Female ; Humans ; Infertility, Female ; surgery ; Laparoscopy ; Male ; Pregnancy ; Pregnancy Outcome

Female ; Humans ; Hysteroscopy ; Infertility, Female ; Laparoscopy ; Pregnancy ; Uterus/surgery*

In this review, we tried to systematize all the evidence (from PubMed [MEDLINE], Scopus, Cochrane Library, EBSCO, Embase, and Google Scholar) from 1993 to 2021 on the predictors of microsurgical varicocelectomy efficacy in male infertility treatment. Regarding the outcomes of varicocele repair, we considered semen improvement and pregnancy and analyzed them separately. Based on the 2011 Oxford CEBM Levels of Evidence, we assigned a score to each trial that studied the role of the predictor. We systematized the studied predictors based on the total points, which were, in turn, calculated based on the number and quality of studies that confirmed or rejected the studied predictor as significant, into three levels of significance: predictors of high, moderate, and low clinical significance. Preoperative total motile sperm count (TMSC) coupled with sperm concentration can be a significant predictor of semen improvement and pregnancy after varicocelectomy. In addition, for semen improvement alone, scrotal Doppler ultrasound (DUS) parameters, sperm DNA fragmentation index (DFI), and bilateral varicocelectomy are reliable predictors of microsurgical varicocelectomy efficacy.
Female ; Humans ; Male ; Pregnancy ; Infertility, Male/surgery* ; Microsurgery ; Semen ; Sperm Count ; Sperm Motility ; Varicocele/surgery*

Pulmonary endometriosis is an uncommon disease, and usually detected by catamenial hemoptysis. Treatment of pulmonary endometriosis may be medical(hormone therapy) or surgical. Since hormone therapy may cause sterility, most of patients who wish to conceive usually choose surgical resection. Although video-assisted thoracic surgery(VATS) has advantage of small scar, reducing postoperative pain and shortening hospital stay, it is not easy to locate the precise lesion and resect whole endometrial tissue not to be remained. 17 years old female with catamenial hemoptysis was treated sucessfully with a partial resection of the lung using VATS, and has been asymptomatic for 7months since the operation.
Adolescent ; Cicatrix ; Endometriosis* ; Female ; Hemoptysis ; Humans ; Infertility ; Length of Stay ; Lung ; Pain, Postoperative ; Thoracic Surgery, Video-Assisted*

OBJECTIVETo investigate the clinical effect of microsurgical vasoepididymostomy and/or vasovasostomy in the treatment of obstructive azoospermia.

METHODSThis study included 76 patients with obstructive azoospermia, 53 treated by bilateral vasoepididymostomy (8 involving the epididymal head, 18 involving the epididymal body, 5 involving the epididymal tail, and 22 involving the epididymal head, body and tail), 14 by unilateral vasoepididymostomy, and the other 9 by unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis). We followed up the patients for 2 to 16 months for the patency rate, routine semen parameters, and pregnancy outcomes.

RESULTSThe success rate of bilateral vasoepididymostomy, unilateral vasoepididymostomy, and unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis) were 62.26% (33/53), 35.71% (5/14), and 77.78% (7/9), respectively. The average sperm concentrations in the three groups of patients were (27.9 +/- 5.74), (11.8 +/- 8.33), and (19.9 +/- 7.53) x 10(6)/ml, the average total sperm counts were (65.6 +/- 13.71), (28.0 +/- 15.86), and (69.2 +/- 28.59) x 10(6), and the mean rates of progressively motile sperm were (22.3 +/- 3.18), (11.0 +/- 9.77), and (15.8 +/- 5.05)%, respectively. The success rates of bilateral vasoepididymostomy that involved the epididymal head, body, tail, and all the three parts were 62.5, 72.22, 60, and 54.55%, respectively. Natural pregnancy was achieved in 8 (10.53%) of the total number of cases.

CONCLUSIONMicrosurgery is effective for the treatment obstructive azoospermia. Unilateral vasoepididymostomy + unilateral vasovasostomy is superior to the other procedures, followed by bilateral vasoepididymostomy. Bilateral vasoepididymostomy involving the epididymal body may achieve a slightly better effect than that involving the other epididymal parts.

Adult ; Anastomosis, Surgical ; methods ; Azoospermia ; etiology ; surgery ; Epididymis ; surgery ; Female ; Humans ; Infertility, Male ; surgery ; Male ; Microsurgery ; Pregnancy ; Pregnancy Rate ; Sperm Count ; Treatment Outcome ; Vas Deferens ; surgery ; Vasovasostomy ; methods

We report 3 cases of successful pregnancies in women with a history of surgeries for gynecological malignancies and postoperative infertility, achieved by in vitro fertilization-embryo transfer (IVF-ET) with controlled ovarian hyperstimulation. All the 3 patients had clinical pregnancies without cancer recurrence. In such cancer survivors with infertility, the ovarian reserve is severely impaired by cancer therapies and assisted reproductive techniques should be the primary option.
Embryo Transfer ; Female ; Fertilization in Vitro ; Gynecologic Surgical Procedures ; adverse effects ; Humans ; Infertility, Female ; therapy ; Neoplasms ; surgery ; Pregnancy ; Reproductive Techniques, Assisted

