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Surgical Treatment for Infertility in Men

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Surgical Treatment for Infertility in Men: Varicocele Ligation, Vasectomy Reversal, Transurethral Resection of the Ejaculatory Duct, Sperm Retrieval and IVF/ICSI techniques

 

Surgery is  an option to treat male Infertility and is sometimes required to treat conditions associated with infertility.  Following are surgical treatments available to men for who are experiencing infertility problems that are preventing them from successfully conceiving a child with their partner.

 

Varicocele Ligation

 

Surgical ligation is one of the most common treatments for the treatment of male infertility and repairing the varicocele is a relatively simple surgical procedure.  Usually done by a Urologist, a Varicocele Ligation begins with an incision being made in the skin above the scrotum, down to the testicular veins and then tied off with sutures. Patients can leave the hospital the same day but about 20 percent of surgical ligation patients have an overnight stay at the hospital.  Recovery period for a surgical ligation is two to three weeks.

 

Vasectomy Reversal

 

Vasectomies are considered a permanent form of contraception however,  advances in microsurgery have improved the success of vasectomy reversal procedures.  A Vasectomy Reversal Surgery reconnects the male reproductive tract after a vasectomy.  Vasovasostomy, also known as Vasectomy Reversal, is a procedure where the cut ends of the vas deferens are stitched back together in two layers.  When the epididymis is inflamed or scarred and is blocking the sperm from reaching the vas deferens, a patient may need a Vasoepididymostomy.  In this procedure, the surgeon will bypass the blockage and stitch the vas deferens to the epididymis in two layers.

 

Transurethral Resection of the Ejaculatory Duct

 

Transurethral Resection of the Ejaculatory Duct  is a method to treat ejaculatory duct obstruction and this procedure may help couples who want to conceive naturally and avoid assisted reproductive technologies such as IVF/ICSI.  This procedure is usually done on an outpatient basis.  It is performed endoscopically by inserting instruments into the patient’s penis.  Dye is injected into the seminal vesicle, the surgeon resets the duct, removes the obstruction, and reconnect.  The dye will flow freely through the duct if the procedure is successful.  The procedure removes the ejaculatory duct obstruction and opens the ejaculatory ducts which allows for the normal flow of ejaculate and improvement of semen parameters.

 

Sperm Retrieval and IVF/ICSI Techniques

 

There are several methods available for Sperm Retrieval also known as Sperm Extraction.  Depending on the reasons why a patient does not have enough sperm in their ejaculate will determine the right method for them.. Once the patient meets with their doctor to discuss their fertility problems,the doctor will determine the best method based on the patients individual case.

 

Following are some of the most common methods available for Sperm Retrieval for In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI):

 

Percutaneous Epididymal Sperm Aspiration (PESA)

 

PESA requires a needle to be inserted into the epididymis and sperm is withdrawn.  This procedure is used to find sperm when there is no sperm found in the male partners ejaculate.  The procedure can be performed using a local anesthetic with a quick recovery time.

 

Testicular Sperm Extraction (TESE)

 

TESE is a surgical biopsy of the testis.  The surgery is performed using a local anesthetic and a small cut is made in the scrotum where a small portion of the tissue is removed to extract a few viable sperm cells  This method is usually used when there is evidence of an obstruction.

 

Microsurgical testicular sperm extraction (Micro-TESE)

 

Micro-TESE surgery is the opening of the outer cover of the testicle and examining the inside of the testis under an operating microscope.  This procedure is performed in an operating room under local anesthesia.  More of the testis is examined however, less testicular tissue is removed.  Also this procedure causes less damage to the structure inside the testicle and causes fewer blood supply problems caused by tiny blood vessels being cut. This procedure appears to increase the number of sperm that can be retrieved.

 

 

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How Health Affects Male Fertility

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How Health Affects Male Fertility

 

Male fertility can be affected by your lifestyle.  If you have a healthy lifestyle, you are more likely to have healthy sperm.  Smoking, sexually transmitted diseases, alcohol, and your weight can also affect male fertility. To improve your chances of conceiving a child, make lifestyle changes and commit to living a healthy lifestyle.

