Vasoepididymostomy to the head of the epididymis: recovery of normal spermatozoal motility.

We previously reported a microsurgical technique for bypassing epididymal obstruction by performing a specific microanastomosis to the epididymal tubule. When obstruction was near the head of the epididymis, spermatozoal motility was always poor (0 to 1%) even though the numerical count was high. There are now over 1 1/2 years of follow-up on the first five patients who had a vasoepididymostomy performed in the proximal region (head) of the epididymis. None of these patients had more than 0 to 1% spermatozoal motility postoperatively despite counts of more than 50 million sperm/ml. However, within 1 1/2 to 2 years the spermatozoa of these patients eventually developed normal motility. This study verifies that in humans spermatozoa derived from the head of the epididymis are at first not capable of motility. However, after 1 or 2 years, these spermatozoa eventually recover normal motility. This unexpected finding sheds new light on epididymal physiology and offers some hope for men with proximal epididymal obstruction.