Surgery for Male Infertility

When non-surgical and natural remedies fail to improve male fertility, surgical options are the key to fulfill the dream of having children. What is nice about surgical treatments for male infertility is that they can “cure” the problem and allow for conception at home and not in the laboratory.

The following types of surgery are procedures for treating some male fertility problems:

A varicocele is a cluster of varicose veins around the vas.

The increased blood circulation in these veins is thought to increase testicular temperature and may reduce sperm production.

In cases where the sperm count or sperm quality is very poor and the varicocele is very large, there may be benefit in removing or tying off the varicocele.

When there is a zero sperm count and the testicles are of normal size, the cause is either an obstruction to sperm outflow or a failure of the testicles to produce sperm.

A testicular biopsy, performed under a light general anaesthetic, can find out the reason for the low sperm count. A small portion of tissue is removed from both testicles and sent for histological laboratory examination.

If this reveals sperm in normal numbers, the sperm ‘factory’ is working normally and the zero sperm count is due to an obstruction.

Pre-operation If there has been an interval of more than seven years since your vasectomy operation, your surgeon may suggest you are screened for anti-sperm antibodies before proceeding with surgery.

If you have high antibody levels, it may be difficult for your sperm to fertilise an egg, even after surgery.

The operation Usually, the operation is carried out under general anaesthetic, although occasionally, a local anaesthetic or epidural / spinal may be used instead.

The operation can take up to one - three hours and may be performed using open or micro surgery.

The operation can either be performed through a small incision on each side of the scrotum or as a single mid-line incision to expose the cut ends of each vas deferens – the tubes that carry sperm from the epididymis of each testicle during ejaculation. One of two methods may then be used:

With an operation called a vasovasostomy, the cut ends of the vas deferens are rejoined.

- OR -

With an operation called a vaso-epididymostomy, the cut end of the vas deferens is joined to the tube that makes up the epididymis. This operation is not usually as successful as vasovasostomy.

Recovery takes between 7-10 days.

Success rates As with all surgery, there is no guarantee of a successful outcome. Sometimes only one side can be reversed, or one side have a vasovasostomy and the other a vaso-epididymostomy.

Approximately 60 - 80% of reversal procedures are successful. If you are successful, it is recommended that you arrange to bank sperm with your assisted conception unit. Sometimes the vas that was opened by surgery closes up again.

If your operation was not successful, your surgeon may agree to perform a second attempt, but the success rate will not be as high as after a first attempt.

Sometimes it isn't possible to reverse a vasectomy or you may not wish to undergo such surgery.

If you can't produce any sperm, a small operation known as surgical sperm retrieval can be carried out to remove the sperm from the epididymis or directly from the testicles.

These are minor surgical procedures and can be performed either under local anaesthetic or light general anaesthetic. They can be moderately painful.

PESA (Percutaneous Epididymal Sperm Aspiration) involves guiding a small needle through the skin into the epididymis to draw out a small amount of fluid containing sperm.

TESA (Testicular Sperm Aspiration)uses a small needle to extract relatively mature sperm from the substance of the testicles.

TESE (Testicular sperm extraction) uses the same method to remove a small amount of tissue from the testes.