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Microsurgery for Male Infertility

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Male Infertility

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Abstract

About one in six men with infertility has azoospermia, defined as the complete absence of sperm in the ejaculate. Obstructive azoospermia is an important diagnostic category since a number of these cases can be treated surgically. Microsurgery is currently offered for bypassing an obstruction in the epididymis or the vas deferens and for correction of a varicocele. The evaluation and investigations are tailored to diagnose suitability for microsurgery and maximize successful outcomes. Vaso-epididymal anastomosis, vasovasostomy, and microsurgical varicocele ligation are the most common microsurgical procedures performed for male infertility. There are variable success rates depending on the etiology, patient selection, and surgical technique. Simplified procedures can help increase acceptability and practice of these procedures.

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References

  1. Aanesen A, Westerbotn M. Prospective study of Swedish infertile cohort 2005–08: population characteristics, treatments and pregnancy rates. Fam Prac. 2014;31:290–7.

    Article  Google Scholar 

  2. Siddiq FM, Sigman M. A new look at the medical management of infertility. Urol Clin North Am. 2002;29:949–63.

    Article  PubMed  Google Scholar 

  3. Brandes M, Hamilton CJ, Vandeer Steen JO, et al. Unexplained infertility: overall ongoing pregnancy rate and mode of conception. Hum Reprod. 2011;26:360–8.

    Article  CAS  PubMed  Google Scholar 

  4. Martin E, Carnett JB, Levi JV, Pennington ME. The surgical treatment of sterility due to obstruction at the epididymis; together with a study of the morphology of human spermatozoa. Univ Pa Med Bull. 1902;15:2–15.

    CAS  PubMed  Google Scholar 

  5. Hagner F. The operative treatment of sterility in the male. JAMA. 1936;107:1851.

    Article  Google Scholar 

  6. Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978;30:565–71.

    Article  CAS  PubMed  Google Scholar 

  7. Fogdestam I, Fall M. Microsurgical end-to-end and end-to-side epididymovasostomy to correct occlusive azoospermia. Scand J Plast Reconstr Surg. 1983;17:137–40.

    Article  CAS  PubMed  Google Scholar 

  8. Thomas AJ Jr. Vasoepididymostomy. Urol Clin North Am. 1987;14:527–38.

    PubMed  Google Scholar 

  9. Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998;159:1951–3.

    Article  CAS  PubMed  Google Scholar 

  10. Marmar JL. Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol. 2000;163:483–6.

    Article  CAS  PubMed  Google Scholar 

  11. Chan PT, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU Int. 2005;96:598–601.

    Article  PubMed  Google Scholar 

  12. Kumar R. Chapter 1: Evaluation of an infertile male. In Male infertility in everyday practice. 1st edn. New Delhi, India: Kontentworx Publication; 2018. p. 1–13. ISBN- 978-93-83988-11-2.

    Google Scholar 

  13. Donovan JF Jr, DiBaise M, Sparks AE, et al. Comparison of microscopic epididymal sperm aspiration and intracytoplasmic sperm injection/in-vitro fertilization with repeat microscopic reconstruction following vasectomy: is second attempt vas reversal worth the effort? Hum Reprod. 1998;13(2):387–93.

    Article  PubMed  Google Scholar 

  14. Hansen M, Bowen C, Milner E, et al. Assisted reproductive technologies and the risk of birth defects—a systematic review. Hum Reprod. 2005;20:328.

    Article  PubMed  Google Scholar 

  15. Hull MG, Fleming CF, Hughes AO, et al. The age-related decline in female fecundity: a quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization. Fertil Steril. 1996;65:783.

    Article  CAS  PubMed  Google Scholar 

  16. Belker AM, Thomas AJ Jr, Fuchs EF, et al. Results of 1,469 microsurgical vasectomy reversals by the vasovasostomy study group. J Urol. 1991;145:505.

