Male Fertility and surgery

In our blog titled Treatments for Male Infertility: PESA,TESA and MESA, we discussed the various sperm retrieval procedures used for collection of sperm in men with nil or low sperm count. Sperm retrieval (PESA, TESA, MESA, TESE) is useful when the male partner is unable to provide a semen sample to be used in an IUI or IVF/ICSI cycle.

In some men, the problem of infertility cannot be resolved through sperm retrieval methods, and depending on the diagnosis of infertility, one of the following microsurgeries may be recommended by the fertility specialist.

Varicocelectomy (Varicocele repair)

Varicocele is the name given to swollen veins in the scrotum.

The scrotum (the bag of skin that houses the testicles) has a network of veins running through it that drain blood outwards from the testicles. Each vein has a valve (a plug) to ensure that the blood flows in the right direction. A varicocele is a vein with a malfunctioning valve which causes blood to flow backwards into the testes, causing the swelling and pain in the affected vein.

Varicoceles are not dangerous as such; however in some men they can cause pain in the scrotum, may create hormonal imbalance, and lead to infertility by affecting sperm production. Detected through physical examination or ultrasound scan, varicoceles are found in almost 1 in 3 men diagnosed with infertility.

While not all varicoceles require surgery, the fertility specialist may recommend varicocele repair surgery or varicocelectomy in patients with:

  • male factor infertility that cannot be treated through standard treatment
  • Testicular atrophy (shrinkage of the testicle)
  • Unbearable pain and discomfort in the scrotum that is affecting the patient’s everyday life

Microsurgical varicocelectomy is a minimally invasive outpatient procedure performed under general anesthesia. A cut is made near the scrotum, the affected veins are located using a microscope and tied off with sutures to obstruct blood flow. It is an extremely sophisticated procedure and should be done by an experienced urologist only. Recovery can take from about two to six weeks.

Studies show that varicocelectomy can significantly increase sperm count, and can also improve the likelihood of spontaneous (unassisted) pregnancy.

Today, another varicocele repair technique known as varicocele embolization(blocking blood flow to the affected vein by inserting a metal coil or balloon) is gaining favor over varicocele surgery. This is because, unlike varicocelectomy, varicocele embolization does not require an incision, general anesthesia or post-surgery stitches. The blocking material is placed in the abnormal vein through a thin tube inserted through a vein in the neck or the groin. This technique also requires shorter recovery time compared to surgery.

Varicocelectomy vs Varicocele embolization: Which method is better?

Patients worldwide seem to be favoring embolization as it means no cuts, no stitches, and a lot less pain. The patient can resume normal life soon after the procedure and most return to work the next day itself.

As with any surgical procedure, both methods come with some likely complications. While open surgery (varicocelectomy) is still more widely practiced, only well-equipped fertility clinics with experienced specialists on panel can be relied upon for non-invasive advanced treatmentmethods such as embolization. Accuracy in such procedures is extremely important.

If you need a varicocele repair surgery, ensure to check with your doctor which method they recommend for you and why.

To ensure that you have access to advanced variococeletreatment options, opt for a reputed, experienced and credible fertility specialist who can guide you about the pros and cons of both methods.

Vasectomy reversal

Vasectomy is undertaken by men looking for a foolproof way to avoid pregnancy. In this surgery, the vas deferens – the tubes that carry sperm from the testes further into the reproductive tract – are cut so that the sperm produced in the testes are unable to reach the semen. This surgery does not affect ejaculation of semen, only, it does not contain any sperm and hence pregnancy cannot be achieved.

Vasectomy is inarguably the most effective birth control solution, but it can be reversed only through surgery known as vasectomy reversal.

As the name indicates, vasectomy reversal is the procedure where the sperm transportation is restored by reconnecting the vas deferens.

Vasectomy reversal surgery is of two types:

-Vasovasectomy: Rejoining the previously cut ends of the tubes.

-Microsurgical Vasoepididymostomyor epididymovasostomy: Connecting the upper end of the vas deferens to the epididymis-a coiled structure which temporarily stores the sperm where they mature before moving into the vas deferens. Vasoepididymostomyis considered to be the most complex procedure for treating male infertility.

Vasectomy reversal is done for patients who wish to restore their fertility. The procedure enables a patient to father a child without the use of assisted reproductive technology. In cases where the cause of infertility lies with the female partner, vasectomy reversal enables the male partner to provide his own sperm for IUI/IVF as opposed to using donor sperm.

Of the two vasectomy methods described above, your fertility specialist is the best person to decide which one is suitable in your case.

If you or your partner has been recommended a surgical procedure for varicocele repair, or if you are considering a vasectomy reversal surgery, Gaudium team of fertility super specialists will be happy to help you make an informed decision.

Have further questions about male infertility treatment? Our experienced Urologist at Gaudium IVF Centre would be pleased to answer your query.

For a free second opinion, please contact us here.