Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes

Abstract

A male factor plays a significant role in a couple’s reproductive success. Today, advances in reproductive technology, such as intracytoplasmic sperm injection (ICSI), have allowed it to be possible for just a single sperm to fertilize an egg, thus, overcoming many of the traditional barriers to male fertility, such as a low sperm count, impaired motility, and abnormal morphology. Given these advances in reproductive technology, it has been questioned whether a reproductive urologist is needed for the evaluation and treatment of infertile and subfertile men. In this review, we aim to provide compelling evidence that collaboration between reproductive endocrinologists and reproductive urologists is essential for optimizing a couple’s fertility outcomes, as well as for improving the health of infertile men and providing cost-effective care.

Surgical management of male infertility: An overview

“…1 A contributing male factor is responsible in up to 50% of cases, and the male partner should therefore undergo assessment by a doctor trained in male reproduction. [3][4][5] Of concern, however, is that surveys suggest that the male was not evaluated in 18-27% of couples with infertility. 6 With the aid of technological advances -especially in the fields of microsurgery, endoscopy, laparoscopy, assisted reproductive technology (ART) and now robotics -the surgical treatment of male infertility has expanded, with more tailored, safer and evidencebased options available.…”

A Narrative Review Discussing Vasectomy-Related Impact upon the Status of Oxidative Stress and Inflammation Biomarkers and Semen Microbiota

“…The popularity of microsurgical reconstruction has increased over the years among men who undergo a vasectomy as it is more cost-effective compared with in vitro fertilization (IVF) and ICSI or sperm retrieval [ 193 ]. However, conditions in such cases are that vasectomy was performed less than fifteen years prior and there are no female risk factors, as female age and obstruction epididymal are of interest, and the procedures should be individualized [ 194 ].…”

Evaluating the Predictive Value of Diagnostic Testicular Biopsy for Sperm Retrieval Outcomes in Men with Non-Obstructive Azoospermia

“…The current gold standard in this realm combines mTESE with ICSI cycles [ 22 , 23 ]. Using a surgical microscope for examining seminiferous tubules is crucial for the success of this procedure, as it improves the odds of successful sperm retrieval and minimizes the risk of injury to the testicles, especially compared to the earlier conventional TESE methods [ 24 ]. However, despite these advances, the sperm recovery rate via mTESE, as per the literature review, still ranges between 40% and 60%—a figure that is less than satisfactory when considering this procedure’s physical, emotional, and financial implications [ 23 ].…”