Microsurgery in common cases of male infertility.

Prior to the advent of microsurgical equipment and techniques, it was rare for urologists or other surgeons to produce a full pregnancy as a result of reconstructing fine tubal blockages in the male reproductive tract. Perhaps 2% of vasectomized men, and a large percent of men born sterile, are desirous of being able to start a pregnancy, and so in 1970, I began a research project with new equipment to find a reliable way of joining fine body tubes. I found that our bodily tubes can be grouped as being three-layered and that their differences lay mainly in the kind of inner, individual mucosal cell structure and their type and thickness of the muscular layer. The latter was most important, because the pressure built up on peristaltic movement waves in extremely small diameter tubes can be very high indeed, forcing tubal contents out, and early escape of fluid from the anastomotic site will easily occur unless the joining technique is designed to specifically prevent this eventuality. Based on this anatomical and physiological information, new techniques for reconstruction of the vas deferens and the epididymis were perfected. Consecutive personal series of 5000 vaso-vasostomies and almost 500 epididymo-vasostomies have now been carried out since 1971 with extraordinary results in baby birth rates-far better than those that occurred before microsurgery.