Student at Jawahar Lal nehru medical college bhagalpur Approximately 1% of men are permanently sterile, with about 20% of men having sperm quality below the threshold thought compatible with normal fertility (conception within 1 year). Eur Urol 27:18-22, 1995Hirsch IH, Abdel-Meguid TA, Gomella LG: Postsurgical outcomes assessment following varicocele ligation: laparoscopic versus subinguinal approach. J Urol 148:1190-1194, 1992Wosnitzer M, Roth JA: Optical magnification and Doppler ultrasound probe for varicocelectomy. Fertil Steril 59:613-616, 1993Sigman M, Jarow JP: Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles. Arch Surg 2005; 140:300. Aspiration alone is ineffective. Laparoscopy. 35); (3) percutaneous aspiration (testicular sperm aspiration [TESA]) with a high-suction glass syringe and a 23-gauge needle. J Urol 167:310, 2002Matthews GJ, Matthews ED, Goldstein M: Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Surgical and Medical Management of ... Surgical and Medical Management of Male Infertility. It is a common hormonal disorder that is poorly understood and clinically characterized by lack of regular ovulation, irregular menstrual cycles, infertility, abnormal facial hair growth, obesity and polycystic ovaries. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. Postoperative adhesions occur in 60% to 90% of patients undergoing major gynecologic surgery. The incidence of these complications can be reduced by using microsurgical techniques, with inguinal or subinguinal operations, and exposure of the external spermatic and scrotal veins. This third layer of closure is performed purely on the adventitial layer that covers the underlying mucosal suture. The ultrasound-guided aspiration of the chocolate-colored fluid aspiration sometimes have serious consequences including post aspiration infection, pelvic adhesions, and ovarian abscess. Problems from anesthesia, bleeding and infections can occur with either type of surgery. Infertility, Weill Cornell Medical Center, New York, NY, USA They can cause torsion, infection, rupture, and cancer. Association between endometriosis and autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, hypothyroidism, hyperthyroidism, and multiple sclerosis have recently been described. Hum Reprod 9:2058-2061, 1994Craft IL, Tsirigotis M, Bennet V et al: Percutaneous epididymal sperm aspiration (PESA) and intracytoplasmic sperm injection (ICSI) in the management of infertility due to obstructive azoospermia. at There is secondary hyperplasia and hypertrophy of the surrounding myosalpinx, and hence at laparoscopy, localized nodular thickening or swelling of the isthmus is identified.Laparoscopic finding: enlargement of the tubocornual or isthmic portion of the fallopian tube. Lancet 340:17-18, 1992Van Steirteghem AC, Nagy Z, Joris H et al: High fertilization and implantation rates after intracytoplasmic sperm injection. Retrograde ejaculation Retrograde ejaculation is the commonest cause of aspermia. Postoperative adhesions are squeal of impaired fibrinolysis of the fibrin and cellular exudates after peritoneal injury. In: Neves PA, Netto NR Jr (eds): Infertilidade Masculina. pp 149-162, Atheneu, Sao Paulo, 2002Goldstein M, Chan PTK, Li PS: Multi-layer Microsurgical Vasovasostomy: Tricks of the Trade. Fertil Steril 57:174-177, 1992Jarow JP, Ogle SR, Eskew LA: Seminal improvement following repair of ultrasound detected subclinical varicoceles. Pelvic examination may be normal, or findings may include a retroverted and fixed uterus, enlarged ovaries, fixed ovarian masses, thickened rectovaginal septum, indurations of the cul-de-sac, and nodules on the uterosacral ligament. The cord is then dissected and all the internal spermatic veins are ligated.The introduction of microsurgical technique to varicocelectomy (Fig. Evaluation of infertility. The risks of laparoscopy are minimal. The Role of Endoscopy in Management of Infertility, Enhancing Success of Assisted Reproduction, Atef M.M. This consists of: opening the cyst, identifying the cyst wall and removing it from the ovarian cortex by traction and with grasping forceps. J Urol 159:1951-1953, 1998McCallum S, Li PS, Sheynkin Y et al: Comparison of intussusception pull-through end-to-side and the conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in ale Wistar Rats. Laparoscopic myomectomy has evolved into a safe, efficient, and cost effective approach for the treatment of intramural, subserosal, and pedunculated fibroids. Laparoscopy allows seeing abnormalities that might interfere with a woman's ability to conceive a pregnancy. Postoperative management is focused upon reducing the risk of reformation of adhesions.Complete septum extending from fundus of uterus till cervix. No intercourse or ejaculation are allowed for 4 weeks postoperatively. Histologicaly, the testis should be delivered with the development of operative laparoscopic equipment surgical. 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