Vasectomy re-reversal: effectiveness and parameters associated with its success

ABSTRACT Introduction: When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. Purpose: To determine the VRR effectiveness and whether specific parameters can be associated with its success. Materials and Methods: We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). Results: The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01). Conclusions: VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.

Portable model for vasectomy reversal training

ABSTRACT Objectives To validate an experimental non-animal model for training of vasectomy reversal. Materials and Methods The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. Results Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). Conclusion The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.

Crossover transseptal vasovasostomy: alternative for very selected cases of iatrogenic injury to vas deferens

ABSTRACT Inguinal herniorraphy is a possible cause of iatrogenic seminal tract obstruction. Diagnosing and correcting these vasal injuries can be challenging. Successful re-anastomosis is technically challenging, with relatively low success rates. An uncommon alternative for selected cases is the crossover transseptal vasovasostomy. We herein report a case of a 36-year-old male patient with vas deferens injury after herniorraphy and a contralateral hypotrophic testis. He was successfully treated through microsurgical crossover transseptal vasovasostomy, with spontaneous pregnancy achieved, and the technique is presented in details.

Reversión de vasectomía: técnica simplificada / Reversal vasectomy: a simpliefed technique

Introducción. Aproximadamente un 3 por ciento de los hombres que se han sometido a una vasectomía se realizan posteriormente una reversión de ésta con intención de fertilidad. La vasovasostomía (VV) microquirúrgica como técnica de reversión de vasectomía, permite la recanalización de los conductos deferentes, ofreciendo muy buenos resultados. Objetivo. Describir los resultados quirúrgicos y la efectividad de la VV en una serie de pacientes operados mediante una técnica simplificada. Materiales y Métodos. Estudio retrospectivo. Se analizaron antecedentes demográficos y quirúrgicos. Se utilizó una técnica de VV simplificada que consiste en realizar una miniincisión de abordaje (1 cm), sin evaluar el líquido seminal mediante la graduación de Silber y realizar la anastomosis en un plano único con material de sutura no reabsorbible 9-0. Se controló con espermiograma al primer y tercer mes post-cirugía, evaluando concentración espermática, motilidad progresiva, morfología y volumen seminal entre otros. Se calculó la tasa de permeabilidad deferencial (definida como presencia de espermatozoides en el eyaculado) y la tasa de embarazo post VV. Resultados. Un total de 75 pacientes fueron incluidos en el estudio, operados entre agosto de 2009 y julio de 2016 por 2 cirujanos (CP, MM). La edad media (± desviación estándar) de los pacientes y de sus parejas fue de 43,9 ± 6,4 años y 34,4 ± 4,2 años, respectivamente. La mediana del tiempo transcurrido entre la vasectomía y la VV fue de 8 años (2 ­ 21 años). La mediana del tiempo quirúrgico fue de 110 minutos (85 ­ 183 minutos), con menos de un 3 por ciento de complicaciones post-operatorias (todas grado-I según escala Clavien-Dindo). Al primer mes el 93% de los pacientes tenía espermatozoides en el eyaculado, con una mediana de concentración de 12 x 10

Introduction. Approximately 3 pertcent of men subjected to a vasectomy undergo a subsequent reversal with fertility purposes. The microsurgical vasovasostomy (VV) as a vasectomy reversal technique allows recanalization of the deferential ducts, offering very good results. Objetive. To describe the surgical results and effectiveness of VV in a series of patients in whom a simplified technique was performed. Materials y Methods. Restrospective study. Demographic and surgical records were analyzed. The VV was performed using a simplified technique, meaning a mini-incision approach (1 cm), avoidance of the proximal seminal fluid analysis using the Silber score and performing the anastomosis in a single-layered fashion with a 9-0 non-absorbable suture. A sperm analysis was performed at first and third postoperative month., assesing sperm concentration, progressive motility, morphology and sperm volume among other factors. The deferential permeability rate (defined as presence of spermatozoids in semen) and pregnancy rates after VV were calculated. Results. A total of 75 patients were included in the study. All surgeries were performed by 2 surgeons (CP, MM) between August 2009 and July 2016. The average age (± standard deviation) of patients and their sexual partners were 43.9 ± 6.4 years and 34.4 ± 4.2 years, respectively. The median time span between the vasectomy and reversal was 8 years (range 2 ­ 21 years). The median surgical time was 110 minutes (range 85 ­ 183 minutes), with less than a 3 pertcent rate of postoperative complications (all grade-I according to Clavien-Dindo classification). At the first postoperative month 93 pertcent of the patients had spermatozoids in the eyaculate, with a median concentration of 12 x 10

