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Minimally invasive surgery for male subfertility

BMJ 1996; 312 doi: (Published 06 January 1996) Cite this as: BMJ 1996;312:5
  1. Y Khalifa,
  2. J G Grudzinskas
  1. Clinical research fellow in reproductive medicine Professor of obstetrics and gynaecology Joint Academic Unit of Obstetrics, Gynaecology, and Reproductive Physiology, London Hospital Medical College, London E1 2AD

    Giving hope to azoospermic men

    Minimally invasive surgery is well established in the diagnosis and treatment of infertile women. With continuing advances in the design of fibreoptic instruments, especially the development of small diameter endoscopes, the concept of minimally invasive surgery can now be applied to the diagnosis and treatment of male subfertility, particularly in the management of azoospermic men.1 2

    Azoospermia is caused either by obstruction or absence of the vas deferens or by abnormalities in spermatogenesis. Obstructive azoospermia—due to bilateral congenital absence of the vas deferens, a failed reversal of vasectomy, or inflammatory epididymitis—is the reason for infertility in 1-2% of infertile couples.3 Until recently, azoospermic men were considered to be irrevocably sterile, with their only option being donor insemination. It is now clear that spermatozoal transit through the epididymis is not crucial for fertilisation as pregnancies have occurred after epididymovasostomy4 and …

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