Era Of Assisted Reproductive Technology Research Articles

Noneffectiveness of cryostorage duration on clinical and neonatal outcomes after single vitrified-warmed blastocyst transfers

BackgroundIn the current era of assisted reproductive technology, the strategy of single vitrified-warmed blastocyst transfer (SVBT) is acknowledged for positively impacting clinical outcomes and preventing the risk of multiple conceptions. Previous studies have indicated that blastocyst grade and the day of blastocyst positively correlate with outcomes. Moreover, storage duration has no significant effect on survival rates, clinical outcomes, and neonatal outcomes. However, some researchers express controversial opinions on cryostorage duration, and their findings suggest a negative impact on clinical outcomes. These results remain subject to controversy, and limited studies exist regarding the outcomes after SVBT. Therefore, our study aims to investigate the impact of the day of blastocyst, blastocyst grade, and blastocyst cryostorage duration on clinical and neonatal outcomes following SVBT in patients who underwent clomiphene-citrate-based minimal stimulation.Material and methodsIn this study, retrospective cohort study data collected from June 2015 to April 2023 included 2107 patients with first SVBT cycles who underwent a clomiphene-based minimal ovarian stimulation protocol or a drug-free natural protocol at the Ojinmed IVF Center. Patients were categorized into four groups based on blastocyst cryostorage duration: group 1 (< 2 months, n = 882), group 2 (3–6 months, n = 794), group 3 (7–12 months, n = 187), group 4 (13–24 months, n = 126), and group 5 (25–81 months, n = 118). The patient’s clinical and neonatal outcomes were compared with cryostorage duration after the propensity score matched.ResultMultivariable logistic regression analysis revealed that prolonged cryostorage duration insignificantly correlated with clinical outcomes. Additionally, neonatal outcomes are not correlated with cryostorage duration.ConclusionsThe patient must consider several parameters when selecting embryos for transfer, including the duration of cryostorage. Our study results show that for the first single vitrified-warmed blastocyst transfer of patients who underwent clomiphene citrate-based minimal stimulation, cryostorage duration does not affect outcomes.

Role of varicocele repair in the era of assisted reproductive technologies: Lessons from 2000 cases of microsurgical varicocele repair.

In an era of advanced maternal age, there is less conclusive evidence regarding the treatment outcomes of varicocele repair for assisted reproductive technology (ART). Progress in basic research on varicocele is notable whereas there are many clinically relevant points to discuss. Based on our experience with more than 2000 cases of microsurgical varicocele repair, we focused on the effectiveness of varicocele repair, pathophysiology, surgical approaches, contributions to ART, sperm DNA fragmentation, and varicocele-associated azoospermia in this review with the aim of identifying clearer directions for basic and clinical research on varicocele. Microsurgical low ligation for varicocele repair is expected to remain the gold standard for surgical therapy. Based on the findings from a number of systematic reviews and meta-analyses, negative opinions regarding the efficacy of microsurgical varicocele repair in male infertility treatment have become virtually nonexistent. However, the majority of evidence regarding surgical indications and effectiveness pertains to improvements in semen parameters or non-ART pregnancy rates. Further understandings regarding to pathophysiology of varicocele will likely be gained through comprehensive genetic, transcriptomic, and epigenetic analyses using blood and testicular samples from humans and we hope to develop new diagnostic methods and pharmacotherapy.

Endoscopic Tubal Restorative Surgeries for Tubal Factor Infertility at a Teaching Hospital in North Central Nigeria: A Preliminary Report of a Prospective Longitudinal Study

