A susceptibility locus rs7099208 is associated with non-obstructive azoospermia via reduction in the expression of FAM160B1

Non-obstructive azoospermia （NOA） is a severe defect in male reproductive health that occurs in 1% of adult men. In a previous study, we identified that rs7099208 is located within the last intron of FAM160B1 at 10q25.3. In this study, we analysed expression Quantitative Trait Loci （eQTL） of FAM16OB1, ABLIM1 and TRUB1, the three genes surrounding rs7099208. Only the expression level of FAM16OB1 was reduced for the homozygous alternate genotype （GG） of rs7099208, but not for the homozygous reference or heterozygous geno- types. FAM160B1 is predominantly expressed in human testes, where it is found in spermatocytes and round sper- matids. From 17 patients with NOA and five with obstructive azoospermia （OA）, immunohistochemistry revealed that expression of FAM160B1 is reduced, or undetectable in NOA patients, but not in OA cases or normal men. We conclude that rs7099208 is associated with NOA via a reduction in the expression of FAM160B1.

Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility

We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia （100%; adjusted odds ratio： 0.033; 95% Ch 0.007-0.164; P 〈 0.001）. Live birth rates after sperm injections were lower in men with testicular failure （19.9%） compared with donor sperm （37.5%; adjusted OR： 0.377 （95% Ch 0.233-0.609, P 〈 0.001）） and obstructive azoospermia （34.2%; adjusted OR： 0.403 （95% CI： 0.241-0.676, P= 0.001）. Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection （ICSI） are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure.

Can inhibin-B predict the outcome of microsurgical epididymal sperm aspiration in patients with suspected primary obstructive azoospermia？

Aim： To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration （MESA） procedure in patients with suspected primary obstructive azoospermia （OA） and if inhibin-B can replace testicular biopsy in the diagnostic work-up of these patients. Methods： Inhibin-B levels and testicular biopsy scores were related to the outcome of MESA in 43 patients with suspected primary OA. MESA was considered to be successful when epididymal sperm could be identified during the procedure. Results： Spermatozoa were present in the epididymal aspirate in 28 out of the 43 patients （65%）. lnhibin-B values were not significantly different in patients with successful or unsuccessful MESA. The modified Johnsen score, however, was significantly lower in patients with unsuccessful MESA （P = 0.003）. A rete testis obstruction or epididymal malfunctioning was found in 15% of patients with suspected primary OA, reflected by unsuccessful MESA despite normal inhibin-B levels and normal testicular histology. Conclusion： Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.

Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia(analysis of 49 case reports)

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy(VE)in the treatment of epididymal obstructive azoospermia(EOA),we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy(LIVE)between 2000 and 2007.The data included the surgical method,postoperative motile sperm count per ejaculation,percentage of progressive motile sperm and patency and pregnancy outcomes.There were a total of 49 men undergoing scrotal exploration,and epididymal obstruction was found in all cases.Bilateral or unilateral anastomoses were performed in 40 and 6 men,respectively.The postoperative courses of 42 patients were followed up for more than 6 months,and the courses of 38 patients were followed up for more than 1 year.The overall patency and pregnancy rates were 71.4%and 26.3%,respectively.Moreover,progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput.Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis.We think that the loupe-assisted method,with a lower overall cost and a simplified surgical procedure,can achieve satisfactory patency outcomes and pregnancy results.Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.

Surgical management of nonobstructive azoospermia

Nonobstructive azoospermia(NOA)is characterized by the complete absence of sperm in the ejaculate due to testicular failure.The evaluation and management of patients with NOA offer a challenge to the reproductive urologist.In the era of in vitro fertilization with intracytoplasmic sperm injection,surgical sperm extraction techniques can afford men with NOA biologic paternity.To provide a comprehensive review of surgical sperm retrieval approaches in the patient with NOA emphasizing complications,success rates and outcome optimization,a Medline search was conducted querying surgical approaches used to manage NOA.Four sperm extraction techniques are described including:testicular sperm aspiration,testicular sperm extraction,fine needle aspiration mapping and microdissection testicular sperm extraction.In addition,the roles for pre-extraction varicocelectomy and sperm cryopreservation are discussed.The management of NOA continues to evolve as newer tools become available.Several modalities of sperm acquisition exist.An understanding of their complications and success rates is fundamental to the treatment of NOA.

