Q&A column

In upcoming issues, we will reprint a few coagulation-related questions and answers in a “Best of Q&A” series. They date back to 2014 but all have been reviewed for their timeliness and relevance today. The following question and answer were published in March 2015.

Q. The absence of coagulation of seminal fluid has been attributed to bilateral congenital absence of the vas deferens and seminal vesicles due to the absence of the coagulation substrate (fibrinogen-like precursor). What is the significance of the absence of coagulation of seminal fluid in a patient who previously experienced normal seminal fluid coagulation, followed by normal liquefaction, and had fathered children? Are there medications that can prevent seminal fluid coagulation? Are there pathologic processes—carcinoma, for example—that can affect the prostate gland and prevent seminal fluid coagulation (possibly due to an increase in enzymes of prostatic origin such as acid phosphatase), causing a localized acceleration of the fibrinolytic process?

A. I discussed this at length with our urologic specialist and another teaching faculty physician, and they agree that the coagulation/liquefaction are often variable within multiple samples from any single patient for reasons currently unknown. While men with prostate cancer often exhibit absence of coagulation, it is not necessarily an indicator of that cancer. Anecdotally, several medications have been observed to interrupt coagulation or liquefaction—some antidepressants, antihistamines, and a few others. In the case of a patient who had previously fathered children, neither physician felt this alone was reason for concern.

In the end, the lack of coagulation is not a clinical concern to either physician in routine care. The patient should be able to produce children with assisted reproductive technology in the case of congenital bilateral absence of the vas deferens.

Kepler Johnson IV, ELD
Mid-Iowa Fertility, Clive, Iowa
Member of the CAP Reproductive
Medicine Committee at time of original publication