Incidence of Y-chromosome microdeletions in children whose fathers underwent vasectomy reversal or in vitro fertilization with epididymal sperm aspiration: a case-control study / Incidência de microdeleções do cromossomo Y em filhos de pais que passaram por reversão de vasectomia ou fertilização in vitro com aspiração do epidídimo: um estudo caso-controle

ABSTRACT Objective To evaluate the incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with sperm retrieval by epididymal aspiration (percutaneous epididymal sperm aspiration). Methods A case-control study comprising male children of couples in which the man had been previously vasectomized and chose vasectomy reversal (n=31) or in vitro fertilization with sperm retrieval by percutaneous epididymal sperm aspiration (n=30) to conceive new children, and a Control Group of male children of fertile men who had programmed vasectomies (n=60). Y-chromosome microdeletions research was performed by polymerase chain reaction on fathers and children, evaluating 20 regions of the chromosome. Results The results showed no Y-chromosome microdeletions in any of the studied subjects. The incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with spermatozoa recovered by percutaneous epididymal sperm aspiration did not differ between the groups, and there was no difference between control subjects born from natural pregnancies or population incidence in fertile men. Conclusion We found no association considering microdeletions in the azoospermia factor region of the Y chromosome and assisted reproduction. We also found no correlation between these Y-chromosome microdeletions and vasectomies, which suggests that the assisted reproduction techniques do not increase the incidence of Y-chromosome microdeletions.

RESUMO Objetivo Avaliar a incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados submetidos à reversão de vasectomia ou fertilização in vitro com recuperação de espermatozoides por aspiração do epidídimo (aspiração percutânea de espermatozoides do epidídimo). Métodos Estudo caso-controle que compreende crianças do sexo masculino de casais em que o homem havia sido previamente vasectomizado e escolheu reversão da vasectomia (n=31) ou fertilização in vitro com recuperação espermática por aspiração percutânea de espermatozoides do epidídimo (n=30) para obtenção de novos filhos, e um Grupo Controle de crianças do sexo masculino de homens férteis com vasectomia programada (n=60). A pesquisa de microdeleções do cromossomo Y foi realizada por reação em cadeia da polimerase nos pais e filhos, avaliando 20 regiões do cromossomo. Resultados O resultado não revelou microdeleções do cromossomo Y em qualquer indivíduo estudado. A incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados que sofreram reversão de vasectomia ou fertilização in vitro com espermatozoides recuperados pela aspiração percutânea de espermatozoides do epidídimo não diferiu entre os grupos, e não houve nenhuma diferença entre indivíduos controle nascidos de gestações naturais ou incidência populacional em homens férteis. Conclusão Não foi encontrada nenhuma associação considerando microdeleções da região do fator de azoospermia no cromossomo Y e reprodução assistida. Não houve correlação entre microdeleções do cromossomo Y e vasectomia, o que sugere que as técnicas de reprodução assistida não aumentam a incidência de microdeleções do cromossomo Y.

Sperm analysis of the vas deferens fluid after a long interval of unilateral percutaneous epididymal sperm aspiration in vasectomized patients

Objectives Evaluation of the presence of spermatozoa in vas deferens fluid after a long interval of unilateral and homolateral percutaneous epididymal sperm aspiration (PESA) in vasectomized men. When found, the spermatozoa were evaluated including concentration and motility, in order to verify the patency of the epididymal tubules. Materials and Methods Four patients, numbered in a progressive order, from one to four, with 38, 40, 48 and 51 years old and vasectomy interval of 10, 10, 25 and 11 years, respectively, whose wives did not get pregnant using intracytoplasmic sperm injection of sperm obtained by unilateral PESA and decided to try only natural conception, were submitted to intrasurgical sperm analysis of the vas deferens fluid (ISAVDF) during microsurgery for reconstruction of the seminal tract. Results Time interval between PESA and ISAVDF was 13.75 ± 11.12 months (x ± s) varying from 3 to 29 months. Homolateral ISAVDF and PESA showed the presence of spermatozoa. Patients 1, 2 and 4 had a high concentration of 10 x 106, 64 x 106 and 45 x 106 spermatozoa/ mL; the first two had motile sperms and patient 3 had no sperms. Conclusions Three of four patients showed spermatozoa in the vas deferens fluid after a long interval of unilateral and homolateral PESA with high concentration, including motile forms. These findings support the concept that PESA may not result in late epipidymal tubule obstruction in vasectomized patients. .

