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Abstract
Approximately 40 to 60% of men who undergo a successful vasovasostomy have “functional failure” or failure to conceive even though active sperm are present. Factors of this functional failure include sperm abnormalities (oligoasthenoteratospermia) and antisperm antibodies. Nine male patients 32 to 43 years of age who underwent vasovasostomy were included in the study group. These patients demonstrated ductal patency 3 to 6 months after surgery. After attempts at fertility with their spouses failed, the couples underwent urological and gynecological evaluation. Semen parameters were recorded and further evaluation was performed using immobilizing and agglutination antibodies as well as direct immunobead test and the hemizona assay (HZA). Semen parameters presented varying levels of sperm concentration, percent motility, and morphology (strict). Antisperm antibodies were present in 4 of the 9 patients. Three of 4 patients with antibodies and 4 of 5 patients without antibodies benefitted from hemizona assay results in that it either supported a desired therapy or gave objective data that would dictate more aggressive therapy. Six men had a hemizona index of >35%, predictive of adequate zona binding capability. Using these individual situations combined with gynecologic findings, recommendations are made as to identifying realistic options and therapeutic recommendations.