Microsurgical treatment of obstructive azoospermia
-Li Guangyong, Department of Urology, Ningxia Medical University General Hospital, a new breakthrough in the treatment of male infertility
The development of human process and the influence of people’s traditional concept, every family hopes to have a healthy baby. However, in China, especially in some big cities, the number of couples suffering from infertility is increasing rapidly. According to a survey, 20 years ago, the infertility rate was only 3% among people of childbearing age in China. Nowadays, the infertility rate among people of childbearing age in China has climbed to 15%, which is close to the level of developed countries.
Azoospermia is defined as the absence of spermatozoa in three consecutive centrifugal microscopic examinations of semen, which is what we call the absence of spermatozoa in semen. Azoospermia can be divided into two main categories. The first category is testicular spermatogenic dysfunction, where sperm cannot be produced, also known as non-obstructive azoospermia. The second category is normal testicular spermatogenesis, but the vas deferens is obstructed and sperm cannot be discharged from the body, also known as obstructive azoospermia.
Vasectomy and vasovaginal epididymal anastomosis are two of the most common and effective methods to treat obstructive azoospermia, which accounts for 10% to 15% of male infertility. However, the difficulty of creating a well-aligned, patent and leak-proof anastomosis in a lumen of only 0.3-0.4 mm in diameter is critical to the outcome of the procedure – the recanalization rate and the pregnancy rate. Prior to the use of microsurgical techniques, traditional non-microsurgical procedures had poor results, and patients with obstructive azoospermia often had no choice but to undergo IVF. Since the late 1970s and early 1980s, the introduction of microsurgical techniques has significantly improved surgical outcomes, and microsurgical vasectomy and vasovaginal epididymal anastomosis have definite advantages over non-microsurgical techniques in terms of recanalization and conception rates. Especially in the last decade, these two techniques have developed particularly rapidly and have replaced the traditional methods to enable patients with obstructive azoospermia to conceive naturally.
The technological revolution of recent years should be said to have given new life to microsurgical vasectomy and vasovaginal epididymal anastomosis, making it the method of choice for the treatment of obstructive azoospermia. Microsurgical vasectomy and vasovasovaginal epididymal anastomosis methods have the following advantages over in vitro fertilization/intracytoplasmic single sperm injection (IVF/ICSI) methods.
1. High success rate, the current recanalization rate of microsurgical vasectomy and vasectomy epididymal anastomosis is up to 80-90% or more.
2. Patients can obtain offspring through natural conception, avoiding possible ethical and moral issues and reducing the risk of multiple births.
3.Cost-effective, i.e. the cost of obtaining each offspring is low, while the patient can have multiple chances of re-fertilization, which is currently about 10,000 RMB for surgical treatment in our Ningxia Autonomous Region.
4, IVF / ICSI technology on the female physiological interference, while the line of microscopic surgery on women do not have any treatment.
Comparison of microscopic anastomosis surgery and ICSI
Microscopic technique
ICSI
Success rate
60-87%
30-40%
Fertilization rate
10-43%
Factors related to the number of conceptions
Number of intercourse
Number of ICSI
Subjects involved
Male partner
Both men and women
Invasive degree
Male 1 time sex
Male and female multiple sex
Spending
1~15,000RMB
20,000-30,000 Yuan per session
Surgery time
2.5~6 hours
30 minutes~1 hour
Consultation and treatment process
Relatively simple, short cycle
Both men and women, complex, long cycle
Genetic risk
Natural conception
Genetic risk
Microsurgical vasectomy and vasovaginal epididymal anastomosis techniques have opened a new window and brought a new breakthrough in the treatment of male infertility, allowing natural conception in patients with obstructive azoospermia and greatly reducing the suffering of patients and their families. At present, domestic microscopic reproductive surgery is in full swing in the eastern coastal cities, while the western region is still blank. on May 10, 2014, the Department of Urology of Ningxia Medical University General Hospital took the lead in carrying out microsurgical vasovaginal anastomosis and vasovaginal epididymal anastomosis in the northwest region, which not only filled the gap in the northwest region, but also eliminated the need for patients with obstructive azoospermia in our region to be transferred to foreign countries for treatment. This not only fills the gap in the northwest region, but also eliminates the need for patients with obstructive azoospermia to be transferred overseas for treatment, greatly reducing the medical costs and travel time for patients.