Fertility surgery in men
If you have a low sperm count (oligospermia), poor sperm motility (asthenospermia), or a high number of abnormal sperm (teratospermia), or antisperm antibodies are detected a solution to the problem could be either intrauterine insemination (IUI) or IVF with ICSI technique.
But there are situations that will have to be surgically treated:
Surgical treatment of varicocele
One of the most common causes of oligoasthenospermia is varicocele, that is, the formation of varicose veins in the thin veins surrounding the testis. Surgical correction of severe varicocele only can improve the quality of sperm DNA, the characteristics of the spermiogram, and, in part, restore fertility.
Surgical treatment of azoospermia or severe osteoarthritis with testicular biopsy
Treating azoospermia requires careful evaluation and possibly search for sperm in the testis using a technique known as testicle biopsy. This is a small intervention in which the testicle is opened for the purpose of obtaining sperm, it is performed at a day clinic and does not require hospitalization. This sperm can be used for intracytoplasmic sperm injection (ICSI) during IVF. Prior to testicular biopsy, it is necessary to perform a male complete (karyotype) genetic check and check for some chromosome Y chromosome abnormalities (sex-linked chromosome) that will give evidence of the possibility of finding spermatozoa in the testis. In addition, if genetic abnormalities are found, the couple should be informed of possible genetic problems that can be inherited by a male child. The semen obtained with the testicle biopsy may be used fresh (the same day), or frozen in liquid nitrogen for later use.
There are two techniques [B 4]:
- the collection of semen directly from the testis (TESA – TESE) [B5]: Testicular biopsy during which a small piece of tissue is taken directly from the testis and used for sperm extraction for IVF or ICSI, and
- the fine needle aspiration of sperm from the epidydimis (MESA – PESA): is a process involving the introduction of a needle into the epididymis in an effort to locate and aspirate sperm that may be present therein.
If testicular biopsy does not reveal any trace of sperm in the testicle then donor sperm use remains the only therapeutic option in order to create a family.
The use of surgical techniques for semen collection now gives men who have never imagined that they could ever have biological children of their own, the opportunity to acquire them.
Microsurgical reversal of vasectomy
Male microsurgical procedures include specialized and complex surgical techniques for repairing the very small tubes carrying the sperm.
The results and rates of success of these interventions are controversial and have therefore been replaced by testicular biopsy procedures and subsequent use of microfertilzation (ICSI).