Epididymovasostomy as the first-line treatment of obstructive azoospermia in young couples with normal spermatogenesis.

In the management of obstructive azoospermia (OA), microsurgery is often replaced by testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). Testicular biopsy and microsurgical side-to-side epididymovasostomy were performed in 34 azoospermic men with OA mostly due to inflammation. Ductal system patency was recovered in 21 (63.6%) men and natural pregnancy achieved in 13 (38.2%) of couples. Using multiple logistic regression analysis, it was found that ductal system patency and pregnancy were influenced by male and female age and testicular histology. The chance of obtaining patency was three times higher when male age was <38 years and two times higher when normal spermatogenesis alone was found to be present compared with mixed lesions. The chance of achieving a pregnancy was three times higher when the female partner's age was <29 years or normal spermatogenesis alone was present. The pregnancy rates obtained after surgery were not statistically different from those obtained by TESE-ICSI, but when also considering multiple pregnancies, miscarriages and side effects, the results obtained with surgery are better than those obtained with TESE-ICSI.