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Surgery for Male Infertility

Urologists at NYU Langone sometimes recommend surgery to manage conditions that cause problems with sperm production in men with infertility.

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If your doctor determines you have varicocele, which occurs when blood backs up in the veins along the spermatic cord, varicocelectomy may be recommended. During a varicocelectomy, your doctor surgically seals off the affected vein or veins and redirects blood flow to healthy veins, improving sperm production.

Varicocelectomy can be performed in various ways. In microscopic varicocelectomy, performed with sedation or general anesthesia, your doctor makes a small incision over the inguinal canal, which is located on each side of the groin. Next, he or she uses a special microscope to locate and tie off the affected veins inside the spermatic cord, which travels through the inguinal canals.

The surgeon closes the incision with dissolvable stitches. You can go home the same day. Recovery typically takes one to three days followed by limited activity for two weeks.

In addition to microscopic varicocelectomy, urologists at NYU Langone also regularly perform varicocele repair using laparoscopic surgery. In this procedure, which is performed with general anesthesia, a surgeon makes several small incisions in the abdomen and inserts surgical tools in order to identify, cut, and tie off the affected veins.

The surgeon uses stitches to close the incisions. You may go home the same day, and recovery takes up to three days. Activity is limited for up to two weeks after this procedure.

Varicocele Embolization

Another type of treatment for varicocele, varicocele embolization is a minimally invasive procedure that moves blood away from the enlarged varicocele. During the procedure, performed by an interventional radiologist, a catheter is inserted through a 2- to 3-millimeter incision in the groin. The catheter, which is a long, small tube, travels to the testicular vein.

Once the tip of the catheter is in the abnormal testicular vein, the doctor blocks the vein by injecting either coils, plugs, or sclerosants, which are chemicals that shrink the vein. This is all done under live X-ray, also called fluoroscopy. The procedure reduces pressure in the varicocele and allows the blood to be directed through other pathways. The procedure is done under light sedation and you can return home the same day.

Transurethral Ejaculatory Duct Resection

Transurethral ejaculatory duct resection may be performed to open the ejaculatory duct—the tube that carries semen from the testicles to the urethra—if it is blocked. It may also be used to remove any obstruction that can affect a man’s ability to ejaculate sperm. An obstruction may occur because of trauma to the pelvis or an infection.

This procedure is typically performed using general anesthesia. The surgeon inserts a telescopic device called a resectoscope into the urethra and removes any obstruction to the ducts. A catheter remains in the urethra for a short period of time while the surgical area heals.

Your doctor analyzes the quality of your semen one month after the procedure, assessing semen volume and the number of sperm, their shape, and their motility.

Vasectomy Reversal

Sometimes, men wish to reverse a vasectomy, a surgery used for birth control that prevents the release of sperm during ejaculation. Different techniques can be used for this reversal surgery, which helps to restore fertility by allowing the flow of sperm.

Surgeons at NYU Langone may perform a vasovasectomy to reconnect the vas deferens tubes that carry sperm from the testicles to the urethra during ejaculation. Each of these two tubes is severed during a vasectomy.

During a vasovasectomy, which is performed using a powerful microscope, an opening is created to allow sperm to move through the separated ends of the vas deferens. It is performed if each vas deferens is healthy enough, as determined by the doctor during the surgery, which requires sedation or general anesthesia.

In a vasoepididymostomy, the vas deferens is connected to the epididymis, a tube that transports maturing sperm from the testicle to the vas deferens, circumventing blockages caused by the vasectomy. This procedure is performed using general anesthesia.

After either type of vasectomy reversal, you are able to go home the same day. Recovery typically takes one to three days, followed by two weeks of limited activity.

Microsurgical Testicular Sperm Extraction

Microsurgical testicular sperm extraction, or microTESE, is recommended for some men with severe deficits in sperm production. Highly trained NYU Langone urologists, in conjunction with experts at the NYU Langone Fertility CenterNYU Langone Reproductive Specialists of New York, and other NYU Langone doctor’s offices, perform this procedure.

For men with severe deficits in sperm production, this surgery may be the only way to have a biological child.

MicroTESE is performed with sedation or general anesthesia. Your doctor makes a small incision in the scrotum and then uses a powerful microscope to closely examine the tissue of the testicles, looking for healthy tissue that might harbor sperm that can be extracted.

The surgeon closes the incision with dissolvable stitches. You can go home the day of the procedure. Recovery typically takes one to three days, with limited activity recommended for the following two weeks.

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