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Infertility surgery for men
Some men who don’t produce sperm naturally, or who have a blockage preventing sperm from coming out, can have surgery to increase their chances of conceiving. This includes men with fertility issues following chemotherapy and men who want to try and reverse a vasectomy. Find out more about common surgical procedures for fertility.
Who might be recommended to have surgery for fertility issues?
Your clinic may recommend surgery if:
- your semen analysis shows no sperm
- in your case, the process of making sperm (spermatogenesis) is impaired (due to testicular injury, infection, a genetic problem, drugs (including previous chemotherapy),or some other medical problem)
- you have had a vasectomy and want to reverse the procedure
- you have had a failed vasectomy reversal, or have a blockage which cannot be overcome
- you have a very large collection of varicose veins around the vas deferens (a tube that carries sperm from the epididymis to the ejaculatory ducts).
If you've had medical treatment in the past that can cause infertility you should be able to have fertility testing on the NHS
Surgical sperm extraction
If there is no sperm in your ejaculate, this could be caused by:
- the testicle not being able to make sperm correctly
- a blockage preventing sperm from coming out (obstructive azoospermia)
the number of sperm produced is so low there are not enough to be counted (non obstructive azoospermia). If it’s not possible to open up the blockage (for example being born without a vas deferens), if corrective surgery has failed, or if the problem lies with how the testicle makes sperm, it’s still possible to remove sperm directly from the testicles. This procedure is known as surgical sperm extraction or retrieval (SSR).
Different types of surgical sperm extraction include:
- PESA (Percutaneous Epididymal Sperm Aspiration)
- TESA (Testicular Sperm Aspiration)
- TESE (Testicular Sperm Extraction)
- MicroTESE (Microscopic Testicular Sperm Extraction)
Can you reverse a vasectomy?
If you’ve previously had a vasectomy, it’s possible to reverse it in around 60 – 80% of cases. If successful, you’d be able to conceive naturally, providing neither you nor your partner have any other fertility problems.
Your decision to have a vasectomy reversal is likely to be affected by a number of different factors, including:
- the length of time since your vasectomy
- your partner’s age
- the number of children you want to have
- the costs involved (as a reversal is not available on the NHS).
Generally, if your vasectomy was less than 12 to 15 years ago, you want to have more than one child, and you have a female partner who’s under 35, a vasectomy reversal is usually the preferred approach.
If your vasectomy was 15 to 20 years ago (or more) and you have an older female partner, you may be recommended to have sperm extracted surgically to use in a fertility treatment like ICSI.
The aim of a vasectomy reversal is to re-join the cut ends of the vas deferens. If the surgeon is not able to join the two ends of the vas, it may be possible to join the upper ends of the epididymis to the vas deferens instead. Unfortunately, the results of this are not as good as those from directly re-joining the vas.
It may be sensible to consider extracting sperm for freezing from the testicles at the time of a vasectomy reversal as sometimes the operation may not be successful, or the vas can close up again.
If you have an unsuccessful vasectomy reversal, your chances of being successful a second time around are lower. Talk to your doctor about your options.
What’s my chance of having a baby following a vasectomy reversal?
It’s difficult to say as it depends on your personal circumstances and how long ago you had your vasectomy. Factors that may affect your chances of success with vasectomy reversal include:
- if you have waited more than 10 years between vasectomy and reversal
- if too much of the vas deferens was removed during the vasectomy
- your partner’s age
- if your partner has fertility problems.
Find out more about vasectomy reversal and success rates from NHS Choices
Treatment of varicocele
A varicocele is a cluster of varicose veins around the vas deferens. The increased blood circulation in these veins is thought to increase testicular temperature and may reduce sperm production and affect sperm DNA.
In cases where your sperm count or sperm quality is very poor, and the varicocele is very large, you may be offered treatment. This may involve having these abnormal veins blocked (embolization) or tied off as part of a surgical procedure (ligation).
The American and European Urological Associations (AUA, EAU) both recommend treatment of varicose veins if they are large, and if no other cause for poor sperm count and quality can be found.
Find out more about varicocele on the British Association of Urological Surgeon’s website
Before having any operation, it’s important that you discuss the risks, chances of success and any possible side effects with your surgeon.
From our partners
Information on male fertility procedures (The British Association of Urological Surgeons)
Vasectomy reversal (NHS Choices)
Understanding your semen analysis results (British Fertility Society)
Review date: 17 November 2023
