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

Abstract

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.

An update on sperm retrieval techniques for azoospermic males

“…In testicular sperm aspiration (TESA), the seminiferous tubules and their contents are removed. Percutaneous sperm retrieval may have either a diagnostic or a therapeutic role (19). Regarding the former role, the procedure confirms the presence of viable spermatozoa that can be cryopreserved for future use prior to ICSI.…”

“…The patient should abstain from sports activities, heavy lifting and sexual intercourse for approximately 10 days. Moreover, patients should be informed of the likelihood of scrotal swelling and ecchymosis at the wound site, as well as mild discomfort that should subside in approximately one week (14,19). …”

What every gynecologist should know about male infertility: an update

“…A comprehensive review of surgical modalities for male infertility patients has been discussed elsewhere [54]. It should be stressed, however, that patients must be informed that the success rate of vasovasostomy decreases as time from the vasectomy increases [55].…”

Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells into the Testes of Infertile Male Rats and New Germ Cell Formation

“…Numerous causes are responsible for male infertility, for example environmental factors include infections, smoking, heavy metal exposure, radiation, increase in scrotal temperature and certain drugs, in addition to anatomical defects such as absence of a part of the vas deferens and epididymal obstructions, endocrinopathies that include sex hormone imbalances or lack of secretion of certain hormones (GnRH, FSH, LH), ejaculatory failures (disorders in the dorsal penile nerve), genetic factors [disorders in the Y chromosome and/or in the genes involved in the evolution of germ cells (GCs)] and disorders in proliferation and differentiation of GCs (1–3). Common medical treatments for male infertility consist of surgery (4), hormone and drug therapies (2). In recent years, after identifying the high capability of stem cells to produce different cell types, a number of scientists have proposed the use of stem cells and cell-based therapies as a possible new therapeutic choice for male infertility (5).…”