    Article  CAS  PubMed  Google Scholar 

  17. Kumar R. Surgery for azoospermia in the Indian patient: why is it different? Indian J Urol. 2011;27:98–101.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nagy Z, Liu J, Cecile J, et al. Using ejaculated, fresh and frozen-thawed epididymal spermatozoa gives rise to comparable results after ICSI. Fertil Steril. 1995;63:808.

    Article  CAS  PubMed  Google Scholar 

  19. Gil-Salom M, Minguez Y, Rubio C, et al. Efficacy of intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod. 1995;10:3166.

    Article  CAS  PubMed  Google Scholar 

  20. Tournaye H, Merdad T, Silber S, et al. No difference in outcome after intracytoplasmic sperm injection with fresh or with frozen-thawed epididymal spermatozoa. Hum Reprod. 1999;14:90.

    Article  CAS  PubMed  Google Scholar 

  21. Palermo GD, Schlegel PN, Hariprashad JJ, et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod. 1999;14:741.

    Article  CAS  PubMed  Google Scholar 

  22. Kupker W, Schlegel PN, Al-Hasani S, et al. Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection. Fertil Steril. 2000;73:453.

    Article  CAS  PubMed  Google Scholar 

  23. Habermann H, Seo R, Cieslak J, et al. In vitro fertilization outcomes after intracytoplasmic sperm injection with fresh or frozen-thawed testicular spermatozoa. Fertil Steril. 2000;73:955.

    Article  CAS  PubMed  Google Scholar 

  24. Mercan R, Urman B, Alatas C, et al. Outcome of testicular sperm retrieval procedures in non-obstructive azoospermia: percutaneous aspiration versus open biopsy. Hum Reprod. 2000;15:1548.

    Article  CAS  PubMed  Google Scholar 

  25. Kumar R. Re: microsurgical vasoepididymostomy: a prospective randomized study of 3 intussusception techniques in rats. J Urol. 2004;171:810–1.

    Article  PubMed  Google Scholar 

  26. Kumar R. Microsurgery for male infertility: the AIIMS experience. In: Parekattil SJ, Agarwal A, editors. Male infertility. New York: Springer; 2012. p. 79–88.

    Chapter  Google Scholar 

  27. Kumar R, Gautam G, Gupta NP. Early patency rates following the two-stitch invagination technique of vasoepididymal anastomosis for idiopathic obstruction. BJU Int. 2006;97:575–7.

    Article  PubMed  Google Scholar 

  28. Kumar R, Mukherjee S, Gupta NP. Intussusception vasoepididymostomy with longitudinal suture placement for idiopathic obstructive azoospermia. J Urol. 2010;183:1489–92.

    Article  PubMed  Google Scholar 

  29. Yoon YE, Lee HH, Park SY, Moon HS, Kim DS, Song SH, Kim DK. The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization: a systematic review and meta- analysis. Asian J Androl. 2018;21:67. https://doi.org/10.4103/aja.aja_59_18.

    Article  PubMed Central  Google Scholar 

  30. Schiff J, Chan P, Li PS, Finkelberg S, Goldstein M. Outcome and late failures compared in 4 techniques of microsurgical vasoepididymostomy in 153 consecutive men. J Urol. 2005;174:651–5.

    Article  PubMed  Google Scholar 

  31. Peng J, Yuan Y, Zhang Z, Cui W, Song W, et al. Microsurgical vasoepididymostomy is an effective treatment for azoospermic patients with epididymal obstruction and prior failure to achieve pregnancy by sperm retrieval with intracytoplasmic sperm injection. Hum Reprod. 2014;29:1–7.

    Article  CAS  PubMed  Google Scholar 

  32. Gautam G, Kumar R, Gupta NP. Factors predicting the patency of two-stitch invagination vasoepididymal anastomosis for idiopathic obstruction. Indian J Urol. 2005;21:112–5.

    Article  Google Scholar 

  33. Dhillon BS, Chandhiok N, Kambo I, Saxena NC. Induced abortion and concurrent adoption of contraception in the rural areas of India (an ICMR task force study). Indian J Med Sci. 2004;58:478–84.

