Intravasal azoospermia: a surgical dilemma

Objectives To determine the incidence of intravasal azoospermia (IVA) and e valuate which factors before and during surgery influence outcome, by prosp ectively and intentionally performing bilateral vasovasostomies (VVs) only in men with intraoperative IVA. Patients and methods Using a multilayer technique, 472 men underwent micros urgical reconstructive procedures. Intravasal fluid was examined for sperm by the surgeon and a pathologist. Strict enrolment criteria included total absence of sperm or sperm parts and bilateral VV as a treatment procedure. Patients were followed up by semen analysis and paternity assessed only by naturally conceived pregnancies. Results Of the 472 patients, 27 (5.7%) had bilateral IVA; 15 of these patie nts were available for a follow-up of 1-47 months. Eleven patients had iden tical gross appearance of intravasal fluid bilaterally. Of these patients, five had sperm in the ejaculate after surgery (three with clear intravasal fluid and two with no fluid). Bilaterally different vasal fluid was found i n four men. Unilateral clear fluid was present in three patients, two of wh om had sperm in semen analysed after VV. Overall, there was sperm in the ej aculate in seven of 15 patients with IVA; five of these seven had clear flu id in at least one vas deferens. One patient with unilaterally clear fluid achieved paternity by a naturally conceived pregnancy. The difference betwe en the mean (SEM) obstruction interval in men who had sperm in a semen samp le after VV, at 16.7 (3.30) years, and in persistently azoospermic patients , at 15.5 (1.89) years, was not statistically significant (P = 0.741). Conclusion The results of VV in patients with IVA are unsatisfactory; the p atency rate is higher in men with copious clear fluid in at least one vas. The obstructive interval in patients with IVA does not appear to influence the outcome of VV.