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. 2022 Feb;84(1):133-138.
doi: 10.18999/nagjms.84.1.133.

Secondary male infertility: the importance of the urological assessment for couples who desire children in later life

Hatsuki Hibi  1 , Miho Sugie  1 , Tadashi Ohori  1 , Megumi Sonohara  2 , Noritaka Fukunaga  2   3 , Yoshimasa Asada  2   3
Affiliations

Secondary male infertility: the importance of the urological assessment for couples who desire children in later life

Hatsuki Hibi et al. Nagoya J Med Sci. 2022 Feb.

Abstract

Amongst 942 out-patients who consulted our male infertility division between 2016 to 2020, 85 (9.0%) patients suffered from secondary infertility. Of these, in 59 (69.4%) subjects, the first pregnancy was achieved by natural conception. 81 subjects were evaluated for semen quality except for two subjects who at the time were undergoing cancer treatment and another of two ejaculatory dysfunction (EjD). Semen analysis revealed 16 subjects (19.8%) were azoospermic, whereas 9 (11.1%) were cryptozoospermic at median three years of infertility. Left varicocelectomy had been undertaken in a total of 17 oligoasthenozoospermic and cryptozoospermic cases in order to improve semen quality. For achieving natural pregnancy, microscopic vasoepididymostomy was performed in 3 subjects of obstructive azoospemia and patency was achieved in two of three. 11 azoospermic subjects and two of the EjD underwent sperm retrieval surgery for intracytoplasmic sperm injection (ICSI). Motile sperm recovery was obtained by microscopic epididymal sperm aspiration (5/5=100%), microscopic testicular sperm extraction (micro-TESE, 2/6=33.3%), and retrograde vasal sperm aspiration (2/2=100%). Natural pregnancy was obtained in two subjects following varicocelectomy, and in one following vasoepididymostomy. Seven pregnancies were achieved by ICSI using cryopreserved sperm and surgically retrieved sperm. Even if the first pregnancy occurred naturally, 30.9% subjects showed azoospermia or cryptozoospermia at median duration of three years. We would like to emphasize that earlier urological assessment especially semen analysis is necessary if pregnancy later in life is desired.

Keywords: azoospermia; cryptozoospermia; secondary infertility.

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Conflict of interest statement

Informed consentHuman rights and informed consent statements. All procedures completed were dome in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national), and with the Helsinki Declaration of 1964 and its later amendments. Informed consent was obtained from all individual participants included in the study. Animal rights statements. This article does not contain any studies with animal subjects performed by any of the authors.Funding sources statementEach author has no COI with regard to this manuscript.Statement of ethicsThe protocol for this research project, including its use of human subjects, was approved by a suitably constituted Ethics Committee.

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