Direct epididymovasostomy

Purpose: Direct side-to-end-epidymovasostomy (EVS) is considered internatio nally to be the surgery of choice in obstructive azoospermia. This method w as developed and tested in animal experiments at the University of Restock and has been practiced routinely in epididymal anastomosis since 1983. From 1983 to 199574 patients were operated using this microsurgical technique. Material and Methods: Follow-up examination was performed in 66 (89%) of a total 74 patients who underwent direct EVS. Results: The control spermiogra ms showed in 79% of the cases a patency of the anastomosis. A total of 40 h ealthy children, were born either as first or a second pregnancy, the prima ry pregnancy rate being 45%. Three pregnancies of secondary nature from pat ients with a OAT-Syndrom resulted from usage of methods like homologous ins emination, GIFT and ICSI. Four pregnancies ended in miscarriage, two in fir st pregnancy group (33) and other two in second pregnancy group (10). The s uperiority of bilateral EVS to unilateral surgery was statistically signifi cant (pregnancy rate of 57.1 vs 30.8%). The rate of normozoospermia (40%) i n the control spermiograms also increased through this procedure. Conclusio n: The main aim of EVS is creation of pregnancies through natural means and methods. By appropriate coupling of this microsurgical method with modern procedures of assisted reproduktion techniques, the remaining discrepancy b etween proven patency and actually achieved pregnancies can be narrowed in the future.