Austin Fertility& Reproductive Medicine/Westlake IVF, Austin, TX, USA.
Andrology. 2018 Jul;6(4):556-558. doi: 10.1111/andr.12491. Epub 2018 Apr 2.
The purpose of this study was to identify factors which impact a couples' decision-making between the options of vasectomy reversal vs. sperm retrieval/in vitro fertilization/intracytoplasmic sperm injection when counseled both by a reproductive urologist and a reproductive endocrinologist. A retrospective chart review was performed of couples who wish to achieve a pregnancy with a male partner with a history of prior vasectomy, in a couples' private fertility center. Of patients presenting for fertility options with a history of vasectomy, 175 couples elected to be counseled by both a reproductive urologist and a reproductive endocrinologist on the options between vasectomy reversal and sperm retrieval/in vitro fertilization/intracytoplasmic sperm injection, with 78.3% of the couples opting for vasectomy reversal and 21.7% opting for sperm retrieval/in vitro fertilization/intracytoplasmic sperm injection. The overall mean age of the male partners was 40.5 years of age, and the mean age of the female partners was 33. The mean obstructed interval was 9.7 years. Twenty-three percent of the female partners in couples selecting vasectomy reversal had diminished ovarian reserve, and 31.6% of couples selecting sperm retrieval/in vitro fertilization/intracytoplasmic sperm injection had female partners with diminished ovarian reserve, two of which elected to have donor oocyte in vitro fertilization/intracytoplasmic sperm injection. Male age, female age, and ovarian reserve status did not have significant roles in this decision-making (p value 0.3578, 0.1185, and 0.3041, respectively); however, a longer obstructed interval since vasectomy was a significant factor associated with couples opting for sperm retrieval/in vitro fertilization/intracytoplasmic sperm injection (0.0238). In this study, the majority of couples who were counseled on vasectomy reversal vs. sperm retrieval/in vitro fertilization/intracytoplasmic sperm injection by a reproductive urologist and reproductive endocrinologist chose vasectomy reversal. Neither male partner age, female partner age, nor ovarian reserve status seemed to impact the decision; however, a longer obstructed interval was a significant factor that was associated with the decision of couples toward sperm retrieval/in vitro fertilization/intracytoplasmic sperm injection rather than vasectomy reversal.
本研究旨在确定影响夫妇在接受生殖泌尿科医生和生殖内分泌医生咨询后，在输精管复通术与精子提取/体外受精/胞浆内单精子注射之间做出选择的因素。对在一家私人生育中心寻求生育治疗的、有既往输精管结扎史的男性伴侣进行了回顾性图表分析。在有输精管结扎史的患者中，有 175 对夫妇选择接受生殖泌尿科医生和生殖内分泌医生的咨询，以了解输精管复通术与精子提取/体外受精/胞浆内单精子注射之间的选择，其中 78.3%的夫妇选择输精管复通术，21.7%的夫妇选择精子提取/体外受精/胞浆内单精子注射。男性伴侣的平均年龄为 40.5 岁，女性伴侣的平均年龄为 33 岁。平均梗阻时间为 9.7 年。在选择输精管复通术的夫妇中，有 23%的女性伴侣卵巢储备功能下降，而在选择精子提取/体外受精/胞浆内单精子注射的夫妇中，有 31.6%的女性伴侣卵巢储备功能下降，其中 2 对选择接受供体卵体外受精/胞浆内单精子注射。男性年龄、女性年龄和卵巢储备状态在这一决策中没有显著作用（p 值分别为 0.3578、0.1185 和 0.3041）；然而，输精管结扎后梗阻时间较长是夫妇选择精子提取/体外受精/胞浆内单精子注射的一个重要因素（0.0238）。在这项研究中，大多数接受生殖泌尿科医生和生殖内分泌医生咨询的夫妇选择了输精管复通术而不是精子提取/体外受精/胞浆内单精子注射。男性伴侣年龄、女性伴侣年龄和卵巢储备状态似乎都没有影响这一决策；然而，梗阻时间较长是与夫妇选择精子提取/体外受精/胞浆内单精子注射而不是输精管复通术相关的重要因素。
