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Male-Factor
Infertility
DEFINITION:
It is estimated that one of five couples will have difficulty
establishing a pregnancy and that a male factor will be identified
as the sole or contributing cause in 40% of these cases. As
the number of couples seeking assistance rises, male reproductive
disorders have become an increasingly important part of the
infertility examination. Current diagnostic and advanced treatment
modalities have significantly improved prognosis and created
a new era in the treatment of male-factor infertility. Currently,
a comprehensive male-factor infertility evaluation includes
a test of sperm function aimed at identifying abnormalities
not apparent on the routine semen analysis. Such isolated
defects may allow the clinician to recommend a more appropriate
and informed treatment plan. As specific defects of fertilization
are identified and more appropriate therapeutic plans can
be recommended, it is hoped that improved success rates for
many male-factor patients will be achieved. Variococeles,
which are dilated spermatic veins located within the pampiniform
plexus, are an important treatable cause of male-factor infertility.
TREATMENTS
Microsurgical reconstructive surgery of the male reproductive
tract continues to be an important treatment option for male-factor
infertility. Of the approximately 500,000 men who undergo
vasectomy annually in the United States, an increasing number
present later for vasectomy reversal. Reconstruction of vasal
patency is also indicated following obstruction of infectious,
congenital or iatrogenic origin. Initial macrosurgical approaches
have been replaced by the more-precise microsurgical techniques.
Expected patency rates using these microsurgical techniques
are around 90%, with pregnancy rates ranging from 50% to 80%.Treatment
options for varicocele include surgical repair, percutaneous
venographic occlusion, and laparoscopy. A subinguinal microscopic
surgical repair is advocated by many urologists as the current
treatment of choice
BENEFITS Thoroughness of the ligation,
minimal recurrence and complication rate, and short post-operative
recovery period.
FIND
A DOCTOR This surgery is performed by the following
physician(s). Click on a name for a complete profile and contact
information.
Natan
Bar-Chama, MD
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