Fertility-enhancing male reproductive surgery: glimpses into the past and thoughts for the future

Abstract

Over the past few decades, there have been numerous paradigm shifts in male reproductive surgery, resulting from a combination of technologic advancements in both the operating room and the laboratory. The operating microscope transformed the field of male reproductive surgery, enabling novel techniques and higher precision for the treatment of male-factor subfertility. The subsequent widespread adoption of microsurgical approaches was largely responsible for the emergence of a cadre of highly specialized male infertility microsurgeons. The advent and evolution of in vitro fertilization/intracytoplasmic sperm injection was a concurrent story that further revolutionized the field. The ability to achieve fertilization and pregnancy with just a single sperm changed the ways in which male reproductive surgeons could approach a wide range of pathologies from obstructive to nonobstructive causes, culminating in the microdissection testicular sperm extraction procedure for the treatment of nonobstructive azoospermia. Here we review the recent advancements in fertility-enhancing male reproductive surgery for the treatment of four disease processes: varicocele, obstruction of the excurrent ductal system, ejaculatory duct obstruction, and nonobstructive azoospermia. While examining the great strides of the past, we look forward to exciting developments on the horizon. (Fertil Steril Ò 2019;112:426-37. Ó2019 by American Society for Reproductive Medicine.

Practice patterns of vasal reconstruction in a large United States cohort

“…While VV and VE have been performed for over 100 years, data concerning practice patterns and outcomes remain sparse, as most studies originate from single‐centre, high‐volume experiences or from questionnaire‐based data (Halpern et al., 2019). In the current study, we explored the practice patterns of VV and VE in a large, geographically diverse and national commercial dataset.…”

Reproductive outcomes of testicular and ejaculated sperm for ICSI in patients with previous ICSI failures: a systematic review and meta-analysis

“…(3) Study design; (4) Sperm extraction method; (5) Age of participants; (6) Outcome data (fertilization rates, CPRs, and take home baby rates. Nonrandomized studies were also assessed for the risk of bias [10] as shown in Supplemental Table 1.…”

“…Testicular sperm extraction (TESE), microscopic TESE (microTESE), or testicular sperm aspiration (TESA) are methods commonly utilized to harvest testicular sperm. When the non-obstructive azoospermia leading to infertility occurs, and sperm donor assistance is refused, testicular retrieved sperm are conventionally used [6]. During the course of an ART cycle, the source of sperms could possibly influence SDF levels [7].…”

Vasectomy and vasectomy reversal: a comprehensive approach to the evolving spectrum of care

“…The last article, by Fantus and Halpern, is entitled ''Vasovasostomy and Vasoepididymostomy: Indications, Operative Technique, and Outcomes.'' Many advances in microsurgical vasectomy reversal have occurred in recent years, and it is important for specialists in both male and female reproduction to have a clear understanding of the progress made in surgical techniques and outcomes to guide patients as they consider reproductive options after vasectomy (5). The authors detail preoperative patient assessment, state-of-the-art operative techniques for vasovasostomy and vasoepididymostomy, postoperative care, potential surgical complications, and surgical outcomes.…”