Male Infertility

Male Infertility and Microsurgery

In up to 50% of couples experiencing infertility, the male partner is contributing to the problem. Sometimes the cause can be as simple as an infection treatable with antibiotics. Other times the sperm may be abnormal in number, shape or movement because of hormonal or anatomical problems. All in all, most male fertility problems can be treated with reasonably good success.

If a couple is having difficulty conceiving, the man should have a semen analysis as a first step. If this is abnormal, then an evaluation is required by an urologist. This is especially important not only to identify any reason for the male infertility, but also to look for any potential health problem that can be related to male infertility.

The term Microsurgery refers to the performance of an operation on very small body parts using a large operating microscope and special instruments. In the field of Urology, this technique can be used to treat infertility or erectile dysfunction. In order to perform microsurgery well, the Urologist must have specific training as a micro-surgeon. Further, to develop and maintain skill as a micro-surgeon, the Urologist must perform these delicate and specialized operations on a regular basis.

The indications for microsurgery for Male Infertility include treatment of a blockage in the tiny ducts or tubes that carry the sperm from the testicles. Reversing a vasectomy is a good example of this. Sometimes infection or inflammation can cause an obstruction and this can require reconstruction of the ductal system, another area where microsurgery is needed. When it is not possible to reconstruct these tiny tubules, microsurgical techniques can be employed to harvest sperm directly from the testicle or the epididymis to be used for in vitro fertilization.

The most common identifiable factor in Male Infertility is a varicocele and this is also best treated with a microsurgical approach. This allows the highest rate of success as far as eradication of the varicocele and improvement of the semen analysis. At the same time, this approach has the lowest rate of complications when compared to any other technique.

In the area of Erectile Dysfunction, microsurgery can be employed to bypass blood vessels in the penis that may have been damaged by an injury to this area. In young men, these tiny vessels can be injured by blunt trauma to the perineum, the area between the scrotum and the anus. Injury sustained while riding a bike typically affects this area. In selected cases, microsurgical penile revascularization can reverse the erectile dysfunction that sometimes ensues.

Microsurgery can take several hours to complete due to the complexity of these operations and the minute size of the involved body parts. In spite of this, the anesthesia required is usually a light general and patients typically leave the hospital the same day as their surgery.