Role for male reconstruction in the era of assisted reproductive technology

Kelly A. Chiles, M.D., Peter N. Schlegel, M.D.

Volume 105, Issue 4, Pages 891-892


Microsurgical reconstruction for male infertility is a relatively recent development in the history of urology therapy. The results of the first microsurgical vasovasostomy (VV) were published in the late1960s, and this epic achievement has been followed by almost fifty years of microsurgical innovation (1). Despite the well-established success of microsurgery, the role of male reproductive tract reconstruction has been called into question because of the many advances made in assisted reproductive technology (ART).

  • Jason Kovac

    In my opinion, with a patient 20 years out from their vasectomy and have a 40 year old female partner.

    Perhaps some patient education from ASRM/Fertility & Sterility would be beneficial. But, I doubt that something like that would ever happen.

    I would be interested in getting some thoughts from IVF/RE doctors on this topic.

  • I agree with Dr. Samplaski’s comment as well as the commentary by the Cornell group.
    Most couples I see desire to conceive naturally. However, I will occasionally recommend taking out insurance (sperm extraction) at the time of reconstruction in the event that the reconstruction is not successful, or has issues (return of sperm but none are motile, significant anti sperm antibodies, etc.).

  • msamplaski

    While the role of the male reproductive tract reconstruction is changing, it is far from obsolete. Many couples prefer to have children “naturally”, by restoring sperm to the ejaculate. Reconstruction also affords couples the option to have multiple children without IVF. Many couples have (substantiated) concerns regarding the safety of IVF, with the ovarian hyperstimulation, oocyte retrieval and embryo transfer. The cost of reconstruction is generally less than IVF; which is a major factor for many of our patients. Finally, IVF success rates are not 100%, a factor which is troubling for many patients. For these reasons, there will always be a role for male reconstructive surgery, even with the increasing use of ART.

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