Identification of CFTR Gene Mutations in Chinese Patients with Congenital Obstructive Azoospermia

ve To analyze the frequency and hot spot of CFTR gene mutations in Chinese patients with congenital obstructive azoospermia

Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia:a tertiary care center experience

Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is a lack of relevant reports.In this study,we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA.From December 2015 to December 2020,33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital(Shanghai,China).Patient information,ultrasound findings,semen analysis,hormone profiles,and treatment information were collected,and the clinical outcomes were evaluated.Of 33 patients,29 patients were retrospectively analyzed.Vasoepididymostomy(VE)or cross VE was performed in 12 patients,the patency rate was 41.7%(5/12),and natural pregnancy was achieved in one of the patients.The other 17 patients underwent testicular sperm extraction as the distal vas deferens(contralateral side)was obstructed.These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA,even with a relatively low rate of patency and natural pregnancy.

Microsurgical vasoepididymostomy for patients withinfectious obstructive azoospermia, cause, outcome,and associated factors

Azoospermia is of great importance to male infertility. Obstructive azoospermia （OA） due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of microsurgical vasoepididymostomy （VE） and also to identify the factors relative to the result after reconstructive surgery. Two hundred and eight men presenting with OA due to infection during the study period from July 2010 to July 2013 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone （FSH）, and scrotal ultrasound were done before surgical exploration. Among the 198 men who were selected for surgical procedures, 159 candidates underwent microsurgical VE with sperm detected in the epididymal fluid. As for the other 39 cases, reconstruction was not feasible. The average age was 28.5 ＋ 3.9 years （range 22-38）, with average follow-up being 16.5 ~ 5.9 months （range 4-28）. According to the 150 cases being followed after VE procedures, the total patency rate was 72% （108/150）. During follow-up, 38.7% （58/150） natural pregnancies occurred, with overall live birth rate being 32.7% （49/150）. Our data suggested that microsurgical VE is an effective therapy for postinfectious epididymal OA. Individualized counseling with prognosis based on etiology should be offered to patients to select optical therapy.

Testicular sperm extraction and intracytoplasmic sperm injection in non obstructive azoospermia

Objective To report the experience in sperm extraction from testicular biopsies (TESE) performed from March 1996 to July 1998 in men with non obstructive azoospermia (NOA) Methods Comparisons of age, volume of both testes, serum FSH and testosterone in men, and histology of testicular samples in the first cycles between cycles with spermatozoa found and those without spermatozoa found were performed Comparisons of fertilization, cleavage and pregnancy rates between cycles with spermatozoa injected and those with spermatids injected were performed Results Spermatozoa were found in only 12 out of 26 first TESE cycles (46 2%) and other cycles had spermatids (round cells) only Age of men, history of mumps orchitis/oligozoospermia, volume of both testes and serum FSH/testosterone levels in men were not significantly different between cycles with and without spermatozoa The fertilization rate was significantly higher in cycles with spermatozoa injected than those with round cell injections (63 3% vs 23 2%, P <0 0001, Chi squared test) The pregnancy rate was 14 3% per cycle when spermatozoa were injected Conclusions TESE followed by Intracytoplasmic sperm injection (ICSI) is an effective treatment in patients with NOA Less than half of the patients undergoing TESE had spermatozoa recovered Age of men, volume of both testes and serum FSH/ testosterone levels in men were not useful in predicting successful recovery Compared to using ejaculated and epididymal spermatozoa, fertilization and pregnancy rates were achieved when testicular spermatozoa were used for ICSI

Proposed age-stratified reference intervals of FSH derived from normozoospermic men

Objective:To demonstrate that serum follicle-stimulating hormone(FSH)in men rises with age,and to explore FSH reference intervals of age-related partitioning.Methods:Men aged 20-50 years(n=1190)underwent semen analysis according to World Health Organization(2010)methods.Serum was frozen prior to measurement of FSH by using the Siemens ADVIA Centaur®XP immunoassay system.FSH central 95%intervals after logarithmic transformation based on age were derived from 1037 normozoospermic men.These were then applied to oligozoospermic and azoospermic men.Men producing azoospermic semen samples were further classified as having non-obstructive azoospermia by clinical diagnostic criteria,including genetic analysis and surgical exploration.Results:Serum FSH in normozoospermic men increased with age(P<0.05),and reference intervals were determined with 10-year brackets:21-30 years[(1.0-8.2)IU/L],31-40 years[(1.4-9.5)IU/L],41-50 years[(1.9-12.0)IU/L].The proportion of oligozoospermic men with normal FSH concentrations was less than the normozoospermic men,which in turn was lower among azoospermic men(both P<0.01).The azoospermic men were further broken down according to the nature of the azoospermia as either obstructive or non-obstructive azoospermia,and 86.4%(38/44)men with non-obstructive azoospermia had elevated serum FSH concentrations whereas only 6.7%(1/15)men with obstructive azoospermia had high FSH levels,and this was significantly different(P<0.01).Conclusions:FSH concentrations increase in men between 20-50 years,and clinical interpretation of serum FSH results in men must be made by using age-based reference intervals.

