Nonobstructive azoospermia(NOA)is the most challenging and complex clinical scenario for infertile men.Besides circumstances such as hypogonadotropic hypogonadism,surgical sperm retrieval is typically necessary,and mi...Nonobstructive azoospermia(NOA)is the most challenging and complex clinical scenario for infertile men.Besides circumstances such as hypogonadotropic hypogonadism,surgical sperm retrieval is typically necessary,and microdissection testicular sperm extraction(micro-TESE)is the procedure of choice for men with NOA desiring to father children with their own gametes.Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection(ICSI)in comparison to all other techniques for surgical sperm retrieval in men with NOA.Several factors may affect sperm retrieval rate and ICSI outcomes,including the patient’s age,testicular volume,histopathological and genetic profile,and serum hormone levels.This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.展开更多
Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwen...Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.展开更多
This review highlights the evaluation and treatment of men who have undergone vasectomy and desire vasectomy reversal to father children. For surgeons offering this treatment, the appropriate evaluation and treatment ...This review highlights the evaluation and treatment of men who have undergone vasectomy and desire vasectomy reversal to father children. For surgeons offering this treatment, the appropriate evaluation and treatment are crucial for acceptable outcomes. Although variations on surgical approaches have evolved over the years, one constant is the need for a high level o training and skill in microsurgical techniques.展开更多
Nonobstructive azoospermia(NOA)is considered the most challenging clinical scenario for infertile men and current treatments leave many men unsuccessful at being able to achieve a pregnancy with their partner using th...Nonobstructive azoospermia(NOA)is considered the most challenging clinical scenario for infertile men and current treatments leave many men unsuccessful at being able to achieve a pregnancy with their partner using their own sperm.Microdissection testicular sperm extraction(micro-TESE)is the choice for men with NOA desiring to father children with their own gametes.Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection.With suboptimal micro-TESE success rates of sperm retrieval and then pregnancy and live birth using the retrieved sperm within vitro fertilization/intracytoplasmic sperm injection,advances to improve outcomes are necessary.This article comprehensively reviews the technologies investigated to date to improve the outcomes for men undergoing micro-TESE.展开更多
Approximately 15%of men in the general population have varicoceles,and varicoceles are diagnosed in 40%of men presenting for fertility evaluations.One percent of men in the general population are azoospermic,and 15%of...Approximately 15%of men in the general population have varicoceles,and varicoceles are diagnosed in 40%of men presenting for fertility evaluations.One percent of men in the general population are azoospermic,and 15%of men presenting for fertility evaluations are diagnosed with azoospermia.This article aims to review the impact of varicoceles on testicular function in men with azoospermia,the impact of varicocele repair on the semen parameters of azoospermic men,and the impact of varicocele repair on sperm retrieval and pregnancy outcomes when the male partner remains azoospermic after varicocele repair.展开更多
文摘Nonobstructive azoospermia(NOA)is the most challenging and complex clinical scenario for infertile men.Besides circumstances such as hypogonadotropic hypogonadism,surgical sperm retrieval is typically necessary,and microdissection testicular sperm extraction(micro-TESE)is the procedure of choice for men with NOA desiring to father children with their own gametes.Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection(ICSI)in comparison to all other techniques for surgical sperm retrieval in men with NOA.Several factors may affect sperm retrieval rate and ICSI outcomes,including the patient’s age,testicular volume,histopathological and genetic profile,and serum hormone levels.This article aims to review the medical literature describing predictors of successful micro-TESE and the outcomes of ICSI in men with NOA.
文摘Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.
文摘This review highlights the evaluation and treatment of men who have undergone vasectomy and desire vasectomy reversal to father children. For surgeons offering this treatment, the appropriate evaluation and treatment are crucial for acceptable outcomes. Although variations on surgical approaches have evolved over the years, one constant is the need for a high level o training and skill in microsurgical techniques.
文摘Nonobstructive azoospermia(NOA)is considered the most challenging clinical scenario for infertile men and current treatments leave many men unsuccessful at being able to achieve a pregnancy with their partner using their own sperm.Microdissection testicular sperm extraction(micro-TESE)is the choice for men with NOA desiring to father children with their own gametes.Micro-TESE results in the highest numbers of sperm cells retrieved for use with in vitro fertilization/intracytoplasmic sperm injection.With suboptimal micro-TESE success rates of sperm retrieval and then pregnancy and live birth using the retrieved sperm within vitro fertilization/intracytoplasmic sperm injection,advances to improve outcomes are necessary.This article comprehensively reviews the technologies investigated to date to improve the outcomes for men undergoing micro-TESE.
文摘Approximately 15%of men in the general population have varicoceles,and varicoceles are diagnosed in 40%of men presenting for fertility evaluations.One percent of men in the general population are azoospermic,and 15%of men presenting for fertility evaluations are diagnosed with azoospermia.This article aims to review the impact of varicoceles on testicular function in men with azoospermia,the impact of varicocele repair on the semen parameters of azoospermic men,and the impact of varicocele repair on sperm retrieval and pregnancy outcomes when the male partner remains azoospermic after varicocele repair.
