AB031. Challenge of microsurgery for male infertility in China

Abstract: There are more than 15% couples suffer from infertility within 1 year. One in eight couples encounters problems when attempting to conceive a first child and one in six when attempting to conceive a subsequent child. The causes of infertility both of male and female could share 50%. With the recent advances in assisted fertilization such as in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), the couples suffer from infertility would like to choose assisted fertilization and nearly 1 million cycles ICSI were carried out in China every year, even its pregnancy rate 40% and live birth rate 35%, with very costed and with risks of inherent and born defects. Among of male factors of infertility, varicoceles are highly relevant (38%) and can result in a myriad of deleterious effects on male reproduction. Varicocele repair may be effective in men with subnormal semen analysis, a clinical varicocele and otherwise unexplained infertility. Numerous therapeutic options are available for correcting varicoceles, including surgical varicocelectomy and radiographic venous embolization. However, recent studies demonstrated that microsurgery for varicocele correction, with the lowest recurrence rate and the highest pregnancy rate compared with other surgical approaches, is a more cost-effective therapeutic modality than both assisted fertility for in infertility couples and it is safe and effective compared to the others surgical approaches. Obstructive azoospermia (OA) are highly prevalent (13%) in male infertility results from obstruction of the excurrent ducts (due to many causes) at any location between the rete testis and the ejaculatory ducts. Recent advances in microsurgical approaches with reversal rate 63.8–79.2%, pregnancy rate 30.6–35.8%. According to the calculations of cost per delivery for vasectomy reversal vs. sperm retrieval/ICSI, under a wide variety of initial assumptions, it is clear that vasectomy reversal/epididymovasostomy is associated with a considerably lower cost per delivery and higher delivery rates. Sperm retrieval and ICSI must yield an 81% pregnancy rate per cycle to achieve equal costs to vasectomy reversal. For the treatment of non-obstructive azoospermia (NOA), microdissection TESE is a more effective approach than other TESE approaches for ICSI, with a patency rate 40–60%, which change the impossible to possible for NOA patients, who want their own inherent child. In our center, there are more than 4,000 cases of patients were treated by microsurgery, including microsurgical varicocelectomy/vasectomy reversal/epididymovasostomy/microdissection TESE, from 2006 to 2016. We think that microsurgical training is important for urologists and clinical. Up to now, in the recent decade, we have trained about 500 surgeons for microsurgery from 30 provinces in China. In summary, the excellent efficacies were noted by microsurgical approaches for male infertility on varicoceles and OA, with lower cost and risks of inherent and born defects compared to in assisted fertilization such as IVF and ICSI.

Keywords: Microsurgery; male infertility; azoospermia