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The Role of Microsurgical Reconstruction in the Era of ICSI

  • Karen Baker
  • Edmund SabaneghJr
Chapter

Abstract

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.

Keywords

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 

References

  1. 1.
    Anon. Clinic Summary Report. Available at: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0. Accessed 15 Sept 2011.
  2. 2.
    Delvigne A. Symposium: update on prediction and management of OHSS. Epidemiology of OHSS. Reprod Biomed Online. 2009;19(1):8–13.PubMedCrossRefGoogle Scholar
  3. 3.
    Heidenreich A, Altmann P, Engelmann UH. Microsurgical vasovasostomy versus microsurgical epididymal sperm aspiration/testicular extraction of sperm combined with intracytoplasmic sperm injection. A cost-benefit analysis. Eur Urol. 2000;37(5):609–14.PubMedCrossRefGoogle Scholar
  4. 4.
    Kolettis PN, Thomas Jr AJ. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol. 1997;158(2):467–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Lee R, Li PS, Goldstein M, et al. A decision analysis of treatments for obstructive azoospermia. Hum Reprod. 2008;23(9):2043–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Donovan Jr JF, DiBaise M, Sparks AE, Kessler J, Sandlow JI. 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Deck AJ, Berger RE. Should vasectomy reversal be performed in men with older female partners? J Urol. 2000;163(1):105–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Pavlovich CP, Schlegel PN. Fertility options after vasectomy: a cost-effectiveness analysis. Fertil Steril. 1997;67(1):133–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol. 2005;174(5):1926–31. discussion 1931.PubMedCrossRefGoogle Scholar
  10. 10.
    Belker AM, Thomas AJ, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145(3):505–11.PubMedGoogle Scholar
  11. 11.
    Boorjian S, Lipkin M, Goldstein M. The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal. J Urol. 2004;171(1):304–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Magheli A, Rais-Bahrami S, Kempkensteffen C, et al. Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal. Int J Androl. 2010;33(5):730–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Kolettis PN, Sabanegh ES, D’amico AM, et al. Outcomes for vasectomy reversal performed after obstructive intervals of at least 10 years. Urology. 2002;60(5):885–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Gerrard ER, Sandlow JI, Oster RA, et al. Effect of female partner age on pregnancy rates after vasectomy reversal. Fertil Steril. 2007;87(6):1340–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Kolettis PN, Sabanegh ES, Nalesnik JG, et al. Pregnancy outcomes after vasectomy reversal for female partners 35 years old or older. J Urol. 2003;169(6):2250–2.PubMedCrossRefGoogle Scholar
  16. 16.
    Paick J-S, Park JY, Park DW, et al. Microsurgical vasovasostomy after failed vasovasostomy. J Urol. 2003;169(3):1052–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Parekattil SJ, Kuang W, Agarwal A, Thomas AJ. Model to predict if a vasoepididymostomy will be required for vasectomy reversal. J Urol. 2005;173(5):1681–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Chan PTK, Goldstein M. Superior outcomes of microsurgical vasectomy reversal in men with the same female partners. Fertil Steril. 2004;81(5):1371–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Bolduc S, Fischer MA, Deceuninck G, Thabet M. Factors predicting overall success: a review of 747 microsurgical vasovasostomies. Can Urol Assoc J. 2007;1(4):388–94.PubMedGoogle Scholar
  20. 20.
    Kolettis PN, Woo L, Sandlow JI. Outcomes of vasectomy reversal performed for men with the same female partners. Urology. 2003;61(6):1221–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Hernandez J, Sabanegh ES. Repeat vasectomy reversal after initial failure: overall results and predictors for success. J Urol. 1999;161(4):1153–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Kim SW, Ku JH, Park K, Son H, Paick J-S. A different female partner does not affect the success of second vasectomy reversal. J Androl. 2005;26(1):48–52.PubMedGoogle Scholar
  23. 23.
    Hinz S, Rais-Bahrami S, Weiske WH, et al. Prognostic value of intraoperative parameters observed during vasectomy reversal for predicting postoperative vas patency and fertility. World J Urol. 2009;27(6):781–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19255761. Accessed 6 Mar 2011.PubMedCrossRefGoogle Scholar
  24. 24.
    Witt MA, Heron S, Lipshultz LI. The post-vasectomy length of the testicular vasal remnant: a predictor of surgical outcome in microscopic vasectomy reversal. J Urol. 1994;151(4):892–4.PubMedGoogle Scholar
