medicine. His work is defined by thoughtful care, advanced treatment strategies, and a long-standing commitment to helping patients achieve better health and quality of life.
About Maze
Maze Sexual & Reproductive Health is a specialized medical practice dedicated to men’s health, women’s health, sexual medicine, and fertility care. Our approach emphasizes personalized care, clinical excellence, and innovative solutions that help patients feel informed, supported, and empowered.
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Maze’s modern facilities in Westchester, NY, and New York City are designed to provide expert care in a comfortable, private setting. Our on-site diagnostics, advanced therapies, and coordinated care allow patients to receive comprehensive services in one location.
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Serving Westchester County, New York City, Connecticut, and New Jersey, Maze supports patients locally and from out of state. Many seek our care for specialized expertise, with flexible options that include both in-person appointments and telemedicine consultations.
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