Fertility in cases of hypergonadotropic azoospermia

Objective: To review the outcome of reconstructive microsurgery in men with hypergonadotropic azoospermia. Design: A retrospective study on patients with hypergonadotropic azoospermia who underwent scrotal exploration and bypass microsurgery. Setting: Male infertility microsurgery clinic affiliated with a tertiary university hospital. Patients: Thirty-one hypergonadotropic azoospermic men with evidence of spermatogenesis on testicular biopsy. Interventions: Microsurgical exploration of the testes, operative sperm aspiration, and bypass procedures: vasoepididymostomy or vasovasostomy. Main Outcome Measures: Intraoperative aspirated sperm, postoperative ejaculated sperm, proof of fertilizing ability (fertilizations), and pregnancies. Results: Sperm were aspirated intraoperatively in all cases and were detected in postoperative ejaculations in 87%. Of the 14 patients with long-term follow-up data, 6 achieved pregnancies (8 children), and 3 more demonstrated the capacity for fertilization at IVF. Conclusions: The observation of a high serum FSH in men with azoospermia does not tale out the possibility of obstruction and the capacity for fertility. Caution should be exercised particularly if unilateral testicular atrophy is present. A testicular biopsy should be performed to detect possible spermatogenesis and, if present, then a microsurgical bypass can lead to a successful pregnancy.