Two cases of delayed patency following "failed" epididymovasostomy and subsequent percutaneous epididymal sperm aspiration.
CONCLUSIONS
We describe two patients who underwent bilateral epididymovasostomy and subsequent percutaneous epididymal sperm aspiration (PESA) because of persistent azoospermia, after which sperm returned to the ejaculates of both patients, resulting in an unexpected natural pregnancy in one of the couples.


METHODS
Two men, Patient A (age 35 years) and Patient B (age 37 years), underwent vasectomy reversal 8 and 9 years following vasectomies, respectively. In both cases, bilateral epididymovasostomy was required due to epididymal obstruction. Semen analysis was performed at 3 month intervals following the procedure. Both patients underwent PESA, and one couple completed intracytoplasmic sperm injection (ICSI).


RESULTS
In Patient A, PESA and ICSI resulted in a dizygotic twin pregnancy, which was followed by an unexpected natural pregnancy 3 years after the epididymovasostomy. Semen analysis indicated late patency. This experience prompted us to advise Patient B to continue undergoing semen analyses every 3 months, even though PESA and ICSI treatment had been initiated. One year after the reconstructive procedure, and after PESA was performed, semen analysis indicated patency. This couple has stopped ICSI treatments and is now attempting a natural pregnancy.


CONCLUSIONS
Epididymovasostomy may result in delayed patency and natural pregnancy, even after PESA has been performed. This finding should be taken into consideration by clinicians and by couples trying to conceive a child following "failed" epididymovasostomy and subsequent PESA.
Department of Urology, St. Elisabeth Hospital, Tilburg, The Netherlands.
J Herman
JH
van Roijen
D000328:Adult; D004822:Epididymis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D055101:Semen Analysis; D020554:Sperm Injections, Intracytoplasmic; D053625:Sperm Retrieval; D014649:Vas Deferens / Q000601:surgery; D014669:Vasovasostomy