Korean J Androl.  2011 Aug;29(2):151-155. 10.5534/kja.2011.29.2.151.

Causes of Obstructive Azoospermia and Outcome of Microsurgical Reconstruction

• Park SH
• Jo DG
• Lee JS
• Seo JT

• KMID: 2226468
• DOI: http://doi.org/10.5534/kja.2011.29.2.151

Abstract

PURPOSE
To define the causes of obstructive azoospermia (OA) and evaluate the possibility and efficacy of microsurgical correction.
MATERIALS AND METHODS
Sixty-seven patients diagnosed as OA with normal spermatogenesis preoperatively and initially planned to microsurgical vasoepididymostomy from December 2003 and November 2009 were retrospectively analyzed. Causes of OA were analyzed and patency rate and pregnancy outcomes of their female partners were measured.
RESULTS
Thirty-one patients (46.3%) could not correct their OA because of obstruction of the distal vas deferens, epididymal atrophy and/or hypotrophy and vasal injury due to previous surgery. Among the 36 patients undergone microsurgical vasoepididymostomy (mean age of patients and their female partners were 32.9 and 31.3 years, respectively), 32 patients (88.9%) were corrected bilaterally and 4 patients (11.1%) unilaterally. The overall patency rate was 17 patients (47.2%); being 15 and 2 patients for bilateral and unilateral procedure, respectively. Among the 17 patients regained the patency after surgery, except 3 cases without followed up, 6 cases achieved natural pregnancy and also 6 cases achieved the pregnancy using the assisted reproduction.
CONCLUSIONS
According to the affected point of reproductive tract, not all men with obstructive azoospermia were candidates for microsurgical reconstruction. However, reasonable outcomes were achieved in the microsurgical reconstruction cases and it should be primary therapeutic method in obstructive azoospermia. For those in whom reconstruction is not a viable option, surgical methods for sperm retrieval are available to have their own biological children.

Keyword

vas deferens; Epididymis; Microsurgery; Azoospermia

MeSH Terms

Atrophy
Azoospermia
Child
Epididymis
Female
Humans
Male
Microsurgery
Pregnancy
Pregnancy Outcome
Retrospective Studies
Sperm Retrieval
Spermatogenesis
Vas Deferens

Reference

1). Lee R, Li PS, Schlegel PN, Goldstein M. Reassessing reconstruction in the management of obstructive azoospermia: reconstruction or sperm acquisition? Urol Clin North Am. 2008; 35:289–301.

2). Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Male Reproduction and Urology. The management of infertility due to obstructive azoospermia. Fertil Steril. 2008; 90(Suppl 5):S121–4.

3). Goldstein M, Tanrikut C. Microsurgical management of male infertility. Nat Clin Pract Urol. 2006; 3:381–91.

4). Belker AM, Thomas AJ Jr, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991; 145:505–11.

5). Schlegel PN, Goldstein M. Microsurgical vasoepididymostomy: refinements and results. J Urol. 1993; 150:1165–8.

6). Tanrikut C, Goldstein M. Obstructive azoospermia: a microsurgical success story. Semin Reprod Med. 2009; 27:159–64.

7). Alukal JP, Lamb DJ. Intracytoplasmic sperm injection (ICSI)–what are the risks? Urol Clin North Am. 2008; 35:277–88.

8). Alukal JP, Lipshultz LI. Safety of assisted reproduction, assessed by risk of abnormalities in children born after use of in vitro fertilization techniques. Nat Clin Pract Urol. 2008; 5:140–50.

9). Sutcliffe AG, Ludwig M. Outcome of assisted reproduction. Lancet. 2007; 370:351–9.

10). Hansen M, Kurinczuk JJ, Bower C, Webb S. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med. 2002; 346:725–30.

11). Schenker JG, Ezra Y. Complications of assisted reproductive techniques. Fertil Steril. 1994; 61:411–22.

12). Kolettis PN, Thomas AJ Jr. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol. 1997; 158:467–70.

13). Thomas AJ Jr. Vasoepididymostomy. Urol Clin North Am. 1987; 14:527–38.

14). Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978; 30:565–71.

15). Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998; 159:1951–3.

16). Monoski MA, Schiff J, Li PS, Chan PT, Goldstein M. Innovative single-armed suture technique for microsurgical vasoepididymostomy. Urology. 2007; 69:800–4.

17). Kim YC, Kim JH, Seo JT, Jin JY, Chung YH, Lee YS. Efficacy of intracytoplasmic sperm injection (ICSI) using epididymal and testicular sperm for failed vasoepididymostomy and vasovasostomy. J Korean Androl Soc. 1997; 15:59–64.

18). Lee JS, Seo JT. The need for sperm cryopreservation at the time of vasovasostomy or casoepididymo-stomy. Korean J Urol. 2003; 44:801–4.