The evolution and refinement of vasoepididymostomy techniques

Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy （VE）. Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE （LIVE） in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the oreoDerative evaluation along with the techniaues of various VE will be described in this article.

A modified single-armed technique for microsurgical vasoepididymostomy

This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm （〉 104 m I- 1） in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men （58.8%）, including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.

Successful pregnancy and birth after intrauterine insemination using caput epididymal sperm by percutaneous aspiration

<abstract>Aim: To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration (PESA) and intrauterine insemination (IUI). Methods: Ninety azoospermic patients with congenital bilateral absence of the vas deferens (BAVD, n=58) or bilateral caudal epididymal obstruction (BCEO, n=32) requesting for fine needle aspiration (FNA), PESA and IUI were recruited. The obstruction was diagnosed by vasography and determination of the fructose, carnitine and alpha-glucosidase levels in the seminal fluid. Results: The mean sperm motility, density, abnormal sperm and total sperm count of the caput epdidymis were 16 %±22 %, (12±31) ×106/mL, 55 %±36 % and (16±14)×106, respectively. In the 90 couples, a total of 74 PESA procedures and 66 cycles of IUI were performed. Three pregnancies resulted, including one twin pregnancy giving birth to two healthy boys, one single pregnancy with a healthy girl and another single pregnancy aborted at week 6 of conception. The pregnancy rate per IUI cycle was 4.5 %. Conclusion: The birth of normal, healthy infants by IUI using PESA indicates that the caput epididymal sperm possess fertilization capacity. The PESA-IUI programme is a practical and economical procedure for the management of patients with obstructive azoospermia.

The performance of transrectal ultrasound in the diagnosis of seminal vesicle defects： a comparison with magnetic resonance imaging

Obstructive azoospermia （OA） is one of the most common causes of male infertility. Transrectal ultrasound （TRUS） has been used to diagnose OA for many years. From 2009 to 2013, we evaluated a prospective cohort of 1249 patients with suspected OA using TRUS. It was found that dilation of the ejaculatory duct （ED） （29.9%, 374/1249） was the most common cause of OA, followed by seminal vesicle （SV） abnormalities （28.5%, 356/1249）. A total of 237 patients were diagnosed with congenital defects （agenesis and/or hypoplasia） of the SV, constituting more than half of the cases of SV disease in OA （19.0%, 237/1249）. In contrast to ED, congenital defects of the SV could not be corrected with surgical treatment. Therefore, it is meaningful to compare TRUS and magnetic resonance imaging （MRI） for accurate diagnosis of SV defects. Among our patients, 30 with agenesis or/and hypoplasia of the SV on TRUS were further evaluated using pelvic MRI within 2 years, with the objective of verifying the TRUS results. The concordance rate for diagnosing congenital defects of the SV was 73.3% （22/30）. We concluded that TRUS is a reliable and convenient method for diagnosing agenesis or hypoplasia of the SV in OA patients with a high concordance with MRI while MRI is useful in patients with inconclusive TRUS findings.

Impact of surgical volume and resident involvement on patency rates after vasectomy reversaldA 14-year experience in an open access system

