Different Surgeries for Male Infertility

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Male infertility is an intricate process and can be affected by various day-to-day factors. If a male’s fertility is compromised, he will not be able to impregnate a woman and father a child of his own. Some of these factors can also cause his reproductive health to not be on an optimal level, making it harder and taking much more time to conceive with a partner. Interventions are usually necessary to improve a male’s fertility if he still wants to have a child of his own. These interventions include non-pharmacological options, medications and sometimes, surgery.

Surgeries Related To Male Fertility

Various surgeries are available for various reasons relating to male fertility. These surgeries stretch from diagnostic procedures to procedures that are done to retrieve sperm for assisted reproductive techniques (ART).

Diagnostic surgery

Diagnostic procedures are used to test if a male is producing viable sperm within the testicles. This procedure is usually done when men present with a low sperm count or azoospermia, which is the absence of sperm in the semen. There are two ways to go about it, the first is a testicular biopsy.

A testicular biopsy is an invasive procedure that can be done under local or general anaesthesia. This can be done when a male has azoospermia due to an obstruction in the reproductive tract or due to non-obstructive azoospermia. When a segment of the testicle is biopsied, it can be used to see if there are any mature sperm available and in some cases, if there are, the sperm can be frozen and saved for ART in a later stage. This procedure can be done when doctors are unsure of what is causing a male’s low fertility.

The second diagnostic procedure is testicular FNA mapping. This procedure is less invasive and is suggested as an alternative to a testicular biopsy. This procedure can be done under local anaesthesia and can be completed within one hour. It requires the collection of samples of the content of the small tubules in various parts of the testis. This allows them to locate various areas where more viable and mature sperm are available.

Improve Sperm Production Surgery

The most common surgery to perform in order to improve sperm production is the surgery to correct varicocele. Varicocele is when the veins that carry oxygen-depleted blood back to the heart, do not work optimally and blood starts “pooling” in the vein, resulting in an enlargement of the vein and a disruptance in the testicular temperature. Studies have shown that varicocele also causes an increase in oxidative stress that can alter sperm quality. The most known factors affected by varicocele are sperm concentration, motility and morphology.

The procedure to correct varicocele is called a varicocelectomy. This procedure is done by means of ligating the veins that contribute to the varicocele while ensuring there is still adequate venous drainage and lymphatics. Complications of the procedure might include recurrent varicocele, infections and testicular tenderness.

Improve or Repair Sperm Delivery Surgery

This is done in cases when men request that the vasectomy that they have, be reversed. It is possible to reverse a vasectomy, but the chances of improving sperm delivery and the chances of pregnancy are highly reliable on the time that has elapsed since the vasectomy. The reversal procedure’s chance of being unsuccessful is usually greater when a time of 10 years or more has elapsed since the vasectomy.

The procedure done most of the time is a vasovasectomy. This procedure uses microsurgery to reconnect the tubes that were separated from each other. These tubes are known as the vas deferens. This usually restores the flow of semen and sperm and the male has a chance to impregnate his partner.

Another procedure that can improve sperm delivery is by restoring an ejaculatory duct obstruction. This obstruction can sometimes be congenital and the only way to improve a male’s fertility is to repair it surgically. Some of the complications with this procedure include retrograde ejaculation, bladder neck injury or inflammation of the epididymis.

Surgery To Retrieve Sperm

Various procedures can be done to extract sperm. This can be done on men whose spermatogenesis process is thought to not be affected. The sperm that is extracted can be used to fertilize a female’s egg via assisted reproductive techniques such as in-vitro fertilization (IVF) or intra-uterine insemination (IUI). The sperm can be used either directly after extraction or first be cryopreserved and be used at a later stage.

Testicular sperm aspiration (TESA) can be done under local anaesthesia in men who have obstructive and non-obstructive azoospermia. It requires a small needle to be entered into the testicular tissue and extract fluid and sperm from there. These sperm can be used directly for IVF.

MicroTESE, known as micro testicular sperm extraction, is an invasive procedure that takes longer to complete. This technique allows the magnifying of a tubule that is filled with sperm, to be extracted. This technique also has very little complications.



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