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Surgical Treatment for Infertility in Men

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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Varicoceles

Varicoceles

What is Varicocele?

Varicoceles or varicose veins are a widening of the veins along the cord that holds up a man’s testicles.  It is a common condition that affects 15% of the male population and 40% to 50% of the infertile male population.

 

Symptoms

Varicocele usually does not have any symptoms and there is usually no need for treatment. A physician frequently discovers varicocele during a routine examination or a fertility check. When symptoms are present, they can include the following:

  • Pain ranging from dull to sharp and a feeling of heaviness and discomfort
  • Swelling
  • Infertility

 

Treatment

Varicocelectomy surgery is the primary treatment for Varicocele.  Anesthesia is used to numb the area.  The urologist will make a cut in the lower abdomen and tie off the abnormal veins allowing blood the area into the normal veins. The surgery is usually quick and efficient and the patient can leave the hospital the same day as surgery.  After the procedure, the patient is advised to leave an ice pack on the area for 24 hours.

Varicocele Embolization is an alternative surgery and does not require an overnight stay in the hospital.  This is an image-guided procedure where the cut is much smaller than a surgical cut allowing the patient to heal faster. A catheter is placed into a vein in the groin or neck area and using the patients x-rays as a guide, the doctor moves the catheter into the varicocele.  A tiny coil passes through the catheter into the varicocele allowing the coil to block blood flow to the bad vein and sends it to the normal veins.  After the procedure, the patient will need to place ice on the area and wear scrotal support for a short period.

Urologist Silicon Valley

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Men’s Health – Male Infertility

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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