Lopushnyan, N. A., & Walsh, T. J. (2012). Surgical techniques for the management of male infertility. Asian Journal of Andrology. https://doi.org/10.1038/aja.2011.62
Lopushnyan NA, Walsh TJ. Surgical techniques for the management of male infertility. Asian Journal of Andrology. 2012. doi:10.1038/aja.2011.62
Lopushnyan, Natalya A., and Thomas J. Walsh. "Surgical techniques for the management of male infertility." Asian Journal of Andrology, 2012.
For EndNote, Zotero or Mendeley:
Open access
No open license is recorded for this paper. Reuse terms are set by the publisher.
Open Access
Free full text on PubMed Central (PMC3735154)
RRM Academy Synopsis
Surgery can correct some causes of male infertility, review says
Surgery can correct some causes of male infertility, with results varying by cause. Two urologists wrote this 2012 review. It covers surgery to diagnose, to raise sperm production, to deliver sperm and to retrieve sperm. The authors call for evaluating both partners.
About 3 in 10 couples who had varicocele repair for infertility conceived. Source: Lopushnyan NA et al., 2012, PMID 22120932.Study at a glance, 2012 review: Surgery can correct some causes of male infertility. Source: Lopushnyan NA et al., 2012, PMID 22120932.
Key Findings
A meta-analysis of varicocele repair in men with a palpable varicocele and at least one abnormal sperm parameter reported odds of spontaneous pregnancy of 2.63.
A Cochrane review of eight randomized trials of varicocele repair, including men with subclinical varicoceles and some with normal semen, found no evidence of improved fertility or increased chances of conception.
In one study, 31% of couples undergoing varicocele repair for infertility conceived, and 26% had a live birth uncomplicated by spontaneous abortion.
One report gave spontaneous pregnancy rates after varicocele repair of 35.7% when the woman was under 35 and 23.6% when she was 35 years or older.
After vasovasostomy, a type of vasectomy reversal, one report gave a pregnancy rate of 76% when the interval since vasectomy was under 3 years and 30% at 15 years or longer.
Interpretation
The authors note that most studies of semen gains after varicocele repair lack matched controls. They often just compare the same men before and after surgery. These findings support larger, controlled studies of male fertility surgery.
RRM Context
The review says a male evaluation should find and correct reversible causes, so a couple can conceive through intercourse or with the least technology. It puts the male factor alone at 20% of infertile couples, with another 30% involving both partners. Restorative reproductive medicine shares the principle of finding the cause first. Sperm retrieval, the review's fourth category, supplies sperm for IVF-ICSI. IVF-ICSI bypasses the male problem and leaves the cause unresolved.
Our editorial summary of this paper, not the article's abstract.
Abstract
Evaluation and surgical treatment of male infertility has evolved and expanded, now leading to more precise diagnoses and tailored treatments with diminished morbidity and greater success. Surgeries for male infertility are divided into four major categories: (i) diagnostic surgery; (ii) surgery to improve sperm production; (iii) surgery to improve sperm delivery; and (iv) surgery to retrieve sperm for use with in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI). While today we are more successful than ever in treating male infertility, pregnancy is still not always achieved likely due to factors that remain poorly understood. Clinicians treating infertility should advocate for couple-based therapy, and require that both partners have a thorough evaluation and an informed discussion before undergoing specific surgical therapies.
