This study comprises a systematic review and meta-analysis of micmsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia.A comprehensive literature search was performed using Medline,Embase,and the...This study comprises a systematic review and meta-analysis of micmsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia.A comprehensive literature search was performed using Medline,Embase,and the Cochrane library that included all studies related to microsurgical vasoepididymostomy.Keywords included “vasoepididymostomy,”“epididymovasostomy,”“epididymal obstruction,”and “epididymis obstruction.”Event rate and risk ratio (RR)were estimated.Patency rate and pregnancy rate were investigated.The analysis comprised 1422 articles,including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017.The overall mean patency rate was 64.1%(95%confidence interval [CI]:58.5%-69.3%;F=83.0%),and the overall mean pregnancy rate was 31.1%(95%CI:26.9%-35.7%;I^2=73.0%).We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38%(95%CI: 1.21%-1.57%;P <0.00001).A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR =1.17%;95%CI: 1.01%-1.35%;P =0.04).Patients with motile sperm in epididymal fluid exhibited an RR of 1.53%(95%CI:1.11%-2.13%;P =0.01)with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally,anastomosing a larger caudal area,and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.展开更多
Infertility affects approximately 15% of couples, and male factor is responsible for 30%-50% of all infertility. The most severe form of male infertility is testicular failure, and the typical phenotype of testicular ...Infertility affects approximately 15% of couples, and male factor is responsible for 30%-50% of all infertility. The most severe form of male infertility is testicular failure, and the typical phenotype of testicular failure is severely impaired spermatogenesis resulting in azoospermia or severe oligozoospermia. Although the etiology of testicular failure remains poorly understood, genetic factor typically is an underlying cause. Modern assisted reproductive techniques have revolutionized the treatment of male factor infertility, allowing biological fatherhood to be achieved by many men who would otherwise have been unable to become father to their children through natural conception. Therefore, identifying genetic abnormalities in male is critical because of the potential risk of transmission of genetic abnormalities to the offspring. Recently, along with other intense researches ongoing, whole-genome approaches have been used increasingly in the genetic studies of male infertility. In this review, we focus on the genetics of testicular failure and provide an update on the advances in the study of genetics of male infertility.Infertility affects approximately 15% of couples, and male factor is responsible for 30%-50% of all infertility. The most severe form of male infertility is testicular failure, and the typical phenotype of testicular failure is severely impaired spermatogenesis resulting in azoospermia or severe oligozoospermia. Although the etiology of testicular failure remains poorly understood, genetic factor typically is an underlying cause. Modern assisted reproductive techniques have revolutionized the treatment of male factor infertility, allowing biological fatherhood to be achieved by many men who would otherwise have been unable to become father to their children through natural conception. Therefore, identifying genetic abnormalities in male is critical because of the potential risk of transmission of genetic abnormalities to the offspring. Recently, along with other intense researches ongoing, whole-genome approaches have been used increasingly in the genetic studies of male infertility. In this review, we focus on the genetics of testicular failure and provide an update on the advances in the study of genetics of male infertility.展开更多
文摘This study comprises a systematic review and meta-analysis of micmsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia.A comprehensive literature search was performed using Medline,Embase,and the Cochrane library that included all studies related to microsurgical vasoepididymostomy.Keywords included “vasoepididymostomy,”“epididymovasostomy,”“epididymal obstruction,”and “epididymis obstruction.”Event rate and risk ratio (RR)were estimated.Patency rate and pregnancy rate were investigated.The analysis comprised 1422 articles,including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017.The overall mean patency rate was 64.1%(95%confidence interval [CI]:58.5%-69.3%;F=83.0%),and the overall mean pregnancy rate was 31.1%(95%CI:26.9%-35.7%;I^2=73.0%).We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38%(95%CI: 1.21%-1.57%;P <0.00001).A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR =1.17%;95%CI: 1.01%-1.35%;P =0.04).Patients with motile sperm in epididymal fluid exhibited an RR of 1.53%(95%CI:1.11%-2.13%;P =0.01)with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally,anastomosing a larger caudal area,and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.
文摘Infertility affects approximately 15% of couples, and male factor is responsible for 30%-50% of all infertility. The most severe form of male infertility is testicular failure, and the typical phenotype of testicular failure is severely impaired spermatogenesis resulting in azoospermia or severe oligozoospermia. Although the etiology of testicular failure remains poorly understood, genetic factor typically is an underlying cause. Modern assisted reproductive techniques have revolutionized the treatment of male factor infertility, allowing biological fatherhood to be achieved by many men who would otherwise have been unable to become father to their children through natural conception. Therefore, identifying genetic abnormalities in male is critical because of the potential risk of transmission of genetic abnormalities to the offspring. Recently, along with other intense researches ongoing, whole-genome approaches have been used increasingly in the genetic studies of male infertility. In this review, we focus on the genetics of testicular failure and provide an update on the advances in the study of genetics of male infertility.Infertility affects approximately 15% of couples, and male factor is responsible for 30%-50% of all infertility. The most severe form of male infertility is testicular failure, and the typical phenotype of testicular failure is severely impaired spermatogenesis resulting in azoospermia or severe oligozoospermia. Although the etiology of testicular failure remains poorly understood, genetic factor typically is an underlying cause. Modern assisted reproductive techniques have revolutionized the treatment of male factor infertility, allowing biological fatherhood to be achieved by many men who would otherwise have been unable to become father to their children through natural conception. Therefore, identifying genetic abnormalities in male is critical because of the potential risk of transmission of genetic abnormalities to the offspring. Recently, along with other intense researches ongoing, whole-genome approaches have been used increasingly in the genetic studies of male infertility. In this review, we focus on the genetics of testicular failure and provide an update on the advances in the study of genetics of male infertility.