Abstract Background: Tubal surgery is an acceptable treatment option for infertility due to tubal factors. However, in the era of assisted reproductive technology, the use of restorative tubal surgery for the treatment of tubal factor infertility has been reduced. Objectives: This study was conducted to determine the incidence of endoscopic tubal surgery, tubal factor infertility, fertility outcomes, and factors that influence successful or favorable outcomes among women with gynecological endoscopic surgeries for tubal factor infertility. Materials and Methods: This is a preliminary report of a prospective longitudinal study of women with endoscopic tubal restorative surgery for tubal factor infertility at a Federal Teaching Hospital in North Central Nigeria between November 9, 2016, and February 12, 2020. Thirty-four women aged 26–42 years who had bilateral tubal blockage before surgeries were analyzed. The primary outcome measure was clinical pregnancy, whereas secondary outcomes were tubal patency, live birth, miscarriage, and ectopic pregnancy rates. Data were analyzed using Statistical Package for the Social Sciences version 26. Data analysis was descriptive and inferential at a 95% confidence interval, P &lt; 0.05 was considered statistically significant. Logistic regression was carried out to determine independent factors for successful fertility outcomes after endoscopic tubal surgery. Results: There were 1534 gynecological admissions among whom 159 (10.4%) had endoscopy surgeries for infertility. Of the 159 women, 37 (23.3%) had confirmed tubal infertility with bilateral tubal blockage on hysterosalpingography and laparoscopy with a dye test. Thirty-four (women who met the inclusion criteria were analyzed and three women who had salpingectomy and bilateral tubal disconnection and those with AMH of &lt;1.0ng/mL were excluded from the study. The mean age was 34.0 ± 5.2 years, and the majority (67.6%) were nulliparous. Peritubal adhesions were the most common tubal pathology seen on laparoscopy. Hysteroscopic tubal cannulation with selective salpingography (41%), salpingolysis (29%), salpingostomy (21%), and fimbrioplasty (9%) were the interventions performed. Bilateral and unilateral tubal patencies were achieved in 58.8% and 32.5%, respectively. The overall cumulative clinical pregnancy rate was 38.2%, out of which 35.3% conceived spontaneously. Live births (LBs) and miscarriage rates are 20.6% and 17.6%, respectively. There was no ectopic pregnancy. Regression estimates showed that lower age (P = 0.029), lesser duration of infertility (P = 0.038), and treatment of other etiological factors at the same setting (P = 0.019) are independent factors for successful fertility outcome after endoscopic restorative tubal surgery. Conclusions: The high rate of spontaneous intrauterine pregnancy and LBs in this study rekindles the hope of natural conception at a low cost among women with tubal factor infertility.

Erkek İnfertilitesinin Cerrahi Dışı Tedavisi: Spesifik Olmayan Tedavi

In male infertility, all possible known causes should be carefully evaluated and if detected, targeted treatment options for the cause should be implemented. The known causes of male infertility such as hypogonadotropic hypogonadism, hyperprolactinemia, genital tract infections, disorders of ejaculation, thyroid hormone disorders and varicocele can be treated efficiently by targeted therapies or surgical corrections. Unfortunately, these known causes cover about 20% of male infertility and the rest remains idiopathic. On the other hand, management of idiopathic, unexplained male infertility, in which no etiological factors can be found, is a challenge for both the clinician and couples seeking solutions. In the era of assisted reproductive technology, few medical options in this regard are still available with limited benefits and low scientific foundation based on theoretical concepts but empirical medical therapy continues as a mostly off-label option for obtaining a natural pregnancy. Comprehending the hypothalamic-pituitary-gonadal axis and the regulation of hormones is crucial in this regard. Empirical therapies have the potential to overcome overtreatment with assisted reproductive technology yet clinicians and couples must be aware of the limitations of empirical therapies and should be counseled in this direction. In this review, non-specific medical treatment options for idiopathic male infertility were covered.

A Systematic Review of the Impact of Mitochondrial Variations on Male Infertility.

According to current estimates, infertility affects one in four couples trying to conceive. Primary or secondary infertility can be due either to both partners or only to the man or the woman. Up to 15% of infertility cases in men can be attributed to genetic factors that can lead to irreversible partial or complete spermatogenic arrest. The increased use of assisted reproductive technology (ART) has provided not only insights into the causes of male infertility but also afforded a diagnostic tool to detect and manage this condition among couples. Genes control a variety of physiological attributes, such as the hypothalamic–pituitary–gonadal axis, development, and germ cell differentiation. In the era of ART, it is important to understand the genetic basis of infertility so as to provide the most tailored therapy and counseling to couples. Genetic factors involved in male infertility can be chromosome abnormalities or single-gene disorders, mitochondrial DNA (mtDNA) mutations, Y-chromosome deletions, multifactorial disorders, imprinting disorders, or endocrine disorders of genetic origin. In this review, we discuss the role of mitochondria and the mitochondrial genome as an indicator of sperm quality and fertility.

