Why is an audit needed?
When a spermogram shows azoospermia with preserved spermatogenesis, and ultrasound does not explain the cause, only direct examination reveals the location of the obstacle: a scar in the epididymis after epididymitis, a break in the duct after herniotomy, aplasia of the duct site. During the inspection, contrast or dye is injected into the duct and its passage to the urethra is checked; Fluid is taken from the epididymis to search for sperm. If a removable obstruction is found, the surgeon immediately performs microsurgical reconstruction, and if it is unremovable, he collects sperm for cryopreservation and IVF. Revision is also indicated for scrotal injuries and chronic pain of unknown cause.
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.
