Mr. Tung, 33, sought treatment at Tam Anh General Hospital - District 8, after two years of infertility. Dr. Duong Quang Huy, Head of the Andrology Unit at the Center for Reproductive Support, diagnosed him with primary infertility stemming from a vas deferens obstruction, a condition often caused by inflammation. Four years prior, Mr. Tung had experienced orchitis. Infections in the reproductive organs can trigger an inflammatory response, leading to mucosal edema, tissue damage, and fibrotic scarring that narrows or completely blocks the vas deferens, preventing sperm from exiting.

Despite producing sperm, Mr. Tung's obstructed vas deferens prevented sperm from traveling out and reaching an egg for conception. He also suffered from bilateral varicocele, which increased testicular temperature, further compromising sperm quality and count. To address these issues, Dr. Huy recommended microsurgical vasovasostomy on both sides, combined with varicocele ligation.

Dr. Huy (center) performing surgery on Mr. Tung. *Photo: Tam Anh General Hospital*

The vasovasostomy procedure, particularly when inflammation has caused fibrotic scarring and blockages in multiple sections of the vas deferens, is complex. Using a microsurgical microscope, Dr. Huy meticulously traced each segment of the vas deferens to pinpoint the exact obstruction. He then re-established the pathway for sperm flow and ligated the dilated varicoceles to improve the sperm-producing environment.

The 60-minute surgery was successful, and Mr. Tung was discharged one day later. He was advised to limit movement, avoid strenuous activity, heavy lifting, or any actions that increase pressure in the scrotal-abdominal region, and to refrain from ejaculation for one to two weeks. A follow-up semen analysis to assess sperm count and monitor the recovery of natural reproductive function is scheduled for two to four weeks post-surgery.

Inflammatory blockages of the vas deferens are a common cause of azoospermia in men. The inflammation is often triggered by sexually transmitted infections (STIs) such as gonorrhea or chlamydia, or other conditions like epididymitis, orchitis, or prostatitis.

According to Dr. Huy, this condition typically does not affect sexual function or ejaculation and often presents with no clear symptoms. Consequently, many men are only diagnosed when they face difficulties conceiving or when a semen analysis reveals the absence of sperm.

To prevent prolonged inflammation that can lead to scarring and vas deferens obstruction, men should seek early medical attention if they experience any unusual signs. These include testicular pain or tenderness, scrotal swelling or redness accompanied by fever or fatigue, pain during ejaculation or intercourse, a history of sexually transmitted infections, or scrotal injury.

Dinh Lam

*Patient's name has been changed.