Fertility Surgery: Men/Sperm Producers

Some causes of infertility are structural and can be corrected by surgery, frequently with outpatient or same-day procedures.

For men this can include tissue biopsies, varicocele treatment, vasectomy reversal, opening the sperm ducts or extracting sperm directly from the ducts or testicles.

Surgical options

Washington University surgical options for men and sperm producers include:

Varicocele repair
The varicocele (a tangled mass of veins that can block normal blood flow from the testes) is tied off through an incision in the lower abdomen. Sperm counts improve in about 67% percent of cases within six months of surgery, but the role of surgery remains highly individualized and must be considered in the setting of the intended carriers’ age and contribution to the family’s infertility. Ultimately, no data exists to support surgery for a varicocele that is not clinically evidenced on physical exam.

Sperm duct microsurgery
Sperm duct microsurgery removes obstructions in the ductal system that carries sperm to the penis. Sperm generally regains normal motility within two years.

Microsurgical sperm retrieval
For patients with no sperm in the ejaculate, severe erectile dysfunction or other medical problems prohibiting ejaculation, healthy sperm can be extracted surgically from the sperm ducts in the testicle. Any sperm retrieved surgically can only be used with IVF-ICSI.

Vasectomy reversal
A vasectomy reversal is often performed as an outpatient procedure and is done to reverse a previous vasectomy, restoring the patient’s ability to release sperm into their semen. In general, the success of the reversal is inversely proportional to the length of time since the vasectomy was performed and the age of the intended carrier needs to be considered. The partners of patients seeking a vasectomy reversal (and the patient themself) should have a consultation with a reproductive endocrinology and infertility specialist.