Objective:Evaluate the influence of fellowship training,resident participation,reconstruction type,and patient factors on outcomes after vasectomy reversals in a high volume,open access system.Methods:Retrospective review of all vasectomy reversals performed at a single institution from January 1,2002 to December 31,2016 was conducted.Patient and spouse demographics,patient tobacco use and comorbidities,surgeon training and case volume,resident participation,reconstruction type,and postoperative patency were collected and analyzed.Results:Five hundred and twenty-six vasectomy reversals were performed during the study period.Follow-up was available in 80.6%of the cohort and overall patency,regardless of reconstruction type was 88.7%.The mean time to reversal was 7.87 years(range of 0-34 years).The majority of cases included resident participation.Case volume was high with faculty and residents logging a mean of 37.0 and 38.7(median 18 and 37)cases respectively.Bilateral vasovasostomy was the most common reconstruction type(83%)and demonstrated a significantly better patency rate(89%)than all other reconstructions(p=0.0008).Overall patency and patency by reconstruction type were not statistically different among faculty surgeons and were not impacted by fertility fellowship training,resident participation or postgraduate year.Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency(p=0.0023 and p=0.043,respectively).Conclusions:Surgeons with a high volume of vasectomy reversals have outcomes consistent with contemporary series regardless of fellowship training in fertility.Patency was better for bilateral vasovasostomies.Patency was not negatively impacted by tobacco use,comorbidities,resident participation,or post-graduate year.

The effect of BMI and age on the outcomes of microsurgical vasoepididymostomy: a retrospective analysis of 181 patients operated by a single surgeon

To design a treatment plan for patients with epididymal obstruction,we explored the potential impact of factors such as body mass index(BMI)and age on the surgical outcomes of vasoepididymostomy(VE).In this retrospective study,181 patients diagnosed with obstructive azoospermia(OA)due to epididymal obstruction between September 2014 and September 2017 were reviewed.All patients underwent single-armed microsurgical intussusception VEs with longitudinal two-suture placement performed by a single surgeon(KH)in a single hospital(Peking University Third Hospital,Beijing,China).Six factors that could possibly influence the patency rates were analyzed,including BMI,age,mode of anastomosis,site of anastomosis,and sperm motility and quantity in the intraoperative epididymal fluid.Single-factor outcome analysis was performed via Chi-square test and multivariable analysis was performed using logistic regression.A total of 159(87.8%,159/181)patients were followed up.The follow-up time(mean±standard deviation[s.d.])was 27.7±9.3 months,ranging from 12 months to 48 months.The overall patency rate was 73.0%(116/159).The multivariable analysis revealed that BMI and age significantly influenced the patency rate(P=0.008 and 0.028,respectively).Younger age(≤28 years;odds ratio[OR]=3.531,95%confidence interval[95%CI]:1.397–8.924)and lower BMI score(<26.0 kg m−2;OR=2.352,95%CI:1.095–5.054)appeared to be associated with a higher patency rate.BMI and age were independent factors affecting the outcomes of microsurgical VEs depending on surgical expertise and the use of advanced technology.

High ligation of the hernia sac in open nonmesh inguinal herniorrhaphy is an important cause of iatrogenic vas deferens injury

Vasectomy damage is a common complication of open nonmesh hernia repair.This study was a retrospective analysis of the characteristics and possible causes of vas deferens injuries in patients exhibiting unilateral or bilateral vasal obstruction caused by open nonmesh inguinal herniorrhaphy.The site of the obstructed vas deferens was intraoperatively confirmed.Data,surgical methods,and patient outcomes were examined.The Anderson–Darling test was applied to test for Gaussian distribution of data.Fisher’s exact test or Mann–Whitney U test and unpaired t-test were used for statistical analyses.The mean age at operation was 7.23(standard deviation[s.d.]:2.09)years and the mean obstructive interval was 17.72(s.d.:2.73)years.Crossed(n=1)and inguinal(n=42)vasovasostomies were performed.The overall patency rate was 85.3%(29/34).Among the 43 enrolled patients(mean age:24.95[s.d.:2.20]years),73 sides of their inguinal regions were explored.The disconnected end of the vas deferens was found in the internal ring on 54 sides(74.0%),was found in the inguinal canal on 16 sides(21.9%),and was found in the pelvic cavity on 3 sides(4.1%).Location of the vas deferens injury did not significantly differ according to age at the time of hernia surgery(≥12 years or<12 years)or obstructive interval(≥15 years or<15 years).These results underscore that high ligation of the hernial sac warrants extra caution by surgeons during open nonmesh inguinal herniorrhaphy.

