Soave Armin, Kliesch Sabine, Cremers Jann-Frederik
Klinik und Poliklinik für Urologie, Abteilung für Andrologie der Klinik für Dermatologie und Venerologie, Universitätsklinik Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Abteilung für Klinische und Operative Andrologie, Centrum für Reproduktionsmedizin und Andrologie, WHO Kooperationszentrum und Ausbildungszentrum der Europäischen Akademie für Andrologie, Universitätsklinikum Münster, Münster, Deutschland.
Urologie. 2024 Nov;63(11):1111-1121. doi: 10.1007/s00120-024-02454-9. Epub 2024 Oct 16.
The vasectomy is a safe and effective method of contraception for men. Up to 6% of men who underwent vasectomy have a renewed child wish. Microsurgical vasectomy reversal (VR) in men, microsurgical epididymal sperm aspiration (MESA), or testicular sperm extraction (TESE) in men plus assisted reproductive technology (ART) in the female partner as well as the combination of VR and MESA/TESE plus ART represent established therapeutic strategies. Various factors may impact the success of VR, as defined by patency and pregnancy rate following VR, including the female partner's age, the obstructive interval, and the surgical VR technique. There is no difference in the pregnancy and live birth rate following VR or MESA/TESE plus ART. However, following MESA/TESE plus ART, time to pregnancy is shorter compared with VR. Overall, VR is more cost-effective than MESA/TESE plus ART and allows for a lower therapeutic burden, especially in the female partner. In addition, VR combined with TESE plus-if necessary-ART is more cost-effective than MESA/TESE plus ART alone, even in female partners with advanced age. For successful counseling regarding the different therapy options for a renewed child wish after vasectomy, it is important to evaluate the underlying individual situation of the couple.
输精管结扎术是一种对男性安全有效的避孕方法。接受输精管结扎术的男性中，高达6%的人有生育二胎的愿望。男性的显微外科输精管复通术（VR）、显微外科附睾精子抽吸术（MESA）或睾丸精子提取术（TESE），加上女性伴侣的辅助生殖技术（ART），以及VR与MESA/TESE加ART的联合应用，都是既定的治疗策略。各种因素可能会影响VR的成功率，VR的成功率由复通率和妊娠率来定义，这些因素包括女性伴侣的年龄、梗阻时间间隔以及VR手术技术。VR或MESA/TESE加ART后的妊娠率和活产率没有差异。然而，MESA/TESE加ART后，与VR相比，受孕时间更短。总体而言，VR比MESA/TESE加ART更具成本效益，且治疗负担更低，尤其是对女性伴侣而言。此外，即使是对年龄较大的女性伴侣，VR联合TESE加（如有必要）ART比单独的MESA/TESE加ART更具成本效益。为输精管结扎术后有生育二胎愿望的夫妇成功提供不同治疗方案的咨询时，评估夫妇的个体基本情况很重要。
