Microsurgical single tubular epididymovasostomy: assessment in the era of intracytoplasmic sperm injection

Objective: To reevaluate the role of microsurgical single tubular epididymo vasostomy for the treatment of obstructive azoospermia in the era of intrac ytoplasmic sperm injection (ICSI). Design: Retrospective clinical study. Setting: University infertility clinic. Patient(s): Sixty-one patients with obstructive azoospermia who underwent m icrosurgical single tubular epididymovasostomy. Intervention(s): Microsurgical single tubular epididymovasostomy. Main Outcome Measure(s): The overall patency and live-birth rates and facto rs that influenced the surgical outcome. Result(s): The overall patency rate after surgery was 68.9% (42/61) and the live-birth rate 31.1% (19/61). Of the 19 live-birth cases, 11 were achieve d by natural means and 2 were achieved by conventional IVF soon after the o peration, then subsequently by natural conception. The remaining 6 were the result of conventional IVF after surgery. An analysis of the potential pro gnostic factors previously associated with epididymovasostomy indicated tha t none had a statistically significant correlation with surgical outcome. I n cases of patency, the partners were stratifed into a younger group (21-30 years; n = 12) and an older group (31-36 years; n = 30). There was no stat istically significant difference between the groups in the live-birth rate regardless of the means of conception (natural versus conventional IVF). Conclusion(s): This study demonstrates that the results obtained by microsu rgical single tubular epididymovasostomy are comparable to those obtained w ith the use of IVF and ICSI. Even in this era of ICSI, the option of micros urgical single tubular epididymovasostomy should be considered because ICSI involves surgery to retrieve sperm and complex invasive treatment of the w ife. (Fertil Steril(R) 2000;74:920-4. 02000 by American Society for Reprodu ctive Medicine.)