{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:02:45Z","timestamp":1791378165602,"version":"4.3.2"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100017686","name":"Fujian Provincial Health Technology Project","doi-asserted-by":"publisher","award":["2024CXA022"],"award-info":[{"award-number":["2024CXA022"]}],"id":[{"id":"10.13039\/501100017686","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Andrology"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n In couples with epididymal obstructive azoospermia (EOA), choosing between microsurgical vasoepididymostomy (MVE)\u2010first and primary intracytoplasmic sperm injection (ICSI) remains a practical treatment\u2010selection challenge. Conventional endpoints such as patency and pregnancy rates provide an incomplete assessment of the real\u2010world consequences of an MVE\u2010first strategy, including transition to assisted reproduction, subsequent ICSI outcomes, and time to live birth. It remains uncertain whether MVE\u2010first preserves natural\u2010conception potential without compromising subsequent ICSI live\u2010birth outcomes. How this time trade\u2010off should inform couple\u2010level treatment selection is also unclear.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study included 397 couples (270 MVE\u2011first, 127 primary ICSI). Treatment trajectories after MVE, including postoperative patency, natural conception, transition to assisted reproductive technology, and subsequent ICSI, were evaluated. The primary comparative outcome among ICSI\u2010treated couples was cumulative live birth rate (CLBR) after all embryo\u2010transfer cycles derived from the first oocyte retrieval. Post\u2010MVE ICSI included ICSI using ejaculated sperm after MVE patency and ICSI using surgically retrieved sperm after persistent azoospermia.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 241 men who remained evaluable after MVE, postoperative patency was achieved in 177 (73.4%). After additional follow\u2010up losses, 236 couples comprised the final post\u2010MVE follow\u2010up cohort; 84 couples achieved natural conception (35.6%), resulting in 80 live births. A female age \u2264\u00a028 years and an AMH concentration >2.91\u00a0ng\/mL were associated with a higher probability of natural conception. Among couples who subsequently underwent ICSI, CLBR was 45.9% after MVE versus 43.8% after primary ICSI (difference, +2.1 percentage points; one\u2010sided 95% CI lower bound, \u22128.3%), which met the non\u2010inferiority criterion. Major pregnancy, birth, and neonatal safety outcomes were comparable among the ICSI groups. Among ICSI\u2010treated couples, post\u2010MVE ICSI was associated with a lower live\u2010birth hazard than primary ICSI (adjusted hazard ratio [aHR] 0.22, 95% CI 0.15\u20130.35;\n p\u00a0<\u00a0<\/jats:italic>\n 0.001), whereas higher baseline AMH was associated with a higher live\u2010birth hazard (aHR 1.13, 95% CI 1.03\u20131.25;\n p\u00a0=\u00a0<\/jats:italic>\n 0.010).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n An MVE\u2010first strategy enabled natural conception in over one\u2010third of the post\u2010MVE follow\u2010up cohort. Among couples who ultimately required ICSI, cumulative live\u2010birth outcomes were not compromised by the MVE\u2010first pathway, although time to live birth was longer than with primary ICSI. In this cohort, MVE\u2010first may be favored for couples with a female partner aged \u2264\u00a028 years and an AMH level >\u00a02.91\u00a0ng\/mL. Primary ICSI may be more appropriate when minimizing time to live birth is the main priority.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/andr.70412","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:27:29Z","timestamp":1791376049000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vasoepididymostomy\u2010First Versus Primary ICSI for Epididymal Obstructive Azoospermia: Real\u2010World Reproductive Outcomes for Treatment Selection"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9502-2063","authenticated-orcid":false,"given":"Hong","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilang","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghuai","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianfeng","family":"Chen","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4016-0856","authenticated-orcid":false,"given":"Qiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maoyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoda","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li'e","family":"Zheng","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9631-1430","authenticated-orcid":false,"given":"Yilu","family":"Zou","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-9395","authenticated-orcid":false,"given":"Qicai","family":"Liu","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7154-3657","authenticated-orcid":false,"given":"Huiliang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2443-0836","authenticated-orcid":false,"given":"Songxi","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Andrology and Sexual Medicine The First Affiliated Hospital of Fujian Medical University Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"10271","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(20)32667-2","article-title":"Male Infertility","volume":"397","author":"Agarwal A.","year":"2021","journal-title":"Lancet"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.eururo.2005.06.002","article-title":"EAU Guidelines on Male Infertility","volume":"5","author":"Dohle G. 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A Comparative Analysis","volume":"94","author":"Kamal A.","year":"2010","journal-title":"Fertility and Sterility"},{"key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.juro.2018.07.092","article-title":"Kinetics of Sperm Return and Late Failure Following Vasovasostomy or Vasoepididymostomy: A Systematic Review","volume":"201","author":"Farber N. 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