Male reproductive surgery is performed to diagnose and treat issues of male infertility. While some types of male infertility, particularly those linked to sexual dysfunction, can be addressed by administration of hormones or behavior modification techniques, others must be addressed through surgical procedures offered at our office in La Mesa.
Types of Male Reproductive Surgery
Surgical procedures to increase the chances of conception take several forms. A common type of male reproductive surgery involves the extraction of sperm. This can take place through a few different methods.
Testicular Sperm Extraction
Testicular sperm extraction (TSE), also known as testicular biopsy, is a common in-office procedure performed to harvest tissue for in vitro fertilization (IVF) or for sperm donation. During this procedure a small amount of tissue is removed from the testicle while the patient is under local anesthesia. TSE is also performed to diagnose a low sperm count or azoospermia, a condition in which the man has no sperm in his semen. During TSE, several areas in the testis may be sampled since it is likely that there is a higher sperm count in some regions than in others.
Testicular Sperm Aspiration
Testicular sperm aspiration (TESA) is a similar procedure, differing from TSE only in that a needle biopsy of the testicle is taken. The aspirated sperm may be used for IVF or for intracytoplasmic sperm injection (ICSI), a procedure in which a single sperm is injected directly into an egg.
Percutaneous Sperm Aspiration
In percutaneous sperm aspiration (PESA), a needle is inserted into the epididymis in order to locate and aspirate a pocket of sperm. This technique is used on men who produce normal sperm, but for whom the sperm is not contained in the ejaculate because of an obstruction. The obstruction may be a result of a congenital defect, a previous vasectomy, or a blockage of the ejaculatory duct.
Other types of male reproductive surgery are performed to correct anatomical or medical conditions that may be preventing sperm from passing into the ejaculate.
A vasovasostomy is an operation to reverse a vasectomy. It is performed using microsurgical techniques to reconnect the vas deferens so that sperm can once again pass through during ejaculation. Although this procedure may re-establish male fertility, it is not always effective. For this reason, a vasectomy should be considered permanent. You can learn more about the vasectomy reversal procedure here.
In some men, infertility is caused by an enlarged varicocele (varicose vein) in the scrotum. The varicocele repair is achieved by making a small incision in the abdomen, and cutting the vein that feeds the varicocele. Alternatively, a varicocele may be repaired by percutaneous embolization, in which a catheter is inserted through a large vein in the groin or neck, and moved through the varicocele. The catheter contains a tiny coil that is inserted into the varicocele, blocking blood flow.
In men who have certain medical conditions, such as multiple sclerosis or diabetes, or in men who have suffered traumatic spinal injury, there may be abnormalities in the seminal emission or it may be absent altogether. Electroejaculation has been found to be an effective method of obtaining active sperm for various assisted reproductive techniques, enabling even men who cannot ejaculate normally to conceive young. The procedure takes place through the rectum under general anesthesia.
Epididymal repair is performed to bypass blockages or inflammation (epididymitis) in the epididymis, the tube which carries sperm from the scrotum to the vas deferens. During epididymal repair, viable portions of the epididymis are cut and reconnected using microsurgical techniques. This procedure enables sperm to pass normally during ejaculation.
Risks of Reproductive Surgery
In most cases, male reproductive surgery can be performed laparoscopically to reduce recovery time and risk of complications. The most common risk of such surgery is that it won't be effective in treating infertility.
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