  25. 25.
    Hollingsworth MR, Sandlow JI, Schrepferman CG, Brannigan RE, Kolettis PN. Repeat vasectomy reversal yields high success rates. Fertil Steril. 2007;88(1):217–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Pasqualotto FF, Agarwal A, Srivastava M, Nelson DR, Thomas AJ. Fertility outcome after repeat vasoepididymostomy. J Urol. 1999;162(5):1626–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Fox M. Failed vasectomy reversal: is a further attempt using microsurgery worthwhile? BJU Int. 2000;86(4):474–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998;159(6):1951–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Marmar JL. Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol. 2000;163(2):483–6.PubMedCrossRefGoogle Scholar
  30. 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(2):651–5. quiz 801.PubMedCrossRefGoogle Scholar
  31. 31.
    Chan PTK, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU Int. 2005;96(4):598–601.PubMedCrossRefGoogle Scholar
  32. 32.
    Ho KL, Wong MH, Tam PC. Microsurgical vasoepididymostomy for obstructive azoospermia. Hong Kong Med J. 2009;15(6):452–7.PubMedGoogle Scholar
  33. 33.
    Kumar R, Mukherjee S, Gupta NP. Intussusception vasoepididymostomy with longitudinal suture placement for idiopathic obstructive azoospermia. J Urol. 2010;183(4):1489–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Silber SJ. Microscopic technique for reversal of vasectomy. Surg Gynecol Obstet. 1976;143(4):631.PubMedGoogle Scholar
  35. 35.
    Owen ER. Microsurgical vasovasostomy: a reliable vasectomy reversal. Aust N Z J Surg. 1977;47(3):305–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Gopi SS, Townell NH. Vasectomy reversal: is the microscope really essential? Scott Med J. 2007;52(2):18–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Hsieh M-L, Huang HC, Chen Y, Huang ST, Chang PL. Loupe-assisted vs microsurgical technique for modified one-layer vasovasostomy: is the microsurgery really better? BJU Int. 2005;96(6):864–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Urquhart-Hay D. A low-power magnification technique for the re-anastomosis of the ­vas–further results in a personal series of 125 patients. Aust N Z J Surg. 1984;54(1):73–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Jee SH, Hong YK. One-layer vasovasostomy: microsurgical versus loupe-assisted. Fertil Steril. 2010;94(6):2308–11.PubMedCrossRefGoogle Scholar
  40. 40.
    Dewire DM, Lawson RK. Experience with macroscopic vasectomy reversal at the Medical College of Wisconsin. Wis Med J. 1994;93(3):107–9.PubMedGoogle Scholar
  41. 41.
    Lee L, McLoughlin MG. Vasovasostomy: a comparison of macroscopic and microscopic techniques at one institution. Fertil Steril. 1980;33(1):54–5.PubMedGoogle Scholar
  42. 42.
    Kuang W, Shin PR, Oder M, Thomas Jr AJ. Robotic-assisted vasovasostomy: a two-layer technique in an animal model. Urology. 2005;65(4):811–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Schiff J, Li PS, Goldstein M. Robotic microsurgical vasovasostomy and vasoepididymostomy in rats. Int J Med Robot. 2005;1(2):122–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Kuang W, Shin PR, Matin S, Thomas Jr AJ. Initial evaluation of robotic technology for microsurgical vasovasostomy. J Urol. 2004;171(1):300–3.PubMedCrossRefGoogle Scholar
  45. 45.
    Fleming C. Robot-assisted vasovasostomy. Urol Clin North Am. 2004;31(4):769–72.PubMedCrossRefGoogle Scholar
  46. 46.
    Parekattil SJ, Cohen MS. Robotic microsurgery 2011: male infertility, chronic testicular pain, postvasectomy pain, sports hernia pain and phantom pain. Curr Opin Urol. 2011;21(2): 121–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Matsuda T, Muguruma K, Hiura Y, et al. Seminal tract obstruction caused by childhood inguinal herniorrhaphy: results of microsurgical reanastomosis. J Urol. 1998;159(3):837–40.PubMedCrossRefGoogle Scholar
  48. 48.
    Pasqualotto FF, Pasqualotto EB, Agarwal A, Thomas Jr AJ. Results of microsurgical anastomosis in men with seminal tract obstruction due to inguinal herniorrhaphy. Rev Hosp Clin Fac Med Sao Paulo. 2003;58(6):305–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Shaeer OKZ, Shaeer KZ. Pelviscrotal vasovasostomy: refining and troubleshooting. J Urol. 2005;174(5):1935–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Sabanegh Jr E, Thomas Jr AJ. Effectiveness of crossover transseptal vasoepididymostomy in treating complex obstructive azoospermia. Fertil Steril. 1995;63(2):392–5.PubMedGoogle Scholar

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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