[Surgery to improve male fertility].
Chirurgies visant à améliorer la fertilité masculine.
Kyste de l’utricule
Réversion de vasectomie
Utricle cyst
Varicocele
Varicocèle
Vasectomy reversal
Vaso-epididymostomy
Vaso-épididymostomie
Vasovasostomie
Vasovasostomy
Journal
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie
ISSN: 1166-7087
Titre abrégé: Prog Urol
Pays: France
ID NLM: 9307844
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
22
08
2023
revised:
05
09
2023
accepted:
07
09
2023
medline:
29
11
2023
pubmed:
28
11
2023
entrez:
28
11
2023
Statut:
ppublish
Résumé
At a time when increasing attention is being paid to the limitations and risks of in vitro fertilisation techniques, surgeries to improve male fertility are attracting growing interest. Systematic review based on a Pubmed search of surgeries to improve male fertility. Vasovasostomy (VV) gives patency rates of 70-97% and pregnancy rates of 30-76%. Vasoepididymostomy (VE) gives patency rates of 80-84%, with pregnancy rates of 40-44%. The duration of obstruction and the age of the partner are 2 predictive parameters for the occurrence of a natural pregnancy. In cases of obstructive azoospermia due to pelvic obstruction (prostatic cyst, obstruction of the ejaculatory ducts), several surgical procedures may be proposed. Transurethral resection of the ejaculatory ducts leads to an improvement in sperm parameters in 63-83% of patients, with spontaneous pregnancy occurring in 12-31% of cases. Microsurgical cure of varicocele by the subinguinal route is a benchmark technique with recurrence rates of less than 4%. It improves live birth and pregnancy rates, both naturally and by in vitro fertilization, as well as sperm count, motility and DNA fragmentation rates. Whenever possible, the urologist should present the surgical options for improving male fertility to the ART team and to the couple, discussing the benefit/risk balance of the operation as part of a personalized approach.
Sections du résumé
BACKGROUND
BACKGROUND
At a time when increasing attention is being paid to the limitations and risks of in vitro fertilisation techniques, surgeries to improve male fertility are attracting growing interest.
METHODS
METHODS
Systematic review based on a Pubmed search of surgeries to improve male fertility.
RESULTS
RESULTS
Vasovasostomy (VV) gives patency rates of 70-97% and pregnancy rates of 30-76%. Vasoepididymostomy (VE) gives patency rates of 80-84%, with pregnancy rates of 40-44%. The duration of obstruction and the age of the partner are 2 predictive parameters for the occurrence of a natural pregnancy. In cases of obstructive azoospermia due to pelvic obstruction (prostatic cyst, obstruction of the ejaculatory ducts), several surgical procedures may be proposed. Transurethral resection of the ejaculatory ducts leads to an improvement in sperm parameters in 63-83% of patients, with spontaneous pregnancy occurring in 12-31% of cases. Microsurgical cure of varicocele by the subinguinal route is a benchmark technique with recurrence rates of less than 4%. It improves live birth and pregnancy rates, both naturally and by in vitro fertilization, as well as sperm count, motility and DNA fragmentation rates.
CONCLUSION
CONCLUSIONS
Whenever possible, the urologist should present the surgical options for improving male fertility to the ART team and to the couple, discussing the benefit/risk balance of the operation as part of a personalized approach.
Identifiants
pubmed: 38012911
pii: S1166-7087(23)00214-2
doi: 10.1016/j.purol.2023.09.011
pii:
doi:
Types de publication
Systematic Review
English Abstract
Journal Article
Langues
fre
Sous-ensembles de citation
IM
Pagination
681-696Informations de copyright
Copyright © 2023 Elsevier Masson SAS. All rights reserved.