Abstract：
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: Systematic review based on a Pubmed search of surgeries to improve male fertility.
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.
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.
METHODS: Systematic review based on a Pubmed search of surgeries to improve male fertility.
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.
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.
摘要：
背景：在越来越关注体外受精技术的局限性和风险的时候，提高男性生育能力的手术吸引了越来越多的兴趣。
方法：基于Pubmed搜索提高男性生育力的手术的系统评价。
结果：血管造口术（VV）的通畅率为70-97％，妊娠率为30-76％。血管附睾造口术（VE）的通畅率为80-84％，怀孕率为40-44%。阻塞的持续时间和伴侣的年龄是自然妊娠发生的2个预测参数。在由于盆腔梗阻（前列腺囊肿，射精管阻塞)，可以提出几种外科手术。经尿道射精管切除术可改善63-83％的患者的精子参数，12-31％的病例发生自发妊娠。通过腹股沟下途径的精索静脉曲张的显微外科治疗是一种基准技术，复发率低于4％。它提高了活产和怀孕率，自然和体外受精，以及精子数量，运动性和DNA碎片率。
结论：只要有可能，泌尿科医生应该向ART团队和这对夫妇提供改善男性生育能力的手术选择，作为个性化方法的一部分，讨论运营的收益/风险平衡。
方法：基于Pubmed搜索提高男性生育力的手术的系统评价。
结果：血管造口术（VV）的通畅率为70-97％，妊娠率为30-76％。血管附睾造口术（VE）的通畅率为80-84％，怀孕率为40-44%。阻塞的持续时间和伴侣的年龄是自然妊娠发生的2个预测参数。在由于盆腔梗阻（前列腺囊肿，射精管阻塞)，可以提出几种外科手术。经尿道射精管切除术可改善63-83％的患者的精子参数，12-31％的病例发生自发妊娠。通过腹股沟下途径的精索静脉曲张的显微外科治疗是一种基准技术，复发率低于4％。它提高了活产和怀孕率，自然和体外受精，以及精子数量，运动性和DNA碎片率。
结论：只要有可能，泌尿科医生应该向ART团队和这对夫妇提供改善男性生育能力的手术选择，作为个性化方法的一部分，讨论运营的收益/风险平衡。
