Microscopic Vasectomy Reversal 30 Years Later: A Summary of 4010 Cases by the Same Surgeon

Silber, Sherman J.; Grotjan, H. Edward

doi:10.1002/j.1939-4640.2004.tb03150.x

Cited by 83 publications

(22 citation statements)

References 67 publications

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“…A review of the literature revealed post-reversal patency percentages ranging from approximately 69 to 98% 17,18 with achievement of pregnancy in 37 to 93% of couples 19,20 . The precise extent to which the presence of sperm in the intraoperative vasal fluid is associated with postoperative patency remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Association Between the Presence of Sperm in the Vasal Fluid During Vasectomy Reversal and Postoperative Patency: A Systematic Review and Meta-analysis

Scovell

Mata

Ramasamy

et al. 2015

Urology

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Objective To investigate the association between the presence of sperm in the vasal fluid during vasectomy reversal (VR) and postoperative patency. Methods We performed a systematic review and meta-analysis of the English-language literature reporting on the association between the presence of sperm in the intraoperative vasal fluid (i.e., whole/parts versus none) and patency (i.e., patent or not) after microsurgical vasovasostomy (VV) for men with obstructive azoospermia due to vasectomy. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to quantify the strength of the association reported by each study. Meta-analysis was performed using a random effects model. Results Four case series and two retrospective cohort studies of a total of 1,293 eligible patients were identified. The mean age at VR was 37.8 years and the mean obstructive interval was 7.1 years. The unadjusted odds of postoperative patency were 4.1 (95% CI: 2.3 to 7.3) times higher given the presence of intravasal sperm or sperm parts as opposed to their absence at the time of VR (Q = 3.4; df = 5; p = 0.6; I2 = 22%). The pooled OR should be interpreted with caution as only the two retrospective cohort studies reported meaningful data on this association. Because of inconsistent reporting, analysis of other vasal fluid characteristics (e.g., consistency) and outcomes (e.g., pregnancy) was not possible. Conclusion The presence of whole sperm or sperm parts in the vasal fluid during VR is positively associated with postoperative patency. Our review highlights the poor methodological quality of existing evidence and underscores the need for more thorough follow up and higher standards of reporting in future studies.

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Section: Discussionmentioning

confidence: 99%

Association Between the Presence of Sperm in the Vasal Fluid During Vasectomy Reversal and Postoperative Patency: A Systematic Review and Meta-analysis

Scovell

Mata

Ramasamy

et al. 2015

Urology

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“…[12] Among these studies, live birth rates ranged from as low as 26% to as high as 84% with outcomes inversely dependent on the duration of obstruction. [131415] A large series by Belker and colleagues demonstrated that for intervals of nine to 14 years and 15 years or more, pregnancy rates were 44% and 30%, respectively. [15] Subsequent studies reported cumulative pregnancy rates of 37% and 43% after 10 and 15 years of obstruction.…”

Section: Discussionmentioning

confidence: 99%

A single-center study examining the outcomes of percutaneous epididymal sperm aspiration in the treatment of obstructive azoospermia

2014

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Introduction:Obstructive azoospermia (OA) is characterized by normal spermatogenesis and the absence of sperm in the ejaculate. Variable success rates have been reported using in-vitro fertilization (IVF) combined with PESA in cases of men with OA.Aims:To determine fertilization and pregnancy outcomes from PESA-derived spermatozoa and to ascertain whether frozen spermatozoa yields similar outcomes compared to fresh specimens.Materials and Methods:The charts of 68 consecutive couples undergoing 68 cycles of sperm retrieval for OA over eight years (2002-2010) were retrospectively reviewed. Patients requiring testicular intervention were excluded (n = 17).Results:Viable sperms were identified in 100% of men, and fresh spermatozoa were obtained in 40 patients (78.4%) simultaneously with female egg retrieval. The average fertilization rate was 77.7% with five embryos not surviving to transfer (12.5%). Pregnancies were confirmed in 48.6% (17/35). Twin gestations occurred in 11.8% (2/17) of cases. Frozen-thawed spermatozoa were used in 11 patients (21.6%). In this subgroup, the average fertilization rate was 73.6% with pregnancies confirmed in 54.5% (6/11). No multiple gestations were generated, and no complications occurred. The use of fresh spermatozoa for PESA provided no significant improvements in outcomes over frozen specimens.Summary:PESA is a very effective, simple, and safe method of obtaining spermatozoa for IVF. Outcomes obtained using fresh and frozen PESA-derived spermatozoa were similar and as such, either could be used during the IVF process.

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“…These methods provided a water tight seal, and the reported patency rates were 92% with pregnancy rates of 58%, but some investigators continued to perform a modified full-thickness closure with the operating microscope and achieved similar results with the 2-layer procedures. [15] Nevertheless, Belker[16] and Silber and Grotjan[17] agreed that experience with a 2-layer closure could help clinicians develop the necessary skills needed to perform the more demanding VEs, and manage closures of luminal openings with different diameters. However, it was still unclear when to perform a VV or a VE.…”

Section: Vasovasostomymentioning

confidence: 99%

Techniques for microsurgical reconstruction of obstructive azoospermia

Marmar

2011

Indian J Urol

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About 10%–15% of infertile men present with azoospermia, and ductal obstruction is the cause in 40% of them. For about 25–30 years, microsurgical reconstruction was the only way to manage obstructive azoospermia, and several innovative techniques have been developed and implemented. Presently, assisted reproductive technologies (ART) are available for these men as an alternative to surgery. Clinicians who treat these men must be familiar with all of these options, and many of the ART techniques have been covered in other sections of this symposium. However, the present article focuses on vasovasostomies and vasoepididymostomies. The intent of this review is to critique these microsurgical procedures, and present some surgical “pearls” related to them.

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Microscopic Vasectomy Reversal 30 Years Later: A Summary of 4010 Cases by the Same Surgeon

Cited by 83 publications

References 67 publications

Association Between the Presence of Sperm in the Vasal Fluid During Vasectomy Reversal and Postoperative Patency: A Systematic Review and Meta-analysis

Association Between the Presence of Sperm in the Vasal Fluid During Vasectomy Reversal and Postoperative Patency: A Systematic Review and Meta-analysis

A single-center study examining the outcomes of percutaneous epididymal sperm aspiration in the treatment of obstructive azoospermia

Techniques for microsurgical reconstruction of obstructive azoospermia

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