In the past two decades, with the rapid development of assisted reproductive technology and particularly the technological advances in male infertility microsurgery, many obstructive azoospermia-related infertile couples can now acquire the chances of natural pregnancy via reconstruction of the seminal tract. This article highlights the latest advances in surgical reconstruction of the seminal tract for the treatment of obstructive azoospermia, such as the application of laparoscopic and robotic techniques, with a discussion on microsurgical epididymal sperm aspiration and preservation, potential use of absorbable sutures or the bio-suture tape for microsurgical anastomosis in the management of obstructive azoospermia.
Azoospermia ; surgery ; Female ; Humans ; Infertility, Male ; surgery ; Laparoscopy ; Male ; Microsurgery ; methods ; Pregnancy ; Reproductive Techniques, Assisted ; Robotic Surgical Procedures ; Seminal Vesicles ; surgery ; Sperm Retrieval ; Sutures

The hemodynamic characteristics of venous reflux are associated with infertility in patients with varicocele; however, an effective method for quantifying the structural distribution of the reflux is lacking. This study aimed to predict surgical outcomes using a new software for venous reflux quantification. This was a retrospective cohort study of a consecutive series of 105 patients (age range: 22-44 years) between July 2017 and September 2019. Venous reflux of the varicocele was obtained using the Valsalva maneuver during scrotal Doppler ultrasonography before microsurgical varicocelectomy. Using this software, the colored reflux signals were segmented, and the gray scale of the color pixels representing the reflux velocity was comprehensively quantified into the mean reflux velocity of the green layer (MRVG) and the reflux velocity standard deviation of the green layer (RVSDG). Spontaneous pregnancy and changes from baseline in the semen parameters were assessed during a 12-month follow-up period. Data were analyzed using logistic regression analysis. An association of the high MRVG group with impaired progressive motility (odds ratio [OR] = 2.868, 95% confidence interval [CI]: 1.133-7.265) and impaired sperm concentration (OR = 2.943, 95% CI: 1.196-7.239) was found during multivariate analysis. High MRVG (OR = 2.680, 95% CI: 1.086-6.614) and high RVSDG (OR = 2.508, 95% CI: 1.030-6.111) were found to be independent predictors of failure to achieve pregnancy following microsurgical repair. In summary, intense venous reflux is an independent predictor of impaired progressive motility, sperm concentration, and pregnancy outcomes after microsurgical varicocelectomy.
Pregnancy ; Female ; Humans ; Male ; Young Adult ; Adult ; Varicocele/surgery* ; Retrospective Studies ; Semen ; Veins/surgery* ; Sperm Count ; Infertility, Male/surgery* ; Microsurgery/methods* ; Sperm Motility

Catamenial hemoptysis is a rare condition caused by thoracic endometriosis that presents as tracheobronchial or pulmonary endometriosis. While hormonal treatment may cause virilization and sterility, due to the antiestrogenic effect, its surgical removal via thoracotomy is a particularly invasive procedure and is not recommended as the first choice treatment in young woman. Successful surgical removal by video-assisted thoracoscopic surgery (VATS) has recently been reported, and may be indicated for young patients who at some stage would like to become pregnant. Herein, a case of a 25-year-old unmarried woman with catamenial hemoptysis, cured by VATS, is reported.
Adult ; Endometriosis* ; Estrogen Receptor Modulators ; Female ; Hemoptysis ; Humans ; Infertility ; Single Person ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy ; Virilism

OBJECTIVETo discuss the value of pre-operative semen analysis of patients with varicocele as a predictive restore index of sperm motility and fertilizing capacity after varicocelectomy.

METHODSSemen analysis was carried out with computer-aided sperm analyzer in 107 patients with varicocele and all patients were referred to the clinic with diagnosis of male infertility. Stratification of patients as group A (n = 32), B ( n = 36) and C (n = 39) was based on pre-operative total motile sperm count (TMSC). Follow-up included semen analysis and pregnancy data after three months following left or bilateral varicocelectomy.

RESULTSThe average post-operative TMSC increased significantly when compared with the pre-operative. However, a mean absolute increase in group A and B was better than that in group C (P < 0.05). Of the 68 patients in groups A and B based on pre-operative TMSC, 56 patients' TMSC (82.4%) was > or =20 x 10(6) after varicocelectomy, and that of only 8 (20.5%) patients in group C was > or =20 x 10(6) following varicocelectomy. Of the 98 patients wives, 36 had natural conception. Pregnancy rates in groups A and B were higher than that in group C (P < 0.05).

CONCLUSIONVaricocelectomy may be the most effective method to patients with varicocele with pre-operative TMSC > or = 5 x 10(6), but it may be not the best method for patients with severe oligoasthenospermia (pre-operative TMSC < 5 x 10(6)).

Adult ; Female ; Follow-Up Studies ; Humans ; Infertility, Male ; physiopathology ; surgery ; Ligation ; Male ; Pregnancy ; Pregnancy Rate ; Semen ; physiology ; Sperm Count ; Sperm Motility ; Varicocele ; physiopathology ; surgery