Objective:To analyze the feasibility and safety of microsurgical anastomosis for obstructive azoospermia (OA) patients with prior intracytoplasmic sperm injection (ICSI) failure.Methods:From September 2015 to May 2020, the data of 20 OA patients with previous ICSI-assisted pregnancy failure admitted to the Department of Andrology, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The characteristics of seminal tract microsurgical reconstruction were summarized, and the postoperative recurrence rate and clinical pregnancy rate were calculated.Results:Vasal obstruction was found in 8 patients and epididymal obstruction in 12 patients during microscopically reconstructed seminal tract. Among the patients with vasal obstruction, 1 patient developed OA after trauma and underwent laparoscopic-assisted right vasovasostomy (VV). Totally 7 patients developed OA after juvenile bilateral hernia, among whom 6 patients underwent further laparoscopic-assisted VV and 1 patient underwent vasovasostomy and epididymal cross anastomosis. Of the 8 patients who underwent VV, 6 achieved postoperative patency, and 2 couples achieved natural pregnancy. Patients with epididymal obstruction underwent microscopic vasoepididymostomy (VE), and 6 out of 12 patients achieved postoperative pregnancy, while 3 couples achieved natural pregnancy. No significant complications occurred in all patients during and after operation.Conclusion:Microsurgical anastomosis is an effective remedy for patients with OA after ICSI pregnancy failure, which can help patients achieve natural pregnancy.

Objective:To analyze the effectiveness and safety of reoperation for obstructive azoospermia (OA) with initial microsurgical anastomosis failure.Methods:A retrospective case series was performed for OA patients who underwent reoperation after initial microsurgical anastomosis failure, in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Institute of Urology, Urologic Medical Center from March 2015 to June 2020. Totally, 21 patients were enrolled in the study, and the clinical data, patency and pregnancy outcomes were reviewed.Results:During the initial surgery, 8 cases underwent vasovasostomy and 8 cases underwent vasoepididymostomy, while the other 5 cases underwent crossover anastomosis; 19 cases underwent reoperation because of reproductive needs, and 2 for post-vasectomy chronic testicular pain. During the reoperation, anastomotic stricture was found in 14 cases, and sperm granuloma was found in 6 cases, while spermatogenic dysfunction was confirmed in 1 case. Unilateral or bilateral anastomosis was performed successfully in 19 cases. Testicular sperm extraction was performed for 1 case with non-obstructive azoospermia (NOA) and 1 case with severe adhesion respectively. Totally 19 cases was followed for 3 to 58 months [(30.21±18.43) months], and 2 cases were lost to follow-up. Chronic testicular pain was relieved completely in 1 of the 2 cases suffering from the post-vasectomy testicular pain. Overall, 11 cases achieved patency, and 4 cases concieved naturally. Furthermore, 3 cases underwent in vitro fertilization cycle (1 case with semen sperm, and the other 2 cases with frozen testicular sperm). There were no severe post-operational complications in all cases. Conclusion:Microsurgical reoperation, which allows a favorable patency rate and natural pregnancy rate, is a valid option for the treatment of OA with initial microsurgical anastomosis failure.

Objective:To analyze the feasibility and safety of microsurgical anastomosis for obstructive azoospermia (OA) patients with prior intracytoplasmic sperm injection (ICSI) failure.Methods:From September 2015 to May 2020, the data of 20 OA patients with previous ICSI-assisted pregnancy failure admitted to the Department of Andrology, Urologic Medical Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The characteristics of seminal tract microsurgical reconstruction were summarized, and the postoperative recurrence rate and clinical pregnancy rate were calculated.Results:Vasal obstruction was found in 8 patients and epididymal obstruction in 12 patients during microscopically reconstructed seminal tract. Among the patients with vasal obstruction, 1 patient developed OA after trauma and underwent laparoscopic-assisted right vasovasostomy (VV). Totally 7 patients developed OA after juvenile bilateral hernia, among whom 6 patients underwent further laparoscopic-assisted VV and 1 patient underwent vasovasostomy and epididymal cross anastomosis. Of the 8 patients who underwent VV, 6 achieved postoperative patency, and 2 couples achieved natural pregnancy. Patients with epididymal obstruction underwent microscopic vasoepididymostomy (VE), and 6 out of 12 patients achieved postoperative pregnancy, while 3 couples achieved natural pregnancy. No significant complications occurred in all patients during and after operation.Conclusion:Microsurgical anastomosis is an effective remedy for patients with OA after ICSI pregnancy failure, which can help patients achieve natural pregnancy.

