The simple solution for infertile patients with aspermia in the modern era of assisted reproductive technique

Purpose: The purpose is to investigate the feasibility and outcomes of loupe-assisted vasostomy for sperm retrieval in male infertility due to anejaculation or retrograde ejaculation. Materials and Methods: We retrospectively reviewed the vasal sperm aspirations of 9 patients with anejaculation or retrograde ejaculation from 2015 to 2017. We collected preoperative serum hormone data (testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin) and comorbidities of each patient. The patients underwent standard loupe-assisted modified vasostomy by a single surgeon with immediate specimen interpretation, with follow-up at the clinic. Results: Of the 9 patients, 4 had retrograde ejaculation, and 5 had anejaculation. Seven patients had controlled diabetes mellitus; of them, one had an ejaculating duct stone, and only one had no comorbidity. Aspirations were performed for sequential assisted reproductive techniques in 7 patients and cryopreservation in another two. The average total sperm count was 213 × 106, with motility between 9% and 67% and normal sperm morphology between 4.5% and 50.0%. One patient had undergone microsurgical epididymal sperm aspiration before vasal aspiration, but the semen analysis indicated poor sperm quality and could not be used for in vitro fertilization. In total, 7 of the 8 aspirations (87.5%) resulted in pregnancy. No complications have been observed to date. Conclusion: Vasal sperm aspiration is a simple and effective alternative method for sperm retrieval, with the advantage of a high success rate and less invasiveness and destruction of the reproductive system. It may be performed before sperm retrieval from the epididymis or testis in infertile men with aspermia.