Unilateral versus bilateral vaso-epididymal anastomosis for idiopathic obstructive azoospermia: A randomized controlled trial

ABSTRACT

Purpose: Men with idiopathic obstructive azoospermia (OA) are candidates for surgical reconstruction with a vasoepididymal anastomosis (VEA) performed on one or both testis. There are no randomised trials comparing the success of unilateral versus bilateral VEA. We conducted a randomised trial comparing the two surgical options. Material(s) and Method(s) Between April 2017 and March 2022, men with infertility due to idiopathic OA were randomised to unilateral (Group 1) or bilateral (Group 2) VEA in an ethics committee approved clinical trial registered with the Clinical Trials Registry. The primary outcome was successful surgery defined as appearance of sperms in the ejaculate, evaluated at 3 monthly intervals after surgery. Additional outcomes were pregnancy rates and complications between the two groups. Men with successful surgery were compared with those without patency to identify predictors of success. Result(s) 54 men fulfilled the criteria and 52 who completed follow-up were included in the analysis. Accrual did not reach the planned number of 70 subjects due to the COVID-19 pandemic. Success rate and spontaneous pregnancies were higher in men with bilateral surgery (46%, 3) than unilateral surgery (27%, 0) but were not statistically significant. Both groups had similar complication rates. Although bilateral surgery and presence of sperms in epididymal fluid were higher in men with patency, these were not statistically significant. Conclusion(s) Bilateral VEA was associated with higher patency and spontaneous pregnancy rates compared to unilateral surgery. Although the results were not statistically significant due to the underpowered study, they suggest a clinically significant outcome.