Obstructive azoospermia

A 30-year-old male patient who underwent herniorrhaphy for an omphalocele at birth was referred to a hospital due to infertility after a year of marriage. Multiple semen analyses showed azoospermia, and scrotal examination and MRI revealed no abnormalities. The patient and his wife chose to pursue natural pregnancy, so both of his seminal tracts were reconstructed using intracytoplasmic sperm injection (ICSI) with testicular sperm collected and frozen during a testicular biopsy. Intra-operative vasography demonstrated that both vasa deferentia were interrupted at the internal inguinal rings, but the abdominal end of the right vas leading to the seminal vesicle was found in the abdominal cavity (Figure 1). Although the discharge from the stump of the testicular end had no sperm, the right epididymal tubules had motile sperm and were dilated. As a result, the patient underwent simultaneous right-sided vasovasostomy in the internal inguinal ring and ipsilateral epididymovasostomy.