Outcome Of Patients Undergoing Procedures To Treat Obstructive Azoospermia

Abstract

Infertility is defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year, the time in which about 90% of couples succeed. Azoospermia; is a complete absence of sperms in semen even after centrifuging semen and examination of the pellet. Obstructil'e azoospermia; is azoospermia due to failure of transport of sperms from the testis to the urethra during ejaculation secondary to genital tract obstruction.

Our study included 65 patients aged 24 to 65 years with obstructive azoospermia among infertile men searching for treatment in the Andrology Division, Urology Department, University of Illinois at Chicago at the period between April 1999 to September 2000. Twenty-nine patients (44.6%) presented with primary infertility while thirty-six patients (55.4%) presented with secondary infertility (Figure: 57).

We initially evaluated the entire infertile patients by complete history taking, physical examination and semen analysis. By this initial evaluation we distinguished patients with azoospermia. Azoospermic patients were further evaluated by revising the history, physical examination and semen analysis. We insured that examination of the pellet after centrifugation of semen specimens was done in every case. The presence of a single sperm in the pellet indicated a case of severe oligospennia, not azoospermia, and was excluded from our study.

In patients with semen volume equal to or Jess than 1.5 ml, we did postejacu1ate urine analysis. The presence of significant number of sperms {more than I 0 to 15 sperms/HPF) in the postejaculate urine highly suspects retrograde ejaculation. When no significant number of sperms was found, we did TRUS. Finding of dilated seminal vesicles and midline cyst in TRUS is diagnostic of ejaculatory duct obstruction.

Hormonal evaluation was routinely performed. Scrotal exploration with saline vasography was performed to test the patency of the distal part of the vas deferens and the ejaculatory duct. Examination of the vasal and epididymal fluid, grossly and microscopically, and occasional intraoperative touch prep of testicular biopsy demonstrate obstructive azoospermia and determine the site of obstruction.