The pregnancy outcomes in patients with epididymal obstructive azoospermia after microsurgical vasoepididymostomy: a systematic review and meta-analysis

Frontiers in Medicine

Medicine

Fuding Lu¹  Xinkun Wang¹  Changze Song¹  Senbao Tan¹  Jiawen Zhai¹  Baohong Jiang¹  Zilong Wang¹  Naifa Li¹  Xujun Xuan² 

[1] Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China;Department of Andrology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China;National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Cheeloo College of Medicine, Shandong University, Jinan, China;

关键词: microsurgical vasoepididymostomy;    epididymal obstructive azoospermia;    assisted reproductive technology;    patency rate;    natural pregnancy;    pregnancy outcome;   

DOI  :  10.3389/fmed.2023.1186729

 received in 2023-03-15, accepted in 2023-04-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

PurposePregnancy outcomes (overall patency rate, overall pregnancy rate, natural pregnancy rate, and the ratio of patients with pregnancy by assisted reproductive technology) after microsurgical vasoepididymostomy (MVE) in patients with epididymal obstructive azoospermia (EOA) were assessed through meta-analysis.MethodWe searched PubMed, Embase, Web of Science, and the Cochrane Library databases up to 28 September 2022 for published literature related to retrospective or prospective clinical studies of obstructive azoospermia after apparent microsurgical vasoepididymostomy. Our search terms included obstructive azoospermia, epididymis obstruction, epididymal obstruction and vasoepididymostomy, and epididymovasostomy. Two researchers independently performed the literature search and assessed the eligibility of selected studies according to established inclusion criteria. The meta-analysis was performed using RevMan 5.4 software.ResultA total of 504 patients with EOA were included in 10 studies (including 2 prospective clinical studies and 8 retrospective clinical studies). The mean patency rate after MVE was 72% (95% CI 68–76%). The overall pregnancy rate was 34% (95% CI 30–38%). The natural pregnancy rate is 21% (95% CI 17–24%). The ratio of patients with pregnancy by assisted reproductive technology (ART) was 34.9%. For the factors affecting pregnancy outcomes after MVE, the overall pregnancy rates in patients receiving bilateral MVE were significantly higher than those receiving unilateral MVE (75.4 vs. 24.6%). The mean best sperm count and sperm motility in patients with overall pregnancy were significantly higher than those with failing pregnancies. For the subgroup meta-analysis of microsurgical vasoepididymostomy, there were no statistically significant differences in the overall patency rate (68 vs. 70%), the overall pregnancy rate (33 vs. 37%), the natural pregnancy rate (20 vs. 23%), the ratio of ART (30 vs. 28%) in end-to-side or end-to-end anastomosis, and longitudinal or triangular intussusception MVE.ConclusionVasectomy patency rates are higher, but natural pregnancy rates are lower in EOA male infertility patients after MVE. Altering the MVE procedures alone does not significantly improve pregnancy outcomes, but ART after MVE could improve the chance of pregnancy regardless of sperm parameters. We recommended that human sperms from EOA male infertility patients should be cryopreserved during intraoperative MVE for application in the subsequent ICSI treatment procedure.

【 授权许可】

Unknown   
Copyright © 2023 Wang, Wang, Song, Lu, Zhai, Li, Jiang, Tan and Xuan.