Home >> Patient Info >> Infertility >> Infertility treatment >> Surgery

Infertility Treatment

SURGERY

Varicoele :: Surgical correction of Obstructions
Surgical collection of sperms

i) Varicocoele

A varicocoele is a group of abnormally dilated veins which surrounds the testicle. How varicocoeles cause infertility is not known, but surgical correction of this condition may results in an improvement of sperm quality.

A surgeon, with a specific interest in male fertility, must carry out this type of surgery as an inadequately performed operation can actually lead to testicular damage or failure. The beneficial effects, when they occur, are not usually permanent, and such an operation must be performed at a time suitable to the female so that she can most effectively utilise any improvement in sperm quality that may occur. Today, a number of varicocoeles can be treated during an X-ray investigation (internal spermatic venogram) used to help diagnose varicocoeles. This treatment goes a long way to obviating the need for major varicocoele surgery, and merely involves blockage of the vein through injection of a small coil. This procedure is performed under local anaesthetic.

Results of this type of treatment tend to be overshadowed by ART successes.

ii) Surgical correction of obstructions

Occasionally, surgery can be used to overcome blockages to the male reproductive tract. These blockages include reversal of vasectomy (male sterilisation). However, the success of this surgical approach is variable depending upon the skill of the microsurgeon, the type of operative procedure required and the fertility of the female partner. A further problem occurring in this regard, is that following obstruction to, and or correction of the male tract, antibodies to male's sperm can develop and this may add a secondary cause to the couple's infertility.

An alternative to this type of surgery is ICSI in association with surgical sperm collection (SSC). This treatment decision requires a careful evaluation of the couple and is beyond the scope of this book.

If antisperm antibodies are already present as well ICSI may well be the better alternative.

With regard to surgery on the male it must be pointed out that it should only be undertaken as part of a total treatment package for the couple and not as an isolated procedure by a surgeon who is not part of a fertility team.

iii) Surgical sperm collection (SSC)

With the development of ICSI a new approach to certain types of male problems became available. Certain males have obstructions to sperm leaving the testis. Causes include birth defects (such as congenital absence of the vas deferens), blockages due to infections or men who have had vasectomies. In addition some males produce so little sperm (often due to genetic problems) that when they are sent for a semen analysis no sperm can be found. In many of these cases sperm can be obtained directly from the epididymis or testis by a needle or testicular biopsy, often performed under local or general anaesthesia. With SSC very small numbers of sperm may be obtained and this coupled with ICSI, which only requires a single moving sperm per egg injected, is a powerful tool in the treatment of male infertility.