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The Infertile Male-4: Management of Obstructive Azoospermia

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Scrotal Pathology

Abstract

Azoospermia is the total absence of spermatozoa in the ejaculate. It is found in 10–15% of male infertility cases and is caused by a testicular insufficiency in the majority of patients. Obstructive azoospermia is less frequent and arises in 15–20% of men with azoospermia. Most causes of male infertility are treatable, and many treatments restore the ability to father a children naturally. In case of vasal or epididymal obstruction, microsurgical reconstruction of the seminal pathways, if possible, remains the safest and most cost-effective treatment option for these patients, allowing natural conception in many cases. Not all men with obstructive azoospermia are treatable by microsurgical reconstruction. In such situations, various sperm-retrieval techniques can be employed to take sperm for use with in vitro fertilization (IVF) via intracytoplasmic sperm injection (ICSI).

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References

  • Belgrano E, Puppo P, Trombetta C et al (1984) Monolateral tubulovasostomy. Report of four cases. J Androl 5:330–333

    PubMed  CAS  Google Scholar 

  • Belker AM (1980) Microsurgical two-layer vasovasostomy. Simplified technique using hinged, folding-approximating clamp. Urology 16:376–381

    Article  PubMed  CAS  Google Scholar 

  • Belker AM, Thomas AJ Jr, Fuchs EF et al (1991) Results of 1, 469 microsurgical vasectomy reversals by the vasovasostomy Study Group. J Urol 145:505–511

    PubMed  CAS  Google Scholar 

  • Berger RE (1998) Triangulation end-to-side vasoepididymostomy. J Urol 159:1951–1953

    Article  PubMed  CAS  Google Scholar 

  • Chan PT, Li PS, Goldstein M (2003) Microsurgical vasoepididymostomy: a prospective randomized study of 3 intussusception techniques in rats. J Urol 169:1924–1929

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Craft IL, Khalifa Y, Boulos A et al (1995) Factors influencing the outcome of in vitro fertilization with percutaneous aspirated epididymal spermatozoa and intracytoplasmic sperm injection in azoospermic men. Hum Reprod 10:1791–1794

    PubMed  CAS  Google Scholar 

  • Donovan JF Jr, DiBaise M, Sparks AE et al (1998) 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 13:387–393

    Article  PubMed  Google Scholar 

  • Goldstein M, Li PS, Matthews GJ (1998) Microsurgical vasovasostomy: the microdot technique of precision suture placement. J Urol 159:188–190

    Article  PubMed  CAS  Google Scholar 

  • Lipshultz L HAJ , Khera M (2007) Surgical management of male infertility. In: Wein AJ, Kavoussi LR, Novick AC et al (eds) Campbell-Walsh Urology, 9th edn. Saunders Elsevier, Philadelphia

    Google Scholar 

  • Jarow JP, Oates RD, Buch JP et al (1997) Effect of level of anastomosis and quality of intraepididymal sperm on the outcome of end-to-side epididymovasostomy. Urology 49:590–595

    Article  PubMed  CAS  Google Scholar 

  • Kolettis PN (2008) Restructuring reconstructive techniques—advances in reconstructive techniques. Urol Clin North Am 35:229–234, viii-ix

    Google Scholar 

  • Kolettis PN, Thomas AJ Jr (1997) Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol 158:467–470

    Article  PubMed  CAS  Google Scholar 

  • Marmar JL (2000) Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol 163:483–486

    Article  PubMed  CAS  Google Scholar 

  • Nagler HM, Jung H (2009) Factors predicting successful microsurgical vasectomy reversal. Urol Clin North Am 36:383–390

    Article  PubMed  Google Scholar 

  • Niederberger C, Ross LS (1993) Microsurgical epididymovasostomy: predictors of success. J Urol 149:1364–1367

    PubMed  CAS  Google Scholar 

  • Nudell DM, Conaghan J, Pedersen RA et al (1998) The mini-micro-epididymal sperm aspiration for sperm retrieval: a study of urological outcomes. Hum Reprod 13:1260–1265

    Article  PubMed  CAS  Google Scholar 

  • Palermo GD, Schlegel PN, Hariprashad JJ et al (1999) Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod 14:741–748

    Article  PubMed  CAS  Google Scholar 

  • Pavlovich CP, Schlegel PN (1997) Fertility options after vasectomy: a cost-effectiveness analysis. Fertil Steril 67:133–141

    Article  PubMed  CAS  Google Scholar 

  • Practice Committee of the American Society for Reproductive Medicine (2008a) The management of infertility due to obstructive azoospermia. Fertil Steril 90:S121–S124

    Google Scholar 

  • Practice Committee of the American Society for Reproductive Medicine (2008b) Sperm retrieval for obstructive azoospermia. Fertil Steril 90:S213–S218

    Google Scholar 

  • Royle MG, Parslow JM, Kingscott MM et al (1981) Reversal of vasectomy: the effects of sperm antibodies on subsequent fertility. Br J Urol 53:654–659

    Article  PubMed  CAS  Google Scholar 

  • Schlegel PN, Girardi SK (1997) Clinical review 87: In vitro fertilization for male factor infertility. J Clin Endocrinol Metab 82:709–716

    Article  PubMed  CAS  Google Scholar 

  • Schmidt SS (1978) Vasovasostomy. Urol Clin North Am 5:585–592

    PubMed  CAS  Google Scholar 

  • Sheynkin YR, Hendin BN, Schlegel PN et al (1998) Microsurgical repair of iatrogenic injury to the vas deferens. J Urol 159:139–141

    Article  PubMed  CAS  Google Scholar 

  • Silber SJ, Nagy ZP, Liu J et al (1994) Conventional in vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod 9:1705–1709

    PubMed  CAS  Google Scholar 

  • Silber SJ, Nagy Z, Devroey P et al (1997) The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection. Hum Reprod 12:2693–2700

    Article  PubMed  CAS  Google Scholar 

  • Tournaye H (1997) Use of testicular sperm for the treatment of male infertility. Baillieres Clin Obstet Gynaecol 11:753–762

    Article  PubMed  CAS  Google Scholar 

  • Tournaye H, Devroey P, Liu J et al (1994) Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effective approach to infertility as a result of congenital bilateral absence of the vas deferens. Fertil Steril 61:1045–1051

    PubMed  CAS  Google Scholar 

  • Trombetta C, Liguori G, Gianaroli L et al (2000) Testicular sperm extraction combined with cryopreservation of testicular tissue in the treatment of azoospermia. Urol Int 65:15–20

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Carlo Trombetta .

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Liguori, G. et al. (2011). The Infertile Male-4: Management of Obstructive Azoospermia. In: Bertolotto, M., Trombetta, C. (eds) Scrotal Pathology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_189

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  • DOI: https://doi.org/10.1007/174_2011_189

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-12455-6

  • Online ISBN: 978-3-642-12456-3

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