Update on genetic screening and treatment for infertile men with genetic disorders in the era of assisted reproductive technology.

A genetic etiology of male infertility is identified in fewer than 25% of infertile men, while 30% of infertile men lack a clear etiology, resulting in a diagnosis of idiopathic male infertility. Advances in reproductive genetics have provided insights into the mechanisms of male infertility, and a characterization of the genetic basis of male infertility may have broad implications for understanding the causes of infertility and determining the prognosis, optimal treatment, and management of couples. In a substantial proportion of patients with azoospermia, known genetic factors contribute to male infertility. Additionally, the number of identified genetic anomalies in other etiologies of male infertility is growing through advances in whole-genome amplification and next-generation sequencing. In this review, we present an up-to-date overview of the indications for appropriate genetic tests, summarize the characteristics of chromosomal and genetic diseases, and discuss the treatment of couples with genetic infertility by microdissection-testicular sperm extraction, personalized hormone therapy, and in vitro fertilization with pre-implantation genetic testing.

Lumbar Skin Lesion in a Term Infant.

Lumbar Skin Lesion in a Term Infant.

Role of tubal surgery in the era of assisted reproductive technology: a committee opinion

This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and invitro fertilization. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2015;103:e37-43). This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and in vitro fertilization.

Role of Hysterosalpingography in Diagnosing Tubal Blockage - A Prospective Diagnostic Study.

Background:Women with abnormal hysterosalpingography (HSG) are anxious regarding the presence of tubal pathology. It is important to know the predictive value of HSG and the need for subsequent laparoscopy following an abnormal report. In the era of assisted reproductive technology, the role of invasive testing such as diagnostic laparoscopy is being increasingly questioned due to its invasiveness and associated risks. There is a need to explore the positive predictive value (PPV) of HSG in detecting bilateral tubal block in our population as PPV changes with the prevalence of disease.Aim:The aim of this study was to evaluate the diagnostic accuracy of HSG in identifying tubal blockage in subfertile women.Setting and Design:This was a prospective diagnostic study conducted in the department of reproductive medicine and surgery in a university-level hospital.Materials and Methods:The study included 199 subfertile women who had undergone HSG earlier and were planned for laparoscopy from April 2017 to January 2021. Findings of HSG and laparoscopy were compared with HSG as index test and laparoscopy as reference test, and the outcomes analysed were PPV of HSG for a bilateral tubal block, bilateral hydrosalpinx, abnormal HSG (unilateral or bilateral tubal block) and agreement between HSG and diagnostic laparoscopy in detecting normal and abnormal findings.Statistical Analysis:Kappa statistics, Stuart–Maxwell tests of marginal homogeneity and prevalence-adjusted bias-adjusted kappa (PABAK) statistics were used.Results:The PPV for a bilateral block with HSG was 20.9% (95% CI: 13.7–29.7). The PPV of HSG for bilateral hydrosalpinx was 50.0% (95% CI: 6.8–93.2). PABAK was estimated to be 0.42 (95% CI: 0.30–0.55), suggestive of moderate agreement between the tests. Findings of laparoscopy in women with at least one patent tube in HSG showed that in 12.3% of cases, the management was likely to change due to the operative findings.Conclusion:The current study showed low PPV for bilateral tubal block diagnosed with HSG which translates into a need for further confirmation by laparoscopy. In one out of every eight women with at least one patent tube on HSG, performing laparoscopy changed the management.

Sperm ion channels and transporters in male fertility and infertility.

