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. 2017 Oct 4;17(1):44-51.
doi: 10.1002/rmb2.12065. eCollection 2018 Jan.

Nationwide survey of urological specialists regarding male infertility: results from a 2015 questionnaire in Japan

Yasushi Yumura  1 , Akira Tsujimura  2 , Takashi Imamoto  3 , Yukihiro Umemoto  4 , Hideyuki Kobayashi  5 , Koji Shiraishi  6 , Takeshi Shin  7 , Hisanori Taniguchi  8 , Koji Chiba  9 , Yasushi Miyagawa  10 , Teruaki Iwamoto  11
Affiliations

Nationwide survey of urological specialists regarding male infertility: results from a 2015 questionnaire in Japan

Yasushi Yumura et al. Reprod Med Biol. .

Abstract

Purpose: To investigate the incidence, etiology, treatment indications, and outcomes regarding infertile male patients in Japan.

Methods: Between April, 2014 and March, 2015, the authors contacted 47 clinical specialists in male infertility who had been certified by the Japan Society for Reproductive Medicine. The participating clinicians were sent a questionnaire regarding information on their infertile patients, according to etiology and the number and success rates of male infertility operations that had been performed in their practice.

Results: Thirty-nine specialists returned the questionnaire and provided information regarding 7268 patients. The etiology of infertility included testicular factors, sexual disorders, and seminal tract obstruction. During the study year, the clinicians performed varicocelectomies, testicular sperm extractions (TESEs), and re-anastomoses of the seminal tract. The rate of successful varicocelectomies was >70%. The sperm retrieval rates with conventional TESE and microdissection TESE were 98.3% and 34.0%, respectively, while the patency rates with vasovasostomy and epididymovasostomy were 81.8% and 61.0%, respectively.

Conclusion: Surgical outcomes for infertile male patients are favorable and can be of great clinical benefit for infertile couples. To achieve this, urologists should work in collaboration with gynecological specialists in order to optimize the treatment of both partners.

Keywords: epidemiology; etiology; male infertility; nationwide survey; postsurgical outcome.

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Figures

Figure 1
Figure 1
Responder characteristics: Affiliations of the responding urologists (n = 39)
Figure 2
Figure 2
Distribution of the patients according to a semen analysis. Asthenospermia: sperm motility <40%; severe oligospermia, sperm concentration: <5 × 106/mL; oligospermia, sperm concentration: <15 × 106/mL
Figure 3
Figure 3
Comparison of this study (2015) to that of another study in 1997;5 the distribution of patients according to the etiology of infertility. Compared to the previous study in 1997, the number of patients with sexual dysfunction increased from 50 to 980. There was a reversal in the distribution of patients with a sexual disorder and seminal tract obstruction
Figure 4
Figure 4
Indications for a varicocelectomy, according to the clinical grade and surgical technique. The numbers in parentheses indicate the number of responding urologists. The most common indication for a varicocelectomy (regardless of the surgical technique) was a varicocele greater than Grade 2
Figure 5
Figure 5
Outcomes of varicocelectomy. The overall success rate of the technique was >70% and 316 patients went on to father children
Figure 6
Figure 6
Outcomes of testicular semen extraction (TESE). The number of patients who were treated with conventional TESE and whose sperm were retrieved or who had a confirmed pregnancy was 227 (98.3%) and 130 (56.2%), respectively. The number of patients who were treated with microdissection TESE (micro‐TESE) and whose sperm were retrieved or who had a confirmed pregnancy was 236 (34.0%) and 82 (11.8%), respectively
Figure 7
Figure 7
Outcome of re‐anastomosis of the seminal tract. The success rates of vasovasostomy (VVS) and epididymovasostomy (EVS) were 81.8% (36/44) and 61.1% (22/36), respectively. Pregnancy was confirmed in 22 women whose partner received both of these procedures
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