Who is suitable for bilateral surgery?
In case of azoospermia with normal testicular volume and FSH, but obstruction at the level of both epididymis (confirmed during the audit - there are no sperm in the ducts, but there are sperm in the epididymis), reconstruction on both sides gives the maximum chance for natural conception. The operation requires the endurance of the surgeon and the patient; If it is technically impossible, a unilateral anastomosis is performed on one side plus sperm collection for cryopreservation. If pregnancy does not occur within 12–18 months, frozen sperm are used for IVF-ICSI.
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.
