Microsurgical autogenous sperm reservoir with simultaneous epididymal sperm aspiration: a novel approach for the man with surgically unreconstructable obstruction.

The purpose of this article is to present a technique for microsurgical marsupialization of an epididymal tubule to the tunica vaginalis to create an autogenous sperm reservoir (ASR) with simultaneous epididymal aspiration. This procedure is offered to men with bilateral congenital absence of the vas deferens (CAV) or otherwise surgically unreconstructable reproductive tracts. Sperm (mean +/- standard error of the mean, 33 +/- 13 x 10(6)) have been percutaneously recovered by fine needle aspiration of an ASR in 47% (7/15) of men. Motile sperm have been recovered as long as 2 years following surgery. Simultaneous epididymal aspiration at the time of marsupialization has yielded a mean of 20.2 +/- 6.9 x 10(6) total sperm per aspirate. Thawed sperm, recovered and cryopreserved at the time of ASR surgery, has been successfully employed for two couples in pregnancies achieved with in vitro fertilization. The microsurgical ASR is a viable alternative in the treatment of men with CAV or otherwise unreconstructable reproductive tracts. Simultaneous epididymal sperm aspiration maximizes a couples fertility options with a single surgical procedure.