Surgery for male factor infertility can be a game changer for many men struggling to become fathers. But how do you know whether it’s the right option for you and what can you expect from the procedures? Here we give an overview of some of the common male fertility surgeries.
Who could benefit from surgery for male factor infertility?
There are a few different male factor fertility reasons your specialist might recommend surgery to help you conceive.
It might be that you are showing no sperm cells at all in your semen sample – this is known as azoospermia. Having no sperm cells in your sample, doesn’t necessarily mean that you aren’t producing sperm – it could be that they simply aren’t making it out into your semen. This could be due to a blockage (obstructive azoospermia) or because you have a varicocele – a large collection of varicose veins around the vas deferens (the tube that takes sperm from the epididymis to the ejaculatory duct.
It could also be because your body isn’t producing sperm properly due to testicle injury, previous medical treatment (like chemotherapy) or a genetic problem or infection.
The type of surgery your doctor recommends will depend on what issue you are facing.
Surgeries For Male Factor Infertility
For younger men with a varicocele, surgery is not always recommended. Instead it can be closely monitored to see if it corrects itself over time. However, if you are trying for a baby and the varicocele is impacting your fertility, surgery can be a good option.
There is more than one artery and vein system bringing blood to and flowing the scrotum. Varicocele surgery works by sealing off the affected being and refreshing the blood flow into healthy, working veins.When varicocele surgery is successful it can help to improve sperm count and quality which is helpful whether you are trying to conceive naturally or going through assisted fertility treatment.
Varicocele surgical procedures
There are two different approaches to varicocele surgery:
Microscopic varicocelectomy – This involves making a small incision low in the groin, then using a microscope to find and stitch or clip the affected vein. This process usually takes around 3 hours.
Laparoscopic varicocelectomy – This is a similar procedure but instead of a microscope the surgeon uses a video camera and tools attached to tubes that go through a tiny incision in the lower abdomen. This is a faster process and is usually completed within 405 minutes.
Both of these surgeries happen under general anesthetic but you will usually be released from the hospital the same day. As with most surgeries, there are risks involved including infection and further damage to the arteries – but for many men on a fertility journey they feel that the benefits outweigh the risks.
Surgical Sperm Extraction
Another form of surgery that can help men struggling with fertility is surgical sperm extraction. If it’s not possible to remove a blockage or if the issue lies with how the yetsicles produce sperm, it is possible to extract sperm directly from the testicles. This is known as surgical sperm extraction or retrieval (SSR).
Here are four different types of surgical sperm extraction.
- PESA (Percutaneous Epididymal Sperm Aspiration)
- TESA (Testicular Sperm Aspiration)
- TESE (Testicular Sperm Extraction)
- MicroTESE (Microscopic Testicular Sperm Extraction)
PESA and TESA
During these procedures, a fine syringe is inserted into either your testicle or the epididymis to extra sperm cells. This is pretty quick and painless and is usually done under local anesthetic.
TESE is slightly different as with this procedure a small incision is made and a sample of the testicles is removed and sperm cells extracted from the sample. This procedure can be done under local anesthetic but if you are chafing multiple samples taken from different areas it may be done under general.
MESA and MicroTESE
These surgeries are both undertaken with general anesthetic. With MESA fluid samples are taken from the epididymis to see if there are any sperm cells.
With MicroTESE the testicle is examined with an operating microscope to find the areas (tubules) where sperm are produced. The areas that show the most promise are removed and sperm cells are extracted, if possible.
Many experts believe that out of all these procedures, MicroTESE has the best chance of recovering sperm cells.
Whilst slightly different to male factor infertility, we couldn’t talk about these types of surgeries without mentioning vasectomy reversal.
It’s possible to reverse a vasectomy in around 70% of cases. During a vasectomy the vas deferens is cut. In reversing this, your surgeon will rejoin these cut ends, meaning that sperm can flow through to the ejaculatoy ducts again. If successful you should be able to conceive naturally – as long as you and your partner don’t have any other fertility issues.
A vasectomy reversal is the recommended approach if you had your vasectomy less than 15 years ago and the female partner is under 35. However, if your vasectomy was done more than 15 years ago, or your partner is older, your specialist may suggest that you look into surgical sperm extraction followed by assisted fertility treatment like ICSI instead – as this could give you a better chance of success.
All surgeries involved in male factor infertility come with their risks, but many of them could be the key to unlocking your future as a father. Your doctor or fertility specialist will always help you work out the best treatment plan for you, so be sure to speak to them thoroughly before taking this important step in your fertility journey.