 

Sexually transmitted diseases such as chlamydia and gonorrhea can be a cause for infertility.  To limit your exposure to these diseases, it is important for you to limit your sexual partners, practice safe sex, and commit to a monogamous relationship. Regular use of marijuana, tobacco, and illegal drugs can reduce the quality of your sperm and lead to abnormalities.  Stay clear of illegitimate drugs. Such as tobacco, medical marijuana can certainly reduce sperm movement along with result in sperm for being misshapen. Cocaine along with heroin furthermore obstruct healthy sperm.  Heavy alcohol consumption adversely affects male fertility.  Alcohol in moderation is fine but regularly consuming large quantities can significantly limit the quality and the quantity of your sperm.

 

Studies have found that lubricants such as KY Jelly and Astroglide can inhibit sperm movement and kill sperm.  If you are trying to conceive, it is best to stay from popular lubricants as well as using saliva as a lubricant.  If you must use a lubricant, try to use  Pre-Seed Intimate Moisturizer which is “sperm friendly.”  This product was developed for couples who are trying to conceive but may be experiencing vaginal dryness and not harm the sperm.

 

Adopting a healthy diet is another factor important to male fertility.  Studies have shown that being overweight influences the quality of your sperm and decreases sperm count.  To maximize male fertility and sperm health, consume a balanced and healthy diet that includes fruits, vegetables, and one that is rich in antioxidants.  When it comes to fertility, a healthy diet is just as important for men as it is for women.

 

When trying to conceive, men should avoid hot tubs, hot baths, and saunas.  Spending a significant amount of time in hot tubs, saunas, and hot baths with temperatures over 100 degrees can affect the number of normal sperm, interfere with sperm production, and increase the amount of abnormal sperm.  You should also avoid wearing tight clothing and use a mini-laptop desk instead of your lap when using your laptop computer.

 

Lastly, male fertility can be hampered by prescription medications.  Anabolic steroids can suppress testosterone, limit male fertility, and also cause harm to the male reproductive system which can lead to irreparable damage.  If you are taking prescription medication, it is advised that you speak with your physician and discuss if your medication may cause fertility issues. Prescription medications including antidepressants, antihypertensives, and antibiotics can inhibit sperm production.   If male fertility may be compromised due to prescription medication, discuss alternatives and let your doctor know that it is important for you to protect your fertility.  Also, prescription medication can affect your libido and cause you to lose interest in sexual relations with your partner.  Men who are undergoing chemotherapy and radiation should consider freezing their sperm because cancer treatment can cause damage to sperm cells.  If you have not yet started chemotherapy and radiation, your sperm can be frozen and preserved for future use.

 

 

 

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Micro Surgery and Vasectomy Reversal

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Statistics reveal that 500,000 men in the United States have vasectomies each year and 5% of those men seek a reversal five years after their vasectomies.  Vasectomy Reversal using Micro Surgery is a multifaceted operation that calls for a high degree of expertise and experience to be effective.  When performed by an urologist who is a fellowship-trained male infertility specialist, the success of a vasectomy reversal is increased.

When a vasectomy is performed, sperm production does not stop but it blocks the entry of sperm into the urethra. Unlike women, men produce sperm their entire lives.  The body eventually breaks down the blocked sperm, it is reabsorbed and new sperm continues to be produced.  There are instances when pressure can build up in the tubes behind the vasectomy scar and in some cases, the pressure can build and cause a tiny tubule of the epididymis to rupture.  This is generally referred to as an epididymal “blow out.”   If an epididymal blow out occurs, scar tissue develops and this becomes a new level of sperm blockage.  This is neither painful nor dangerous, but it is significant in that for a vasectomy reversal to be successful, it must be performed in such a way that bypasses this new level of blockage at the epididymal blow out site.

Sperm that is found at the testis end of a vas deferens indicates that an epididymal “blow out” has not occurred in which case a vasovasostomy is planned.  If sperm is not found, a vasoepididymostomy, which is an epididymis to vas deferens connection, is needed in order for sperm to flow.

Once a surgeon performs a thorough examination and the best course to proceed is determined, A Microsurgical Vasectomy can be performed to restore male fertility.  The technique allows for very precise placement of sutures which results in a much more accurate alignment of the vas lumen, which has the advantage of increasing the success rate of a vasectomy reversal.  Using microsurgery, eight or more sutures can be placed around the inside channel of the vas.  Once the surgical procedure is completed, couples may be able to conceive a baby naturally.

Some of the reasons men decide to reverse their vasectomies include wanting to have a child with a new partner, a couple deciding that they now want children after years in a long relationship or marriage, and the unexpected death of a child.  While vasectomies are considered a permanent form of contraception, they can be reversed and barring infertility issues, the chances of conceiving a child after a reverse vasectomy is possible.