Obstructive azoospermia: reconstructive techniques and results

Obstructive azoospermia is a common cause of male infertility and can result from infection, congenital anomalies, or iatrogenic injury. Microsurgical vasal reconstruction is a suitable treatment for many cases of obstructive azoospermia, although some couples will require sperm retrieval paired with in-vitro fertilization. The various causes of obstructive azoospermia and recommended treatments will be examined. Microsurgical vasovasostomy and vasoepididymostomy will be discussed in detail. The postoperative patency and pregnancy rates for surgical reconstruction of obstructive azoospermia and the impact of etiology, obstructive interval, sperm granuloma, age, and previous reconstruction on patency and pregnancy will be reviewed.

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

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.

Vasovasostomía microquirúrgica posvasectomía: una técnica efectiva y segura / Microsurgical postvasectomy vaso-vasostomy: an effective and safe technique

Introducción: La vasectomía es un procedimiento quirúrgico electivo que pretende obstruir o eliminar un segmento de ambos vasos deferentes. Es actualmente la causa más frecuente de azoospermia obstructiva. Se estima que hasta el 6 por ciento de los hombres que se han sometido a ella desean que sea revertida1. El objetivo del estudio fue presentar una serie de vasovasostomías (VV), y demostrar que constituye una técnica microquirúgica efectiva y segura. Material y métodos: Se han revisado 18 casos de VV practicadas en pacientes con vasectomía previa. Todas estas cirugías fueron realizadas por el mismo cirujano en un periodo de un año. Se registraron datos clínicos preoperatorios relevantes, así como datos del intra y posoperatorio. Se evaluaron los desenlaces con parámetros estándar y validados para esos efectos. Resultados: El seguimiento medio fue de 12 meses (rango 8-17). La edad media de los pacientes fue de 44,5 años (37-56); la edad media de la pareja fue de 30 años (24-43); el tiempo desde la vasectomía8 años (2-21) y la media de hijos previos fue del 2,1 (1-4). En el primer control de espermiograma alos 3 meses de la intervención, 16 de los 17 pacientes presentaron espermios en el recuento (94 por ciento).La concentración media de espermatozoides fue de 25x10

Introduction: Vasectomy is an elective surgical procedure, which aims to obstruct or to eliminate a segment of both vas deferens. It is currently considered the most frequent cause of obstructive azoospermia. It is estimated that up to 6 percent of male who have undergone one, is seeking to have it reversed (1). The target of this study is to present a series of vasovasostomy (VV), and to prove it as an effective and secure microsurgical technique. Material and methods: 18 VV cases of patients with a previous vasectomy have been revised. The same surgeon practiced all surgeries during one year. Relevant clinic data, pre-operatory as well as intra and post operatory, were registered. The outcomes were assessed with standard and validated parameters. Results: The average follow up was 12 months (range 8-17). The patients’ average age was 44,5years (37-56); their partners’ average age was 30 years (24-43); time since vasectomy was 8 years (2-21) and the mean of previous children was 2,1 (1-4). 16 out of 17 patients (94 percent) had sperm in the ejaculate at 3 months following the procedure with a mean sperm concentration of 25x10

Reversão de vasectomia microcirúrgica / Microsurgical vasectomy reversal

Introdução: embora a reversão de vasectomia seja amplamente executada, não existem registros que avaliem os resultados obtidos por essa cirurgia no Hospital Getúlio Vargas, em Recife (PE) (HGV-PE). Objetivo: avaliar a taxa de patência e compará-la entre os grupos de pacientes com intervalo de obstrução menor ou igual e superior a oito anos. Materiais e métodos: 21 pacientes foram submetidos à reversão de vasectomia entre março de 2007 a janeiro de 2009 no HGV-PE. Doze pacientes tinham intervalo de obstrução menor ou igual a oito anos e nove deles tinham intervalo de obstrução maior que oito anos. Foram acompanhados por um período mínimo de seis meses e realizaram pelo menos um espermograma após dois meses de pós-operatório. A patência foi definida como qualquer número de espermatozoides no espermograma. Para comparação dos grupos com relação à patência, foi aplicado o teste exato de Fisher. Resultados: houve uma taxa de patência em 19 (90,5%) pacientes. Os dois pacientes que não obtiveram patência pertenciam ao grupo com intervalo de obstrução superior a oito anos. Porém, os grupos não se mostraram estatisticamente diferentes com relação à patência (p=0,171). Conclusões: a reversão de vasectomia microcirúrgica realizada no HGV-PE obteve uma taxa elevada de patência que não foi influenciada pelo intervalo de obstrução.