Objective:To analyze the effectiveness and safety of reoperation for obstructive azoospermia (OA) with initial microsurgical anastomosis failure.Methods:A retrospective case series was performed for OA patients who underwent reoperation after initial microsurgical anastomosis failure, in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Institute of Urology, Urologic Medical Center from March 2015 to June 2020. Totally, 21 patients were enrolled in the study, and the clinical data, patency and pregnancy outcomes were reviewed.Results:During the initial surgery, 8 cases underwent vasovasostomy and 8 cases underwent vasoepididymostomy, while the other 5 cases underwent crossover anastomosis; 19 cases underwent reoperation because of reproductive needs, and 2 for post-vasectomy chronic testicular pain. During the reoperation, anastomotic stricture was found in 14 cases, and sperm granuloma was found in 6 cases, while spermatogenic dysfunction was confirmed in 1 case. Unilateral or bilateral anastomosis was performed successfully in 19 cases. Testicular sperm extraction was performed for 1 case with non-obstructive azoospermia (NOA) and 1 case with severe adhesion respectively. Totally 19 cases was followed for 3 to 58 months [(30.21±18.43) months], and 2 cases were lost to follow-up. Chronic testicular pain was relieved completely in 1 of the 2 cases suffering from the post-vasectomy testicular pain. Overall, 11 cases achieved patency, and 4 cases concieved naturally. Furthermore, 3 cases underwent in vitro fertilization cycle (1 case with semen sperm, and the other 2 cases with frozen testicular sperm). There were no severe post-operational complications in all cases. Conclusion:Microsurgical reoperation, which allows a favorable patency rate and natural pregnancy rate, is a valid option for the treatment of OA with initial microsurgical anastomosis failure.

Objective:To explore the chromosomal genetic factors of maturation arrest non-obstructive azoospermia (NOA).Methods:A case of maturation arrest NOA patients with chromosome reciprocal translocation was retrospective analyzed with literature review.Results:The karyotype of 46,Y,t(X;19)(p22.1;q13.3) was detected in a NOA patient, and the karyotypes of his parents were normal. There were no micro-deletions of Y chromosome. Also, no obvious pathogenic gene mutations were found in whole-exome sequencing (WES). Furthermore, there were no pathogenic copy number variations (CNVs) detected by chromosomal microarray analysis (CMA) in the patient. The histopathological analysis revealed that the spermatogenesis arrested at spermatocyte stage.Conclusion:46,Y,t(X;19) chromosome reciprocal translocation could lead to maturation arrest NOA.

Objective:To explore the chromosomal genetic factors of maturation arrest non-obstructive azoospermia (NOA).Methods:A case of maturation arrest NOA patients with chromosome reciprocal translocation was retrospective analyzed with literature review.Results:The karyotype of 46,Y,t(X;19)(p22.1;q13.3) was detected in a NOA patient, and the karyotypes of his parents were normal. There were no micro-deletions of Y chromosome. Also, no obvious pathogenic gene mutations were found in whole-exome sequencing (WES). Furthermore, there were no pathogenic copy number variations (CNVs) detected by chromosomal microarray analysis (CMA) in the patient. The histopathological analysis revealed that the spermatogenesis arrested at spermatocyte stage.Conclusion:46,Y,t(X;19) chromosome reciprocal translocation could lead to maturation arrest NOA.

Azoospermia accounts for 10%-15% of male infertility, with the prevalence of 1% in male population. Obstructive azoospermia (OA) accounts for 40% of azoospermia and can be caused by a variety of factors, including male reproductive duct inflammation and genetic factors. Given the fact that the spermatogenesis is normal in the testis of OA patients, the OA patients can have their own offspring through testicular biopsy and sperm retrieval followed by assisted reproductive technology (ART). Therefore, the genetic etiology of OA is often overlooked. Subsequently, studies of the following ART strategies and offspring birth defects are also ignored. This article reviewed the genetic disorders of OA patients, and the animal model with OA, providing new ideas for management of OA patients, genetic counseling, and development of male contraceptives.

Azoospermia accounts for 10%-15% of male infertility, with the prevalence of 1% in male population. Obstructive azoospermia (OA) accounts for 40% of azoospermia and can be caused by a variety of factors, including male reproductive duct inflammation and genetic factors. Given the fact that the spermatogenesis is normal in the testis of OA patients, the OA patients can have their own offspring through testicular biopsy and sperm retrieval followed by assisted reproductive technology (ART). Therefore, the genetic etiology of OA is often overlooked. Subsequently, studies of the following ART strategies and offspring birth defects are also ignored. This article reviewed the genetic disorders of OA patients, and the animal model with OA, providing new ideas for management of OA patients, genetic counseling, and development of male contraceptives.