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Men’s Health – Male Infertility

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Male Infertility

What Is Male Infertility?

Male infertility is the failure of a male to impregnate a fertile female and the male partner is the cause of infertility in couples 40% of the time.  A number of factors contribute to male infertility and these range from physical problems to psychological problems.  In any case, there are treatment options available to address male infertility and successfully treat males that will help couples achieve pregnancy.

 

Causes Of Male Infertility

Testicular damage, low sperm production and poor sperm quality are the main causes of male infertility.  Other causes of male infertility include smoking, which can significantly decrease sperm count and sperm cell mobility, recreational drug uses, alcohol abuse, steroid use, tight underwear, and stress.  Several medical conditions and other factors contribute to male infertility and each individual case is different.  There can be one cause, several causes, or there may be no particular cause.


Diagnosing Male Infertility

Male infertility is usually diagnosed by examining a patient’s medical history and then having a medical exam performed.  During the exam, a semen analysis is performed.  The patient provides a semen example, and the lab will evaluate sperm shape, movement, and measure the amount of semen and the number of sperm.  The lab will also check for infections and other problems that may be causing infertility.  To ensure accuracy, a minimum of two semen analyses are performed.  In some cases, if the problem is not found in a semen analysis, additional tests can be performed.  These include scrotal ultrasound, transrectal ultrasound, hormone testing, and genetic testing to name a few.  However, when infertility is an issue, it is recommended that the female partner be examined and tested.

 

Treatment Options

Once diagnosed, there are several treatments for male infertility that a patient can undergo.  These treatments include the following:

  • Surgeries ~ There are different types of surgical procedures that may restore sperm flow such as removing a varicocele, repairing a duct obstruction and performing a vasectomy reversal.
  • Treatment of Infections ~ Patients can be prescribed antibiotics to treat male infertility problems.  If treated early, permanent damage can be avoided.  If there is scarring or blockage caused by infection, surgery may be required.
  • Hormone Treatments and Medications ~ In some cases, medication may be prescribed for hormonal imbalances that may be contributing to male infertility.  Hormone replacement is recommended when there is an indication that infertility is being caused by high or low levels of particular hormones or the way the body is using the hormones.
  • Assistive Reproductive Technology (ART) is also a treatment option when the cause of male infertility is unknown or not treatable.  Sperm is gathered through ejaculation, surgery or donors and then inserted directly into the female partner or through in vitro fertilization or intracytoplasmic sperm injection.

As with any medical treatment, before deciding how to treat your male infertility you should discuss your option with your doctor and an infertility expert.  They will be able to let you know the pros and cons of treatments, the risks involved and the side effects you may experience.

 

 

 

 

 

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What is Sperm Aspiration?

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Sperm Aspiration is a method in which sperm is extracted from the testicles or the epididymis using a very fine needle or through microsurgery and are used in intracytoplasmic sperm injection (ICSI). The viable sperm is then injected into a woman’s egg. This infertility treatment is more cost effective and simpler than in-vitro fertilization.

Sperm Extraction Techniques

Testicular sperm aspiration (TESA) is a procedure performed for men who have had a vasectomy and who are having sperm retrieved for in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). A needle is inserted in the testicle and tissue/sperm are aspirated. This procedure is coordinated with their female partner’s egg retrieval and is done in an operating room or office with local anesthesia. An open testis biopsy is needed when TESA does not provide enough tissue/sperm.

Percutaneous Epididymal Sperm Aspiration (PESA) PESA is a simple and quick procedure to obtain sperm for Intra Cytoplasmic Sperm Injection (ICSI) in men who have an obstruction of the vas deferens, either due to vasectomy, infection, or other obstruction. Sufficient sperm for ICSI is obtained in 80% of attempts. The procedure is usually performed using a mild sedative and local anesthetic. A very fine needle is inserted into the epididymis where sperm are aspirated for use in an IVF procedure.

Microepididymal Sperm Aspiration (MESA) is a procedure performed for men who have vasal or epididymal obstruction resulting from a vasectomy or absence of the vas defrens. The procedure can be scheduled or done in conjunction with their female partner’s egg retrieval. It is performed in an operating under general anesthesia using an operating microscope. MESA allows for an extensive collection of sperm compared to other aspiration techniques and the sperm can be cryopreserved for future IVF/ICSI.

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