”Failure to find a single sperm in the ejaculated semen for three consecutive times is called azoospermia”. As one of the most difficult to treat infertility, azoospermia had caused deep suffering to patients and numerous problems to doctors. Azoospermia accounts for about 15-20% of male infertility patients and has a wide range of causes, which are summarized into two main categories. One is the dysfunction of the testes themselves, called primary azoospermia or non-obstructive azoospermia. The second is normal testicular spermatogenesis, but due to the obstruction of the vas deferens, sperm can not be discharged from the body, known as obstructive azoospermia. Among them, obstructive azoospermia accounts for about 40% of patients with azoospermia.
Obstructive azoospermia drug treatment is basically ineffective, and doctors often advise patients to give up treatment and use allogeneic sperm IVF before microscopic surgery is carried out, which is often difficult for patients and families to accept but have to face the reality due to the influence of traditional concepts. Microscopic vas deferens and epididymal anastomosis is performed with the aid of an operating microscope to anastomose the 0.4mm diameter epididymal duct with the vas deferens under 20 times magnification. Our hospital has successfully carried out dozens of cases of this procedure, which has attracted wide attention from patients and the media, and a large number of patients have consulted on issues related to the procedure, and the answers to common questions are as follows.
1. Is the procedure clinically significant in the era of IVF?
The answer is obviously yes. Many studies have shown that microscopic reconstruction of the vas deferens has the following advantages over in vitro fertilization combined with embryo transfer (IVF)/intracytoplasmic sperm injection (ICSI) methods.
1. Patients can obtain offspring through natural conception, avoiding possible ethical and moral problems and reducing the risk of multiple births;
2. The IVF/ICSI technique interferes more with the female physiology, while the procedure only requires the participation of the male partner, which greatly reduces the pain of the female partner;
3, cost-effective, that is, the cost of obtaining each offspring is low, in China is still a developing country and the income gap is very large, affordability is a factor that can not be ignored.
2. Cost and hospital days?
The procedure requires high requirements for instruments, and at the same time the procedure requires the collaboration of doctors from several departments to complete, so the relative cost is high, and we currently control the cost at about 13,000 yuan, which may fluctuate from patient to patient. Hospitalization is 8-10 days (mainly post-operative bed rest is recommended for 7 days to minimize exercise).
3.Overall success rate?
The overall success rate of the procedure is currently 60%-70% (i.e. sperm found in the semen) and the spousal conception rate is 30%-40%,. If there is more fluid and more sperm in the epididymis, it rarely fails. On the contrary, if there is very little fluid and sperm are rare or only seen after the epididymal duct is cut during the operation, the success rate of the operation will be lower.
4.How long will there be sperm after surgery?
Some patients who are anxious to have sperm found after 20 days or so after surgery, but of course I am against such early examination, because we recommend to start sexual life only after one month, and some patients may take one and a half months to return to sexual life. At the latest, sperm are found one and a half years after surgery. It is generally recommended to check semen routine once a month after 1 month after surgery and inform me of the results for further treatment to improve sperm function. If no sperm is found for one and a half years of continuous examination, the surgery is considered a failure.
5.Will testicular biopsy and vasectomy be checked before surgery?
Vasectomy is generally not done because it can lead to secondary obstruction, and this test has been eliminated; testicular biopsy is analyzed on a case-by-case basis, and generally the spermatogenic function of the testes can be estimated based on semen routine, sex hormones and reproductive ultrasound before surgery.
6.Is there any anastomosis that cannot be done?
For example, in some patients, the vas deferens is inaccessible and the guide wire expansion is unsuccessful, and it is difficult to know in advance before surgery; in some patients, no epididymal duct can be found for anastomosis, etc. In general, a comprehensive assessment will be done before surgery, and such cases are rare. But in any case there are those who can’t do it, or do it reluctantly. Professor Li Shihua of Cornell said that the result of vas deferens epididymal duct anastomosis is not known after the surgery is completed. We think it is necessary to further add that in China, since the obstruction is mostly caused by infection, it is not known whether the anastomosis can be done before the surgery.
7. Is natural pregnancy very low because of poor sperm motility after surgery?
In fact, due to long-term obstruction or antibodies, most patients show weak or dead sperm in the early postoperative examination, but most of them will gradually get better with the opening of the reproductive tract, of course, the process is usually faster at this time with some medication to assist. In this regard, we prefer to recommend patients to use Chinese herbal medicine to regulate. It has been proven that herbs do have a clear effect in sperm production. From the data we have so far, the chance of spouses conceiving naturally after surgery is 30-40%.
8.If there is sperm in the semen after surgery, but the spouse cannot conceive naturally, does it mean that the surgery is a failure?
Even if the spouse cannot conceive naturally after the operation, the chance of success of IVF with sperm extracted from semen is much higher than that with sperm extracted from testes or epididymis (sperm is ejected through the normal sperm production and ejaculation ducts, and its mobility and maturity are significantly higher than that of sperm in testes and epididymis), and the physical and mental pain caused by repeated sperm extraction from testes or epididymis is avoided. It also avoids the physical and mental pain caused by multiple sperm retrieval from the testicles or epididymis.
9. What are the risks of surgery?
There are risks of surgery, mainly post-operative scrotal discomfort and pain, testicular atrophy, epididymitis and other reproductive tract infections, all of which are small probability events.