Introduction: although vasectomy reversal has been widely performed, there are no records that allow assessing the results of this surgery in the Getúlio Vargas Hospital in Recife (PE) (HGV-PE). Objective: to evaluate the patency rate and compare it between groups of patients with obstructive interval less than or equal to eight years and more than eight years. Material and methods: Twenty-one patients underwent vasectomy reversal from March 2007 to January 2009 at the HGV-PE. Twelve patients had obstructive interval less than or equal to eight years and nine had obstructive interval greater than eight years. They were followed for a minimum period of six months and had at least one semen analysis two months after the procedure. The patency was defined as any number of spermatozoa. In order to compare the groups with respect to patency, we used the Fisher’s exact test. Results: there was a patency rate in 19 (90.5%) patients. The two patients who did not obtain patency belonged to the group with obstructive interval greater than eight years. However, the groups were not statistically different with respect to patency (p=0.171). Conclusions: the vasectomy reversal surgery performed at the HGV-PE with microsurgical techniques achieved a high patency rate, which was not influenced by the obstructive interval.

Patência e gravidez após vasovasostomia / Patency and pregnancy after vasovasostomy

A vasovasostomia consiste no reparo microcirúrgico da via seminal pela reanastomose do ducto deferente e/ou epidídimo. É solicitada por até 6% dos pacientes submetidos à vasectomia como uma forma de restaurar a fertilidade masculina. Os objetivos da pesquisa foram determinar a taxa de patência e gravidez após vasovasostomia e determinar a média de idade dos pacientes submetidos à cirurgia, analisando-os de acordo com apatência. O estudo é transversal, retrospectivo. Foram analisadas as fichas de 42 pacientes, operados no período de agosto de 1997 a julho de 2007(9 anos e 11 meses) pelo mesmo cirurgião e acompanhados por no mínimo 24 meses após a vasovasostomia. A taxa de gravidez das parceiras foi de 54,8% e a patência de 81,0%, ocorrendo gravidez em 67,6% dos casos com patência positiva. A idade média variou entre 40,25 (3 anos ou menos devasectomia) a 50,33 anos (15 anos ou mais de vasectomia). Os pacientes mais jovens (<40 anos) apresentaram maiores taxas de patência. O tempo médio entre a vasectomia e a vasovasostomia foi de 8,71 anos, predominando o período entre 3 e 9 anos (50% dos casos).

The vasovasostomy consists on microsurgical repair of seminal tract by reanastomosis of vas deferens and/or epididymis. About 6% of the patient ssubmitted to vasectomy require the surgery to restore fertility. The objectives of this paper are to determine the rates of patency and pregnancy, andthe mean age according to the patency. This is a retrospective cross-sectional study. Data consisted of the records of 42 patients that underwent vasovasostomy (performed by the same surgeon) on the period between August 1997 and July 2007 (9 years and 11 months) and were followed by at least 24 months after vasovasostomy. The pregnancy rate was 54.8% and the patency was 81%, occurring pregnancy on 67.6% of the patients with positive patency. Age ranged from 40.25 (3 years or less of vasectomy) to 50.33 years (15 years or more of vasectomy). Younger patients (<40 years) had better patency rates. The mean time between vasectomy and vasovasostomy was 8.71 years, with predominance of the period between 3 and 9 years after the surgery (50% of the cases).

Vasovasostomía: experiencia personal con una técnica microquirúrgica simplificada / Vasovasostomy: personal experience with a simplified microsurgical technique

La vasectomía es el método de anticoncepción masculina más efectivo y estable, sin efectos adversos en la sexualidad ni función gonadal. En países industrializados es de muy alta demanda, lo que conlleva también una relativamente elevada necesidad de reversión quirúrgica asociada a la inestabilidad de pareja que existe en la sociedad actual. En nuestro país, hasta muy reciente, la frecuencia de realización de la vasectomíaera bastante baja en comparación a Europa y Estados Unidos, por lo cual la vasovasostomía también es de baja demanda. Las técnicas de vasovasostomías descritas son complejas y obligan a un entrenamiento microquirúrgico siginificativo. Se describe aquí una técnica microquirúrgica simplificada y que conserva los resultados de permeabilización óptimos esperados. Quince enfermos son vasovasostomizados, de acuerdo a la técnica microquirúrgica sugerida, con recuperación espermática en semen en todos ellos. Esto nos alienta para insistir, a nivel de programas de salud pública, en fomentar la vasectomía como una forma fácil, sencilla, barata y reversible de contracepción masculina.

Vasectomy is the most effective and stable male contraceptive method. In western countries the rates of vasectomy varies between 18-50 percent of men. This means also high “prevalence” of vasovasostomies due to the current couples instability. In Chile,to recently, vasectomy was a quite low rate surgical procedure, so vasovasostomy has a still lower rate. Described vasovasostomies surgical technique are complex and require a microsurgical significative training. Herein its presented a simplified microsurgical technique with optimal permeability outcomes. This results encoureges to teach about vasectomy as a simple, easy, unexpensive and reversible male contraceptive method for couples in our national health service.

