Intussusception technique
Under a microscope with a magnification of 25×, the surgeon finds the dilated tubule of the epididymis above the obstacle, opens it, makes sure that there are sperm, and “puts” the tubule into the lumen of the duct with two or three microsutures 10/0 (intussusception technique), then fixes the outer layer. Precision is everything: even a slight discrepancy leads to scarring. Sperm from the epididymis are frozen at the same time in case of failure. The result is assessed by spermograms over 12–18 months - recovery after epididymovasostomy is slower than after vasovasostomy.
Obstructive infertility
If the testicles produce sperm (normal testicular volume, normal FSH, spermatogenesis according to biopsy), but there are no sperm in the ejaculate, the reason is an obstruction in the vas deferens: after a vasectomy, previous epididymitis, trauma, surgery on the inguinal canal. Microsurgical reconstruction restores natural patency and allows conception without IVF; effectiveness depends on the level and duration of obstruction.
Results
After vasovasostomy, sperm appear in the ejaculate in 75–90% of men up to 10 years after vasectomy; pregnancy in couples occurs in 40–60%. After epididymovasostomy, patency is restored in 60–80%, pregnancy in 30–40%. If reconstruction fails or is not possible, sperm are obtained from the testicle (MESA/TESE) for IVF-ICSI; During surgery, the surgeon can prepare them for cryopreservation.