Comparison of intracytoplasmic sperm injection(ICSI)outcomes in infertile men with spermatogenic impairment of differing severity

The extent of spermatogenic impairment on intracytoplasmic sperm injection(ICSI)outcomes and the risk of major birth defects have been little assessed.In this study,we evaluated the relationship between various spermatogenic conditions,sperm origin on ICSI outcomes,and major birth defects.A total of 934 infertile men attending the Center for Reproductive Medicine of Ren Ji Hospital(Shanghai,China)were classified into six groups:nonobstructive azoospermia(NOA;n=84),extremely severe oligozoospermia(esOZ;n=163),severe oligozoospermia(sOZ,n=174),mild oligozoospermia(mOZ;n=148),obstructive azoospermia(OAZ;n=155),and normozoospermia(NZ;n=210).Rates of fertilization,embryo cleavage,high-quality embryos,implantation,biochemical and clinical pregnancies,abortion,delivery,newborns,as well as major birth malformations,and other newborn outcomes were analyzed and compared among groups.The NOA group showed a statistically lower fertilization rate(68.2%vs esOZ 77.3%,sOZ 78.0%,mOZ 73.8%,OAZ 76.6%,and NZ 79.3%,all P<0.05),but a significantly higher implantation rate(37.8%)than the groups esOZ(30.1%),sOZ(30.4%),mOZ(32.6%),and OAZ(31.0%)(all P<0.05),which was similar to that of Group NZ(38.4%).However,there were no statistically significant differences in rates of embryo cleavage,high-quality embryos,biochemical and clinical pregnancies,abortions,deliveries,major birth malformations,and other newborn outcomes in the six groups.The results showed that NOA only negatively affects some embryological outcomes such as fertilization rate.There was no evidence of differences in other embryological and clinical outcomes with respect to sperm source or spermatogenic status.Spermatogenic failure and sperm origins do not impinge on the clinical outcomes in ICSI treatment.

Multiple factors affecting surgical outcomes and patency rates in use of single-armed two-suture microsurgical vasoepididymostomy： a single surgeon＇s experience with 81 patients

Vasoepididymostomy （VE）, as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed two-suture VEs on humans and studied the factors that could possibly affect the patency rates. From July 2012 to July 2013, we reviewed 81 patients with consecutive primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon, Kai Hong （KH）. At the same time, we analyzed seven factors that possibly related to the patency rates. With the single-armed technique, a total of 81 men underwent the microsurgical VEs. Data on 62 patients were completely recorded. 19 patients were lost to follow-up. Mean age was 31 years old. Mean follow-up time was 8.8 （2-17） months. The patency rate was 66.1% （41/62）. Natural pregnancy rate was 34.1% （14/41）. Overall pregnancy rate was 22.6% （14/62）. No severe surgical complications were noted. With logistic regression test analysis, there were two factors related to a higher patency rate： anastomosis sites （P = 0.035） and motile sperm found in the epididymal fluid （P = 0.006）. Motile sperm found in the epididymal fluid were associated with a higher patency rate （OR = 11.80, 95% CI = 1.79, 77.65）. The single-armed two-suture longitudinal VE technique is feasible for microsurgical practice. The patency and pregnancy rates are comparable to the doubled-armed technique. Anastomosis sites and motile sperm found in the epididymal fluid were the most two important factors related to higher patency.

Microsurgical transverse 2-suture intussusception vasoepididymostomy： effectiveness and rationality

Background 2-Suture longitudinal vasoepididymostomy shows superiority to transverse technique in an animal study; to date, this has not been consistently confirmed in human body. In the present study, we evaluated the effectiveness of 2-suture transverse intussusception vasoepididymostomy and compared the rationality between transverse and longitudinal techniques. Methods From May 2007 to December 2008, we performed 2-suture transverse vasoepididymostomy in 19 consecutive patients, as described by Marmar with modification. Between March 2009 and January 2010, the internal diameter of the vas lumen and the outer diameter of the epididymal tube were measured using microruler （21 patients and 37 sides）. Results Three patients lost to follow-up. At the first follow-up period （ranged from 10 to 24 months）, the patency rate was 56.3% （9/16） and the natural pregnancy rate was 25% （4/16）. At the second follow-up period （ranged from 46 to 63 months）, the patency rate was 68.8% （11/16）, the natural pregnancy rate was 37.5% （6/16）, respectively, and the take- home baby rate was 31.3% （5/16）. The diameter of the vas lumen and the outer diameter of the epididymal tubule were （0.512±0.046） mm and （0.572±0.051） mm （P 〈0.001）, respectively. Conclusion Transverse 2-suture intussusception vasoepididymostomy is still an effective technique in treating obstructive azoospermia.