Reversión de vasectomía con criopreservación sistemática de espermatozoides testiculares

Abstract

IntroductionAt the present time, a vasectomised man who wishes to have children (besides through adoption and insemination with the semen of an anonymous donor), only has two options to attempt reproduction using his own genetic load: a) to resort to assisted reproduction techniques, by performing an intracytoplasmic sperm injection (ICSI) with sperm extracted from the man's testicle (TESE), which results in an average fertilization percentage per cycle of 27.8%; and b) classic microsurgery, where the aim is to reverse the condition by means of vasovasostomy, is generally performed in a hospital environment and under general anaesthesia, with an average result of 85.4% in relation to the presence of sperm in semen and 46% of pregnancies achieved. If this technique fails, the only alternative would be to resort to the previous technique.Unfortunately, we found that when the bearer of the problem is the man, who voluntarily undergoes male sterilization surgery, it is the woman who suffers almost all the aggressiveness of the technique (ovarian hyperstimulation, puncture under general anaesthesia, embryo transfer, effects of the hormone therapy…).On the other hand, in view of this almost 20% of microsurgical failures, our last option would have been to offer the man further aggression on his testicles to obtain sperm and to use it to attempt assisted reproduction techniques. Material and methodsFor this reason, we have designed a programme through which we aim: a) to simplify the act of microsurgery by converting it into an ambulatory technique performed under local anaesthesia. Furthermore, we have modified the surgical technique by simplifying it using the Simple Biplane Technique, already published by this author; and b) to include the extraction of testicular sperm (TESE) in the same surgical act, for cryopreservation and possible subsequent use if the microsurgery fails.Forty-eight couples were treated, where the men underwent the surgery and were monitored and checked after the surgery by means of successive seminograms, pending possible pregnancies. If these did not occur, but there was evidence of spermatozoa in the semen, assisted reproduction techniques were applied using the spermatozoa obtained from that semen, and in the case of azoospermia, we applied the techniques using the cryopreserved spermatozoa that we had obtained previously. ResultsOur results in relation to the presence of spermatozoa in semen were 85.5%. The rate of spontaneous pregnancies was 45.8%. If to the aforesaid rate, we add all the pregnancies obtained by means of assisted reproduction techniques that allowed frozen spermatozoa to be obtained and those obtained using the semen of our patients who did not achieve spontaneous pregnancies through intrauterine insemination or ICSI, which were 12.5%, our total pregnancies were 58.3%, which significantly exceeds all previous publications. ConclusionsIt is for this reason that we advocate that if a vasectomised man wishes to have children, the technique we would recommend would preferably be microsurgical reversal vasectomy with systematic cryopreservation of testicular sperm.