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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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How Health Affects Male Fertility

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

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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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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