Fertility Surgery: Men

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 for men

Washington University surgical options for men 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 female partner’s age and contribution to the couple’s infertility. Ultimately, no data exists to support surgery for a varicocele that is not clinically evidence on physical exam.

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

Microsurgical sperm retrieval
For men 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 male’s ability to release sperm into his semen. In general, the success of the reversal is inversely proportion to the length of time since the vasectomy was performed and the age of the female partner needs to be considered. The partners of men seeking a vasectomy reversal (and the man himself) should have a consultation with a reproductive endocrinology and infertility specialist.