Chapter 6, Page 3

Duct blockage

If the passage (reproductive tract) between the penis and testes is blocked there will be no sperm in the semen - azoospermia. Blockages can be caused by infection (gonorrhea, chlamydia, filarisias or TB) or by surgery done to repair hernias or hydroceles.

A long and complicated two or three hour microsurgery called a vasoepididymal anastomosis (VEA) can be attempted. This is highly specialised surgery which is best done by an experienced microsurgeon, since the tubes involved are so fine and delicate.

This is a technically difficult and intricate surgery because it needs to be done under high magnification. The surgeon tries to bypass the block, so that the sperm can reach the penis.

Surgical results can be poor for the following reasons:

Technical difficulty, because of the minute size of the tubes; Often be patency cannot be restored, and the sperm count remains zero. The anatomic patency rate is about 50% for most patients (which means that sperm can be found in the semen after surgery).
These sperm are often poor in quality and are successful in giving rise to a pregnancy in only about 25% of patients, as the sperm that make their way out may not be mature or motile since they have not spent enough time in the epididymis, which functions to mature the sperms in the body.
Secondary damage to the epididymis and duct system may have occurred because they have been subjected to high pressure for a long time, causing multiple leaks and blocks, making surgery less successful.
Damage to the functional lining of the epididymis, either as a result of the infection which caused the block or as a result of the high pressure, so that it no longer works effectively and sperms cannot mature here properly.

The best chance of success is with the first surgical attempt - repeat surgery has a dismal success rate and is rarely worthwhile.

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