The management of infertility due to obstructive azoospermia

doi:10.1016/j.fertnstert.2008.08.096

Cited by 35 publications

(21 citation statements)

References 51 publications

(44 reference statements)

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“…OA, which comprises 40% of azoospermia cases, is typically accompanied by preservation of normal exocrine and endocrine function, and normal spermatogenesis in the testis 1 . OA is the consequence of physical blockage to the male excurrent ductal system and may occur in any region between the rete testis and the ejaculatory ducts 2 .…”

Section: Introductionmentioning

confidence: 99%

Review of Azoospermia

Goldstein²,

2014

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Azoospermia is classified as obstructive azoospermia (OA) or non-obstructive azoospermia (NOA), each having very different etiologies and treatments. The etiology, diagnosis, and management of azoospermia were reviewed and relevant literature summarized. Differentiation between these two etiologies is of paramount importance and is contingent upon thorough history and physical examination and indicated laboratory/genetic testing. OA occurs secondary to obstruction of the male reproductive tract, and is diagnosed through a combination of history/physical examination, laboratory testing, genetics (CFTR for congenital OA), and imaging studies. NOA (which includes primary testicular failure and secondary testicular failure) is differentiated from OA by clinical assessment (testis consistency/volume), laboratory testing (FSH), and genetic testing (karyotype, Y chromosome microdeletion, or specific genetic testing for hypogonadotropic hypogonadism). For obstructive azoospermia, management includes microsurgical reconstruction when feasible using microsurgical vasovasostomy or vasoepididymostomy. Microsurgical epididymal sperm aspiration with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is utilized for those cases not amenable to reconstruction. NOA management includes medical management for congenital hypogonadotropic hypogonadism and microdissection testicular sperm extraction with IVF/ICSI for appropriate candidates based on laboratory/genetic testing. Overall, this important review provides an updated summary of the most recent available literature describing etiology, diagnosis, and management of azoospermia.

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Section: Introductionmentioning

confidence: 99%

Review of Azoospermia

Goldstein²,

2014

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“…Meta-analysis results have not demonstrated any significant differences in any outcome measures between the use of epididymal or testicular sperm in men with OA 105. The etiology of the obstruction and the use of fresh or frozen-thawed epididymal/testicular sperm do not seem to affect ICSI outcomes in terms of fertilization, pregnancy, or miscarriage rates 104,106,107. In our series of 142 men with OA, the cumulative successful retrieval rate of PESA and/or TESA was 97.9%, and an adequate number of motile sperm for cryopreservation were obtained in approximately one third of the cases 104.…”

Section: New Insights Into the Surgical Treatment Of Male Infertilitymentioning

confidence: 88%

“…The etiology of the obstruction and the use of fresh or frozen-thawed epididymal/testicular sperm do not seem to affect ICSI outcomes in terms of fertilization, pregnancy, or miscarriage rates 104,106,107. In our series of 142 men with OA, the cumulative successful retrieval rate of PESA and/or TESA was 97.9%, and an adequate number of motile sperm for cryopreservation were obtained in approximately one third of the cases 104. Motile spermatozoa were obtained in approximately 73% of the cases after the first or second PESA aspirations, and TESA was carried out as a rescue procedure after failed PESA in about 14% of the individuals.…”

Section: New Insights Into the Surgical Treatment Of Male Infertilitymentioning

confidence: 96%

“…For example, PESA can be performed without surgical scrotal exploration, it is easily repeatable at a low cost, does not require an operating microscope or expertise in microsurgery, can be performed under local anesthesia, and is associated with minimal postoperative discomfort. Microsurgical aspiration has the advantage of retrieving a larger number of sperm, which facilitates cryopreservation, and it is associated with a reduced risk of hematoma 104. Meta-analysis results have not demonstrated any significant differences in any outcome measures between the use of epididymal or testicular sperm in men with OA 105.…”

Section: New Insights Into the Surgical Treatment Of Male Infertilitymentioning

confidence: 96%

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Surgical treatment of male infertility in the era of intracytoplasmic sperm injection – new insights

Esteves¹,

Miyaoka²,

Agarwal³

2011

Clinics

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Assisted reproductive technology is an evolving area, and several adjuvant procedures have been created to increase a couple's chance of conceiving. For male infertility, the current challenges are to properly accommodate old and new techniques that are both cost-effective and evidence-based. In this context, urologists are expected to diagnose, counsel, provide medical or surgical treatment whenever possible and/or correctly refer male patients for assisted conception. Urologists are sometimes part of a multiprofessional team in an assisted reproduction unit and are responsible for the above-cited tasks as well as the surgical retrieval of sperm from either the epididymides or testicles. We present a comprehensive review of the surgical treatment options for infertile males, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery in the optimization of treatment results. This review also discusses current techniques for sperm retrieval that are used in association with assisted reproductive technology and includes sperm retrieval success rates according to the technique and the type of azoospermia. New insights are provided with regard to each surgical treatment option in view of the availability of assisted conception to overcome male infertility.

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“…2 Physical blockages resulting in OA are most commonly due to prior vasectomy, but may also be caused by epididymal, vasal, or ejaculatory duct pathology secondary to genitourinary infection, iatrogenic injury during scrotal or inguinal surgical procedures, and congenital anomalies such as congenital bilateral absence of the vas deferens (CBAVD). 3 NOA on the other hand accounts for 60% of cases of azoospermia and is caused by either primary or secondary testicular failure and subsequent defective spermatogenesis. 4 Varicocele is considered a correctable cause of NOA.…”

Section: Introductionmentioning

confidence: 99%