Vasoepididymostomy is the microsurgical procedure for treatment of epididymal obstruction. It is the most difficult microsurgical procedures for the treatment of male infertility. Surgeons must have excellent microsurgical skills and extensive experience to be able to perform this anastomosis procedure between the vas deferens and epididymis.
What is the etiology of epididymal obstruction?
The causes of epididymal obstruction include:
- Congenital abnormalities: absence of the distal part of the epididymis (cauda) with absence of the vas deferens.
- Young’s Syndrome.
- Infection or inflammation: history of epididymitis (tuberculosis or chlamydia)
- Iatrogenic injury: accidental injury from prior surgery such as hydrocele repair, orchiopexy (for undescended testes or torsion or testis biopsy)
- After vasectomy.
What are the advantages of vasoepididymostomy?
The advantages of the vasoepididymostomy for treatment for the epididymal obstruction are:
- Patients can father their own children through natural intercourse.
- In vitro fertilization (IVF) with ICSI is a very intense procedure for the female partner and very costly. Also, conception through natural intercourse does not pose ethical issues and it minimizes the risk of multiple births substantially.
- Return of sperm rates (52% to 92%) and pregnancy rates (11% to 56%) are competitive with IVF/ICSI.
- If an experienced surgeon performs the microsurgical procedure, the results (patency rate and pregnancy rates) are better. More importantly, the actual overall cost per live baby is lower than the IVF-ICSI related procedure.
- Insurance companies may cover the expense for correction of an epididymal obstruction
- Sperm can be collected during the procedure and frozen (cryopreserved) for future IVF/ICSI attempts if the microsurgical procedure fails.