for ICSI. The indications for vaso-epididymostomy include obstructions at the level of the epididymis, in the presence of a normal spermatogenesis (testicular biopsy).
Vasovasostomy Vasovasostomy can be performed either macroscopically or microscopically, though the latter is more effective in improving pregnancy rates. The likelihood of initiating preg- nancy is inversely proportional to the obstruction interval and becomes less than 50% after 8 years. Other important prognostic factors are the quality of the semen after the procedure and the partner’s age. In approximately 15% of men who have undergone a vasovasostomy, sperm quality deteriorates to the level of azoospermia or extreme oligosper- mia within 1 year. Poor sperm quality and sometimes sperm antibodies prevent a spontaneous pregnancy and assisted reproduction is indicated.
MESA MESA in combination with ICSI is indicated in men with obstructive azoospermia when reconstruction (vasovasosto- my, vaso-epididymostomy) cannot be performed or is unsuc- cessful. An alternative would be percutaneous aspiration of spermatozoa from the caput epididymis (PESA). If a MESA or PESA procedure does not produce spermatozoa, a testicu- lar biopsy can be performed with testicular sperm extraction (TESE) to be used for ICSI.
TESE In about 50% of men with non-obstructive azoospermia (NOA), spermatozoa can be found in the testis that can be
Male Infertility 167