Surgical Treatments In Infertility

1 Surgical Treatments in Infertility

Before the rise of specific infertility procedures such as in-vitro fertilisation (IVF), surgical procedures were more commonplace. However, many operations have now been superseded by IVF and other such techniques. Despite this, there still exists a role for some patients for various surgical procedures. These are detailed below.

Surgical Procedures for Women

1. To Unblock Fallopian Tubes

Fallopian tubes may be damaged or obstructed by inflammation and scar tissue formation. Frequently, this is caused by infections such as chlamydia. Other causes of obstruction include enlarging fibroids, endometriosis and other conditions of the pelvic organs.

The type of operation you have depends on the severity and cause of the problem. Most such procedures are carried out laparoscopically (through keyhole surgery).

2. Reversal of Sterilisation

Some women choose to undergo a sterilisation procedure, either at the time of delivery of a baby or afterwards. This can be done in several ways including having the fallopian tubes clipped or tied. These procedures are mostly done laparoscopically unless they are done at the time of a Caesarian Section when the open approach is used as the pelvis is already open to deliver the baby.

However, women may choose to have these procedures reversed if they feel that they need to extend their families. The sterilisation reversal operation aims to rejoin the two ends of the fallopian tubes. The success of this procedure depends on a number of factors. The success rates are better for those who have clips rather than ties and for those who have had recent sterilisation. Although laparoscopic anastomosis (keyhole surgery to rejoin the tubes) can be performed, success rates are also better with open procedures.

Surgical Procedures for Men

1. Vasectomy Reversal

As with female sterilisation reversal procedures, vasectomy reversal operations aim to re-establish fertility in men by reconnecting the tube called the vas deferens which carries sperm produced by the testes to the outside. This operation is usually done by a urologist. A small incision is made in the scrotum and the 2 cut ends of the vas deferens are stitched together.

However, success rates for this procedure are 50% at best. Therefore, half of all men undergoing this operation will be unable to conceive with their partners.

2. Varicocele Surgery

Varicoceles are a relatively frequent finding in the scrotum of men. They are often found incidentally or may be diagnosed as men may complain of a dull ache or pain. They are enlarged or dilated veins from the testicle and therefore similar to varicose veins found in legs.

Having an operation to clip, tie or cut these veins to improve the blood flow from the testicle has been shown to improve the quality and number of sperm. This was thought to improve the chances of conception for these men. However, this conclusion remains controversial still as recent evidence questions any improvement in fertility for men undergoing varicocele surgery.

It is therefore recommended that you discuss the options with your urologist in detail before making a decision on whether or not to have varicocele surgery. A further complicating matter is the fact that other procedures are now available to directly retrieve sperm from the testes, thereby reducing the need for varicocele surgery. These procedures are discussed below.

3. Percutaneous Epididymal Sperm Aspiration (PESA)

Some men have no sperm in their semen as a result of having a vasectomy. Often, a vasectomy reversal procedure is attempted in those men wishing to conceive with their partners again. But, as these reversal procedures are often unsuccessful, conception may not be possible. There may be many other reasons why men produce no sperm in their semen. An option available to these man is the procedure known as PESA.

Even in men who have had a vasectomy, sperm cells continue to be produced by their testicles. These sperm cannot ordinarily escape to the outside world and are therefore reabsorbed by the body. In a PESA procedure, a small needle is guided through the skin of the scrotum and into the tube called the epididymis. A small volume of fluid containing normal sperm is drawn out. Sperm can then be used with various assisted conception techniques to fertilise the egg.

4. Testicular Sperm Extraction (TESE)

This technique is similar to PESA described above. But instead of a needle used to draw sperm containing fluid from the epididymis, a small amount of tissue is removed directly from the testicle. Sperm are again isolated and used for conception using various assisted conception methods.

5. Microsurgical Sperm Aspiration (MESA)

This is another procedure which is similar to PESA. Mature sperm are extracted from the epididymis using a guided needle. Again, these sperm are used in assisted conception methods such as Intra-Cytoplasmic Sperm Injection (ICSI) to fertilise the egg.