Predictive Factors for Natural Pregnancy after Microsurgical Reconstruction in Patients with Primary Epididymal Obstructive Azoospermia

Abstract

Primary epididymal obstructive azoospermia (OA) is the most prevalent form of OA in nonvasectomized patients and has been less studied. We aim to assess the results with microsurgical vasoepididymostomy used in the treatment of men diagnosed with primary epididymal obstructive azoospermia and to identify the factors associated with natural pregnancy occurring after microsurgical reconstruction. This prospective study included consecutive patients with epididymal OA who underwent microsurgical reconstruction in our center. Clinical and biological data were obtained every three months during follow-up. Occurrence of natural pregnancy was the primary study outcome. In total, 36 patients underwent microsurgical reconstruction. The mean age was 34 ± 4.5 years (range 24–46 years). Median follow-up time was 15 [IQR 12–21] months. The total patency rate was 77.7% (n = 28). During follow-up, 8 (22.2%) natural pregnancies occurred. The overall live birth rate was 100%. Low FSH levels (HR: 0.22; 95% CI: 0.052–0.88; P = 0.032) and higher total motile sperm count (TMSC) (HR: 1.001; 95% CI 1–1.001; P = 0.012) were associated with a higher rate of natural pregnancy. Our data suggest that microsurgical vasoepididymostomy is an effective therapy of primary epididymal OA. Baseline lower FSH and higher TMSC were independent predictors for natural pregnancy occurrence.

Current progress on the curative effects of vasoepididymostomy for patients with obstructive azoospermia: An updated systematic review and meta‐analysis of human studies

“…All included studies were published between 1978 and 2021, with a cohort size ranging from 8 to 255 patients. Among them, 16 studies were conducted in China, five in Japan, 15 in America, four in India, two in Korea, two in Sweden, two in Saudi Arabia, one in Canada, one in Belgium, one in Egypt, one in Romania, and one in Slovenia, 4–9,12–56 and Table S1.…”

Seminal plasma neutral alpha‐glucosidase activity as an early predictor of patency and natural pregnancy after microsurgical vasoepididymostomy

“…Sperm parameters are the primary factors used to assess male sterility. Previous studies by Harza et al () and Peng et al () found that post‐operative sperm parameters are predictors of pregnancy after MVE. However, the optimal analysis time after MVE when sperm parameters show the greatest predictive value remains uncertain.…”

Retrospective analysis of early outcomes after a single‐armed suture technique for microsurgical intussusception vasoepididymostomy

“…Nevertheless, the macroscopic evaluation of epididymal fullness is not objective or precise. In our opinion, motile spermatozoa in the epididymal fluid is more likely to be associated with higher patency and pregnancy rates (Harza et al ., ). In this study, 14 of 17 (82.4%) men with motile spermatozoa, compared with 10 of 22 (45.5%) men with immotile spermatozoa in the epididymal fluid, showed patency post‐operatively.…”