Abstract
The scrotum was explored in 32 patients who had vasectomy reversal which failed to restore their fertility. Twenty-three patients were azoospermic and nine had severe or persistent oligozoospermia. Amongst the 23 azoospermic cases, the vasa were found to be blocked in 12; following repeat vaso-vasostomy, normal sperm counts were produced in 10 patients; 8 of these patients followed up for 6 months or more successfully impregnated their wives. In four cases there was a secondary epididymal block: following epididymo-vasostomy, three of four patients obtained normal sperm counts and two wives became pregnant. In seven patients there was a very high antisperm antibody titre (greater than 1024 by tray agglutination test) and despite reparative surgery and prednisolone therapy, no pregnancies were obtained. The overall pregnancy rate for this group was 7 of 19 (37%). Amongst nine oligozoospermic cases, unilateral obstruction was found in eight. The block was found in the vas in five and in the epididymis in two, and in two there were very high antisperm antibody titres. After reconstructive surgery, four patients had normal sperm counts and one pregnancy has been obtained.
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