    CAS  PubMed  Google Scholar 

  34. Jina RP, Kumar V. Recanalisation of vas. J Indian Med Assoc. 1979;72:30–2.

    CAS  PubMed  Google Scholar 

  35. Kumar R, Mukherjee S. “4 × 4 vasovasostomy”: a simplified technique for vasectomy reversal. Indian J Urol. 2010;26(3):350–2.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bolduc S, Fischer MA, Deceuninck G, Thabet M. Factors predicting overall success: a review of 747 microsurgical vasovasostomies. Can Urol Assoc J. 2007;1:388–94.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Patel SR, Sigman M. Comparison of outcomes of vasovasostomy performed in the convoluted and straight vas deferens. J Urol. 2008;179:256–9.

    Article  PubMed  Google Scholar 

  38. Schwarzer JU. Vasectomy reversal using a microsurgical three-layer technique: one surgeon's experience over 18 years with 1300 patients. Int J Androl. 2012;35:706–13.

    Article  CAS  PubMed  Google Scholar 

  39. Li B, Chen G, Wang X. Treatment of failed vasectomy reversal using a microsurgical two-layer anastomosis technique. Transl Androl Urol. 2013;2:94–8.

    PubMed  PubMed Central  Google Scholar 

  40. Mui P, Perkins A, Burrows PJ, Marks SF, Turek PJ. The need for epididymovasostomy at vasectomy reversal plateaus in older vasectomies: a study of 1229 cases. Andrology. 2014;2:25–9.

    Article  CAS  PubMed  Google Scholar 

  41. Chen XF, Wang HX, Liu YD, et al. Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood. Asian J Androl. 2014;16:745–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Nyame YA, Babbar P, Almassi N, Polackwich AS, Sabanegh E. Comparative cost-effectiveness analysis of modified 1-layer versus formal 2-layer vasovasostomy technique. J Urol. 2016;195:434–8.

    Article  PubMed  Google Scholar 

  43. Wang J, Liu Q, Zhang Y, et al. Treatment for vas deferens obstruction following childhood herniorrhaphy. Urology. 2018;112:80–4.

    Article  PubMed  Google Scholar 

  44. Namekawa T, Imamoto T, Kato M, Komiya A, Ichikawa T. Vasovasostomy and vasoepididymostomy: review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade. Reprod Med Biol. 2018;17(4):343–55. https://doi.org/10.1002/rmb2.

  45. Sharlip ID, Jarow JP, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, Schlegel PN, Howards SS, Nehra A, Damewood MD, Overstreet JW, Sadovsky R. Best practice policies for male infertility. Fertil Steril. 2002;77:873–82.

    Article  PubMed  Google Scholar 

  46. Kumar R, Gupta NP. Subinguinal microsurgical varicocelectomy: evaluation of results. Urol Int. 2003;71:361–7.

    Article  Google Scholar 

  47. Kumar R, Gupta NP. Varicocele and the urologist. Indian J Urol. 2006;22:98–104.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Urology, All India Institute of Medical Sciences, New Delhi, India

    Rajeev Kumar & Manoj Kumar

Authors
  1. Rajeev Kumar
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  2. Manoj Kumar
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Correspondence to Rajeev Kumar .

Editor information

Editors and Affiliations

  1. PUR Clinic, University of Central Florida (UCF), Clermont, FL, USA

    Sijo J. Parekattil

  2. ANDROFERT and State University of Campinas (UNICAMP), Campinas, Brazil

    Sandro C. Esteves

  3. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Ashok Agarwal

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Kumar, R., Kumar, M. (2020). Microsurgery for Male Infertility. In: Parekattil, S., Esteves, S., Agarwal, A. (eds) Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-030-32300-4_13

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  • DOI: https://doi.org/10.1007/978-3-030-32300-4_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-32299-1

  • Online ISBN: 978-3-030-32300-4

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