Male Infertility and Possible Surgical Therapies

If a man and his partner have been trying to get pregnant with little success, the odds are about equal that it could be due to an issue regarding male infertility. Once tests are done to ensure the woman's fertility is not the issue, the man will face his own barrage of tests. A semen analysis will be done to ensure that sperm functions are normal as far as number of sperm, as well as motility and viability. The male will then be checked for varicoceles, which can be repaired through a variety of surgical routes, the majority of which can take place on an outpatient basis. Occasionally men who have undergone a prior attempt at varicocele or a hernia repair which resulted in a large amount of scarring, may now try an "open" varicocelectomy which is considered the abdominal approach. Certain complications could arise from this operation, including hydroceles, atrophy of the testicles or vas deferens injury. Other men may be able to undergo a laparoscoptic varicocelectomy to separate and mend the damaged vessels, allowing the sperm to travel freely.

Surgical Therapies

Microsurgical varicocelectomy is another form of the operation which uses high-powered magnification and a very small incision in the groin. With this technique, the physician is able to split and maintain the delicate testicular arteries, while nearly eliminating hydroceles, the most common surgical complication. When the microsurgical technique is used, studies show a minimum of forty percent success rate in achieving pregnancy for prior infertile couples after twelve months, and nearly seventy percent after twenty-four months. Another technique known as percutaneous embolization is a different type of approach which uses a flexible tube placed in the groin to remove the blockage. This technique is much less invasive and painful than other forms of surgery, but requires a highly experienced physician.

If infertility is caused by a severed vas deferens in the testicle, a surgery known as microsurgical vasovasostomy can reconnect the vas deferens, allowing the sperm to travel freely once more. This type of surgery can be performed on an outpatient basis, or an ambulatory surgical setting under general anesthesia. When this operation is performed, over ninety percent of male patients will show a return of sperm to their semen, allowing them to have a normal pregnancy in over half of all cases. Another possible surgery to restore a man's fertility, is known as transurethral resection of the ejaculatory duct, and can be managed by passing a scope through the urethra, effectively opening the blocked passageway. Once this resection is completed, sperm will reoccur in over half of the men who undergo the surgery. Complications are possible, including another blockage, incontinence or bladder injuries which cause retrograde ejaculation, and the pregnancy rates following the TURED are only above twenty-percent. Finally, the most common surgical procedure for obstructions is known as a vasoepididymostomy, however it is one of the most difficult surgical treatments for male infertility. There are only a handful of surgeons who perform this surgery which consists of surgically joining the vas deferens and epididymis to allow them to successfully transport sperm, and offering pregnancy rates of between twenty and sixty percent.

In nearly all cases, post-op pain is fairly mild, however the male patient should follow up as his doctor instructs, receiving a physical exam to ensure the surgical procedure was successful. Additionally, the semen should be tested every few months in order to ensure fertility.