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Microsurgical management of male infertility

Nature Clinical Practice Urology volume 3, pages 381–391 (2006)Cite this article

Abstract

The introduction of microsurgical techniques has revolutionized the treatment of male infertility. As a result of technical advances and innovation over the past 10–15 years, previously infertile couples are now able to conceive naturally or to parent their own biological children with the aid of assisted reproductive technologies. This article reviews the indications, techniques, and outcomes of the various microsurgical procedures currently used to optimize male fertility. The most up-to-date methods of microsurgical vasal and epididymal reconstruction, sperm retrieval, and varicocele repair are discussed.

Key Points

  • Successful vasovasostomy is predicated on the basic surgical principles of a tension-free, watertight anastomosis with mucosa-to-mucosa apposition.

  • Performing vasovasostomy or vasoepididymostomy is more cost-effective for achieving pregnancy than assisted reproductive technologies that use sperm aspiration

  • Vasoepididymostomy is the most technically difficult of all microsurgical procedures, and should only be performed by experienced microsurgeons

  • Varicocele is a risk factor for impaired spermatogenesis and Leydig-cell function, and varicocele repair can improve testicular function

  • Ligation of the testicular artery during varicocele repair is not likely to improve testicular function

  • Preservation of lymphatic drainage during varicocele repair decreases the risk of postoperative hydrocele

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Figure 1: Microsurgical vasovasostomy with multilayer microdot method (×25).
Figure 2: Microsurgical end-to-side two-suture intussusception vasoepididymostomy.
Figure 3: Microsurgical epididymal sperm aspiration.
Figure 4: Microdissection testicular sperm extraction.
Figure 5: Microsurgical varicocelectomy (×25)

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Acknowledgements

Dr Tanrikut is supported by The Frederick J and Theresa Dow Wallace Fund of the New York Community Trust.

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Authors and Affiliations

  1. Professor of Reproductive Medicine and a Professor of Urology,

    Marc Goldstein & Cigdem Tanrikut

  2. Fellow in Male Reproductive Medicine and Microsurgery, at Weill Medical College of Cornell University, New York, NY, USA

    Marc Goldstein & Cigdem Tanrikut

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Correspondence to Cigdem Tanrikut.

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Goldstein, M., Tanrikut, C. Microsurgical management of male infertility. Nat Rev Urol 3, 381–391 (2006). https://doi.org/10.1038/ncpuro0524

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