MR 12. The diagnosis and treatment strategy of nonobstructive azoospermia under microscope

Objective: To investigate the application of microsurgical technique in the preoperative diagnosis and therapeutic strategy of obstructive azoospermia (OA).

Methods: 57 infertile patients were diagnosed as OA, and percutaneous epididymal sperm aspiration, seminal plasma fructose andα-glycosidase test, transrectal ultrasound were undertaken and came to a preliminary diagnosis as epididymal obstruction. Then they underwent scrotum exploration to observed the obstruction of epididymis and vas deferens. The patients that definitively diagnosed as epididymal obstruction and live sperm was found in epididymal fluid during the investigative surgery would undergo anastomosis of epididymis to vas deferens; cases that sperm was not found until the exploration was performed to the head of epididymis and vas deferens obstruction with distal end in epididymis, and patients with absence of vas deferens will undergo sperm aspiration and freezing for intra-cytoplasmic sperm injection (ICSI). The follow-up were performed for evaluate the effect.

Results: 53 patients (93%, 53/57) that underwent scrotal exploration were diagnosed as epididymal obstructive azoospermia, microsurgeries were carried out in 47 patients (82.5%, 47/57), sperm aspiration and freezing were performed during operation in 10 cases (17.5%, 10/57). Live sperm were detected in semen in 22 cases (46.8%, 22/47) 1-18 months after micro-surgery; spouses of 5 patients (10.6%, 5/47) underwent natural fertilization, and successful pregnancy achieved by intracytoplasmic sperm injection in spouses of 6 patients (18.5%, 6/32).

Conclusions: With microsurgical techniques become more sophisticated, azoospermia patients should take several non-invasive methods for diagnosis before operation. Take obstructions in the vas deferens and epididymis into consideration, scrotal exploration is needed for definitive diagnosis. Microsurgical anastomosis technique or intraoperative sperm aspiration and freezing may be a more economical method should be promoted.