The Role of Microsurgical Reconstruction in the Era of ICSI

  • Karen Baker
  • Edmund SabaneghJr


Even in the era of advanced assisted reproductive techniques, microsurgical reconstruction is an important and relevant treatment for obstructive azoospermia. Microsurgical reconstruction provides couples the opportunity to create a spontaneous pregnancy and thereby avoiding the expense, limitations, and risks of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). The apparent ease of advanced assisted reproductive techniques should not overshadow the fact that the expense and risks of IVF/ICSI may be unjustifiable. Sperm retrieval relegates couples to IVF/ICSI and subjects fertile female partners and the offspring to potentially avoidable risk. Approximately 30% cycles in 2009 resulted in twin or higher gestation and these pregnancies are associated with higher rates of prematurity, low birth weight, and severe neonatal medical conditions [1]. Ovarian hyperstimulation syndrome is a potentially life-threatening complication of in vitro fertilization and moderate and severe ovarian hyperstimulation syndrome are estimated to occur in 3–6% and 0.1–2% of IVF cycles, respectively [2]. Every surgeon will encounter couples for whom the best option for pregnancy is sperm retrieval paired IVF/ICSI. For couples with amenable conditions, however the safety of a natural conception remains a compelling justification for microsurgical reconstruction.


Vasovasostomy Microsurgery Male infertility Sterilization reversal Cost effectiveness Vasoepididymostomy Obstructive interval Sperm granuloma Intravasal azoospermia Female age Male age Previous pregnancy Length of proximal vas remnant 


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Center for Male FertilityGlickman Urological and Kidney Institute, Cleveland ClinicClevelandUSA

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