Mammalian sperm cells must respond to cues originating from along the female reproductive tract and from the layers of the egg in order to complete their fertilization journey. Dynamic regulation of ion signalling is, therefore, essential for sperm cells to adapt to their constantly changing environment. Over the past 15 years, direct electrophysiological recordings together with genetically modified mouse models and human genetics have confirmed the importance of ion channels, including the principal Ca2+-selective plasma membrane ion channel CatSper, for sperm activity. Sperm ion channels and membrane receptors are attractive targets for both the development of contraceptives and infertility treatment drugs. Furthermore, in this era of assisted reproductive technologies, understanding the signalling processes implicated in defective sperm function, particularly those arising from genetic abnormalities, isof the utmost importance not only for the development of infertility treatments but also to assess the overall health of a patient and his children. Future studies to improve reproductive health care and overall health care as a function of the ability to reproduce should include identification and analyses of gene variants that underlie human infertility and research into fertility-related molecules.

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade.

BackgroundIn the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception.MethodsThis article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches.Main findingsThe reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot‐assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery.ConclusionIn the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.

Fertility preservation for men with testicular cancer: Is sperm cryopreservation cost effective in the era of assisted reproductive technology?

IntroductionMany patients do not cryopreserve sperm before undergoing cancer treatment because of high perceived costs of cryopreservation. We sought to investigate the cost-effectiveness of fertility preservation compared to posttherapeutic fertility treatment in testicular cancer patients. Materials and methodsWe performed a systematic search of the PubMed database for the following: risk of azoospermia 12 months after surveillance, chemotherapy, retroperitoneal lymph node dissection, and radiation therapy (RT); rates of natural conception, and rates of conception with the use of intrauterine insemination or assisted reproductive technology, with or without microsurgical testicular sperm extraction (microTESE). A decision tree was constructed using the TreePlan add-in for Microsoft Excel (TreePlan Software, San Francisco, California). Cost-effectiveness was calculated as the overall cost of a given management branch, divided by likelihood of pregnancy. Calculations accounted for variable number of years of cryopreservation, and variable costs of microTESE. Results1,113 articles were identified; 44 were included in the final analysis. Overall probability of pregnancy was higher among couples who cryopreserved sperm, versus those who did not. In patients undergoing active surveillance or retroperitoneal lymph node dissection, cryopreservation was more cost-effective if storage time was short (<6 years) or microTESE cost was high (>7,000). Cryopreservation prior to chemotherapy was more cost-effective unless microTESE cost was low (<7,000). Cryopreservation prior to RT was more cost-effective in almost all scenarios. ConclusionsSperm cryopreservation prior to undergoing chemotherapy or RT remains the most cost-effective strategy for fertility preservation, across a range of possible costs associated with surgical sperm retrieval and in vitro fertilization/intracytoplasmic sperm injection.

Male factor infertility: Varicocele repair in the era of assisted reproductive technology.

A new publication finds that varicocele repair might improve semen quality enough to enable couples who are awaiting in vitro fertilization or intrauterine insemination to attempt natural conception or less-invasive assisted reproductive techniques. The approach is interesting because it seeks to establish varicocele treatment as one step in a multimodal path to parenthood.

A step-by-step guide to office-based sperm retrieval for obstructive azoospermia.

A variety of surgical options exists for sperm retrieval in the setting of obstructive azoospermia (OA). With appropriate preparation, the majority of these techniques can safely be performed in the office with local anesthesia and with or without monitored anesthesia care (MAC). The available techniques include percutaneous options such as percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA), as well as open techniques that include testicular sperm extraction (TESE) and microsurgical epididymal sperm aspiration (MESA). In addition to providing a step-by-step description of each available approach, we introduce and describe a new technique for sperm retrieval for OA called minimally invasive epididymal sperm aspiration (MIESA). The MIESA utilizes a tiny keyhole incision, and the epididymis is exposed without testicular delivery. Epididymal aspiration is performed in the style of MESA, except using loupe magnification rather than an operating microscope. MIESA is a safe, office-based procedure in which millions of motile sperm can be retrieved for cryopreservation. While we prefer the MIESA technique for OA, there remain distinct advantages of each open and percutaneous approach. In the current era of assisted reproductive technology, sperm retrieval rates for OA should approach 100% regardless of the technique. This reference provides a roadmap for both advanced and novice male reproductive surgeons to guide them through every stage of sperm retrieval for OA, including preoperative evaluation, patient selection, procedural techniques, and complications. With the incredible advances in in vitro fertilization (IVF), combined with innovative surgical treatment for male factor infertility in recent years, OA is no longer a barrier for men to become biologic fathers.