Recanalização espontânea dos ductos deferentes pós-vasectomia / Spontaneous recanalization of vas deferens post-vasectomy

A vasectomia é um método simples e efetivo de contracepção masculina definitiva, com boa aceitação nas diferentes camadas sociais. Entretanto, não é um método isento de falhas. A gravidez após a vasectomia é a complicação mais temida pelos profissionais que realizam o procedimento. Os relatos na literatura não são comuns, embora diferentes autores relacionem esta ocorrência a uma incidência de 0,36 por cento a 1,8 por cento, podendo ocorrer em qualquer momento após a vasectomia, embora seja mais freqüente nos dois primeiros anos.

The vasectomy is a simple and effective male definitive contraception method, with good acceptance in the different social layers. But this is not a free of failure method. The pregnancy after vasectomy is the most feared complication by the professionals which make the procedure. Literature findings are not usual, although different authors relate this occurence to an incidente of 0.36 per cent to 1.8 per cent, and it may happen at any time after vasectomy, being more often in the two first years after the procedure.

Comparison of vasovasostomy with conventional microsurgical suture and fibrin adhesive in rats

OBJECTIVE: Microsurgical procedures are currently the gold standard for vasovasostomy with excellent results, but it takes an increased operative time demanding special training and experience in microsurgery. The objective of this study is to reach the same results with reduced operative time. MATERIALS AND METHODS: Male adults Wistar rats were divided into 3 groups: I) 20 rats in control group, II) 20 with conventional one-layer microsuture and III) 20 with fibrin glue. After four weeks each rat was left for two weeks with two female rats. RESULTS: The fertility rates were 80 percent in group I, 70 percent in group II and 65 percent in group III (p > 0.05). In group II granuloma was found in 75 percent of the rats, while in group III in 85 percent (p < 0.05). Anastomosis was considered with patency in 75 percent and 80 percent of the rats in groups II and III (p > 0.05). Overall operative time was 41.7 ± 2.49 and 28.55 ± 1.14 minutes in groups II and III (p < 0.05) and the time to anastomosis of 24.6 ± 1.8 and 9.35 ± 0.78 minutes (p < 0.05), respectively. CONCLUSIONS: We can conclude that vasovasostomy with fibrin adhesive has the same results of the conventional microsurgery technique but with a reduced operative time and a simplified procedure.

Reversão de vasectomia na era da reprodução assistida: ainda existe espaço? / Vasectomy reversion in assisted reproductive era: does space still exist?

A reconstrução microcirúrgica do trato reprodutivo é preferível à captação de espermatozóides com fertilização in vitro e injeção intracitoplasmática de espermatozóides em homens vasectomizados, quando o intervalo de obstrução for inferior a 15 anos e houver ausência de fatores de risco de infertilizade feminina. Se ocorrer obstrução epidikimária ou se a mulher tiver idade avançada, a decisão para reconstrução microcirúrgica, captação de espermatozóides com fertilização in vitro ou injeção intracitoplasmática de espermatozóides deve ser individualizada. A captação espermática com fertilização in vitro e a injeção intracitoplasmática de espermatozóides são preferíveis ao tratamento cirúrgico, quando a terapêutica do fator feminino requerer fertilização in vitro ou quando a chance de sucesso com a captação de espermatozóides e injeção intracitoplasmática de espermatozóides for superior à chance de sucesso com o tratamento cirúrgico.

The best infertility treatment for vasectomized men: assisted reproduction or vasectomy reversal?

Reconstrução microcirúrgica do trato reprodutivo é preferível à captação de espermatozóides com Fertilização in vitro e Injeção intracitoplasmática de espermatozóides em homens vasectomizados quando o intervalo de obstrução for inferior a 15 anos e ausência de fatores de risco para infertilidade feminina. Se ocorrer uma obstrução epididimária ou se a mulher possuir uma idade avançada, a decisão para ou reconstrução microcirúrgica ou captação de espermatozóides com fertilização in vitro ou Injeção intracitoplasmática de espermatozóides deve ser individualizada. Captação espermática com fertilização in vitro e Injeção intracitoplasmática de espermatozóides é preferível ao tratamento cirúrgico quando o tratamento do fator feminino requer fertilização in vitro ou quando a chance de sucesso com a captação de espermatozóides e Injeção intracitoplasmática de espermatozóides são superiores às chances de sucesso com a captação de espermatozóides e Injeção intracitoplasmática de espermatozóides são superiores às chances com o tratamento cirúrgico.