With the advancement of medical technology, many infertile couples, first thought of undergoing assisted reproductive treatment (IVF). Although it is easy to go for it, the amount of warp power, financial resources and time involved cannot be explained in a single sentence, only those who have done it can appreciate it. For patients with obstructive azoospermia, it is entirely possible to obtain a natural pregnancy through surgery. Now let’s introduce microsurgical vasovaso-epididympanic anastomosis (ve anastomosis) in detail! Applicable types of infertility 1. One type of azoospermia belongs to the obstructive azoospermia: the obstruction here refers to the obstruction of the reproductive tract, the channel through which the sperms are produced and expelled from the body. The obstruction prevents the sperm from reaching the body, while a large number of sperm are present at the distal end of the obstruction. These patients often have good spermatogenesis and are expected to have natural fertility after the obstruction is removed. 2. Part of the vasectomized patients who ask for recanalization after vasectomy. 3. Those who have failed vasectomy anastomosis after vasectomy. Traditional vasectomy anastomosis is very prone to failure Vasectomy and vas deferens anastomosis are the most common and effective treatment for obstructive azoospermia. However, it is very difficult to create a relatively good, smooth and leak-proof anastomosis in a lumen of only about 0.3-0.4mm in diameter, which is the key to the outcome of the surgery – the recanalization rate and the fertility rate. Prior to the use of microsurgical techniques, the results of traditional non-microsurgical procedures were very poor. Although traditional general surgery was able to sew the vas deferens together, it could not achieve accurate alignment, the vas deferens mucosa was poorly aligned or had tissue embedded in it, there was luminal stenosis or chronic obstruction, and there was increased intravesical pressure in the proximal testicular end of the vas deferens, which led to surgical failure. Advantages of microsurgical vasovaso-epididympanic anastomosis Vasovaso-epididympanic anastomosis is performed by microscopically selecting the anastomosis at the epididymal ducts that have been dilated prior to incision. The main advantage of this technique is that the epididymal tube is eventually lodged inside the vas deferens, reducing the chance of anastomotic leakage, and this improved technique may speed up recanalization. The current literature reports that the use of this international state-of-the-art microsurgical localization of the vaso-epidididymal anastomosis has resulted in recanalization rates as high as 80%-91.7%, with spermatozoa appearing in the semen at 3 months postoperatively, and the incidence of postoperative vasovaginal cysts has been greatly reduced compared to traditional surgical methods. Comparison of VE anastomosis and ICSI after sperm retrieval Many couples are torn between whether it is better to undergo VE anastomosis to achieve natural conception, or “plain and simple” IVF. Authorities have provided a set of data. (Table quoted from http://www.maleinfertility.org/procedures/vasectomy-reversal-vasovasostomy) The table shows that the natural pregnancy rate after vasectomy was 52% in 2000 and 48% in 2008, while the pregnancy rate of ICSI (IVF) was 22% in 2000. The pregnancy rate was 22% in 2000 and 34% in 2008, and then in terms of cost than ICSI cost is almost 3 times higher than after anastomosis. Obviously, the pregnancy rate and cost effectiveness after vasovaginal tract recanalization is higher than that of ICSI. here it is important to highlight that micro anastomosis to relieve the obstruction is to allow the patient to conceive naturally, while ICSI is artificial in the process of conception, and the joy of natural conception is not experienced. As far as the doctor’s advice is concerned, pregnancy should be achieved as naturally as possible, and assisted reproduction is only a treatment option for infertility, not the first choice. After all, there are risks involved in both egg retrieval and sperm-egg binding. Real Case The patient Jia, more than ten years after vasectomy sterilization, had a vasectomy anastomosis under direct vision locally, and after a small amount of sperm appeared, he was again obstructed with no sperm. We gave microsurgical vasectomy with end-to-end anastomosis three months ago, which was very difficult because it was the second surgery. Now there is already a large amount of sperm on the first review, and with this sperm count and vigor there is hope that natural conception will be achieved as soon as possible. Lastly, I would like to send you some tips for a healthy lifestyle for men (unhealthy lifestyle may lead to infertility) 1. Men should avoid overheated environments (water beds, saunas, hot springs, etc.); 2. You should avoid placing your laptop on your lap and avoid placing your cell phone in your pants pockets; 3. Coffee should be limited to 600 ml per day; 4. Don’t smoke; 5. Don’t take drugs; 6. Exercise moderately on a regular basis; 7. Don’t Drink alcoholic beverages (wine, beer, strong liquors) for more than 6 weeks in a row. If a woman is pregnant she should abstain from alcohol; 8. have good nutritional habits, especially a diet rich in vegetables and fresh fruits (oranges, tomatoes, peppers, green leafy vegetables – any brightly colored vegetables or fruits), and fish (e.g., salmon, mackerel, anchovies, sardines, and herring). Avoid excessive animal fats (red meats, fried foods, whole milk, and cheese). A diet of animal fats is a high risk factor for prostate cancer and heart disease; 9. Become aware of problems with sexual functioning, and dare to ask for medical help; 10. Seek psychological or emotional help, and use meditation to reduce stress; 11. Do not use finasteride; 12. Take vitamin supplements. There is evidence that antioxidant vitamins and supplements can improve male fertility. Doctors recommend: Vitamin C: 500 mg/day Selenium: 100 mcgs/day Coenzyme Q10: 200 mg/day Vitamin E: 200 IU/day Folic acid 400 mcg/day Multivitamin, which contains no more than 20 mg of zinc and no more than 200 IU of vitamin E.