The Role of Varicocele in Male Factor Subfertility.

Varicocele may play a significant role in a subset of patients presenting with male factor infertility. Despite its relatively high prevalence amongst subfertile men, there has been controversy over the effectiveness of surgical treatments, patient selection, and when to administer treatment, particularly in the era of assisted reproductive technology. In line with earlier finding, recent evidence strongly suggests that varicocelectomy improves pregnancy rates and semen parameters. The currently available literature still does not clearly elucidate the answer to this question, due to flaws in retrospective study design. Patients undergoing subinguinal microsurgical varicocelectomy appear to have the highest pregnancy rates, and lowest complication rates, compared to other surgical approaches. Current research has given us a better understanding of the relationship between varicocele and infertility. Amongst men presenting with semen analysis abnormalities and varicoceles, including those patients presenting with non-obstructive azoospermia or couples with a significant male factor component failing previous attempts at in vitro fertilization, varicocelectomy may improve take home baby rates. More robust, prospective, controlled studies are needed to further clarify the population of subfertile men with varicocele most likely to benefit from varicocelectomy.

PD68-11 FATE OF RECURRENT OR PERSISTENT VARICOCELE IN THE ERA OF ASSISTED REPRODUCTION TECHNOLOGY: MICROSURGICAL SUBINGUINAL REDO VARICOCELECTOMY VERSUS OBSERVATION

You have accessJournal of UrologyInfertility: Therapy II1 Apr 2017PD68-11 FATE OF RECURRENT OR PERSISTENT VARICOCELE IN THE ERA OF ASSISTED REPRODUCTION TECHNOLOGY: MICROSURGICAL SUBINGUINAL REDO VARICOCELECTOMY VERSUS OBSERVATION Selahittin Çayan and Erdem Akbay Selahittin ÇayanSelahittin Çayan More articles by this author and Erdem AkbayErdem Akbay More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3139AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of redo varicocelectomy in infertile males with recurrent or persistent varicocele is controversial in the era of assisted reproductive technology (ART). The aim of the study was to compare sperm parameters, pregnancy and miscarriage rates between the men with recurrent or persistent varicocele who underwent redo microsurgical subinguinal varicocelectomy or had observation only. METHODS The study included 217 infertile men with recurrent or persistent varicocele. The patients were divided into two groups: 120 men underwent redo microsurgical subinguinal varicocele repair, and 97 had observation only, as the control group. All patients had clinical varicoceles, and recurrences were confirmed with color Doppler ultrasound. Indications for redo varicocelectomy were no improvement in semen parameters and not achieving pregnancy after at least 6 months of initial varicocelectomy. Difference in total motile sperm count (TMSC), serum follicle stimulating hormone (FSH) and total testosterone levels from the beginning to the end of the study, pregnancy (spontaneous or with the use of ART) and miscarriage rates were compared between the two groups. RESULTS Baseline mean patient and female partners ages, recurrent varicocele sites, TMSC, serum FSH and total testosterone levels, time to recurrence and follow-up period did not significantly differ between the two groups. The mean TMSC increased from 20.93±2.87 to 45.54±6.28 million in the microsurgical redo varicocelectomy group, and decreased from 16.62±2.75 to 15.6±2.81 million in the control group, revealing significant difference between the two groups (p=0.000). Increase in total testosterone was significantly higher in the microsurgical redo varicocelectomy group (+1.36±0.32 ng/ml) than in the control group (-0.23±0.1 ng/ml) (p=0.000). Of the couples, 63 (52.5%) achieved to pregnancy in the redo microsurgical varicocelectomy group, and 38 (39.2%) had pregnancy in the control group (p<0.05). Spontaneous pregnancy rate was significantly higher in the microsurgical varicocelectomy group (39.7%) than in the control group (15.8%) (p<0.01). Use of ART to achieve pregnancy was significantly lower in the microsurgical varicocelectomy group (60.3%) than in the control group (84.2%) (p<0.01). CONCLUSIONS Microsurgical subinguinal redo varicocelectomy improves postoperative semen parameters, serum total testosterone level and spontaneous pregnancy rates, compared to the controls. It also decreases need for use and level of ART. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1343 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Selahittin Çayan More articles by this author Erdem Akbay More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fertility Outcomes after Laparoscopic Reversal of Tubal Sterilization

Objective: To know pregnancy outcome in the tubal reversal of sterilized women.&#x0D; &#x0D; Method: Literature review.&#x0D; &#x0D; Results: Sterilization is considered the most common contraception methods in United States of America, approximately 39% women in reproductive age (15 - 44 years) used this method. However, approximately 15% of these patients deplored this decision due to the influence of their own environment and some factors, such as: young age, the death of a child, the disability of child, and change of partner/ remarried. Tubal reanastomosis or tubal reversal is a surgical procedure that attempts to restore the fallopian tube patency following sterilization. To date, the modern procedure is performed by doing an excision of the tubal segment and reanastomosis by transabdominal laparoscopy. Recently, the laparoscopic technology has developed and evolved rapidly as the robotic assisted laparoscopy was invented. There is alternative method for restoring the fertility in sterilized women who regretted the decision of being sterilized.&#x0D; Unlike the tubal reversal which is conducted in order to restore the tubal function, the IVF is performed to bypass the function of tubes in fertility. The major advantage for laparoscopic surgery is short postoperative stay duration with minimal tissue handling, less postoperative&#x0D; adhesions, and diminish morbidity rate. Despite of its&#x0D; major drawback, high-cost of robotic machine and machine maintenance; there are advantages of robotic laparoscopy compared to the conventional laparoscopy, such as improved dexterity, more precise and accurate articulation, reduced tremor, and better visualization&#x0D; of the operating field. In vitro fertilization (IVF) is the hallmark in the era of assisted reproductive technology and became an alternative option to regain the fertility in sterilized women.&#x0D; &#x0D; Conclusion: The pregnancy rate and live birth rate in laparoscopy, robotic and open surgery were relatively similar. Surgical reversal to women younger than 40 is recommended and laparoscopic reversal should be performed if the expertise is available. It is reasonable to&#x0D; counsel IVF to over 40 women.&#x0D; [Indones J Obstet Gynecol 2012; 36-3: 154-60]&#x0D; &#x0D; Keywords: gynecology, IVF, pregnancy outcomes, reanastomosis, robotic laparoscopy, tubal reversal

Challenges Towards Establishing Germline Gene Therapy for Inherited Mitochondrial Diseases

Abstract: Mitochondrial DNA (mtDNA) mutation is associated with serious human disorders and affects multiple organs and tissues with high-energy requirements. Since the transmission of mtDNA is complex and is not fully understood, an accurate estimation of mtDNA disease transmission by preimplantation genetic diagnosis (PGD) or by prenatal diagnosis (PND) remains challenging. Recently, nuclear transfer techniques, including maternal spindle transfer (MST), pronuclear transfer (PNT) and polar body transfer (PBT), have shown the promising results. These methods avoid the transmission of mutated mtDNA from mother to offspring, and are collectively known as the mitochondrial replacement therapy (MRT). Further, the United Kingdom Parliament approved the Human Fertilisation and Embryology Authority (HFEA) to grant licenses for experimental use of MST and PNT in humans in 2015. Thus, a new era of assisted reproductive technology (ART), in which cures can be provided at the gamete or early zygote stages, is reali...

Cost-effectiveness of varicocele surgery in the era of assisted reproductive technology.

The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.

Role of tubal surgery in the era of assisted reproductive technology: a committee opinion

This document reviews surgical options for achieving patency in obstructed fallopian tubes and the factors that must be considered when deciding between surgical repair and IVF. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2012;97:539–45).