Following your initial testing and assessment, you or your partner may need to have surgery. This could be for further investigation into the cause of your fertility issues, or to try and improve your ability to conceive.
Fertility surgery for men
Retrieving sperm from the testes using microsurgery (TESA/MESA)
Azoospermia is the condition where a man has no sperm in his ejaculated semen. This doesn’t mean he’s not producing any – in fact it’s possible he’s producing some in the testes, but they’re just not contained in the ejaculate. Intra Cytoplasmic Sperm Injection (ICSI) is used to facilitate fertilisation with sperm surgically recovered from the testes.
Causes of azoospermia:
- Obstructions in the vas deferens (the tubes leading from the testes to the penis), which can prevent sperm reaching the penis for ejaculation
- Low numbers of sperm-producing cells in the seminiferous tubules
- Sperm not reaching the stage of maturity where the tails needed for motility develop. While these sperm lack the ability to fertilise an egg by themselves they can be successfully injected into eggs to achieve fertilisation using ICSI.
Depending on your medical history, one of two approaches may be used to retrieve sufficient sperm for injection into your partner’s eggs:
Testicular Sperm Aspiration (TESA)
A fine needle is passed through the skin of the scrotum, into the testes, and suction is used to pull out some of the seminiferous tubules. This is usually done several times in different parts of the testes until an area of reasonable sperm production is found.
The procedure may be done under a local or a general anaesthetic, depending on the anticipated difficulty in finding areas of reasonable sperm production. We recommend some time off work following the procedure, as there will be some pain and bruising.
Microepididymal Sperm Aspiration (MESA) or Testicular Biopsy
Performed under a general anaesthetic, the scrotum is opened to expose the testis and its epididymis. The epididymis may be surgically opened and its fluid aspirated to see if it contains live sperm, or a piece of testicular tissue may be surgically excised.
This is passed to a scientist who dissects out the tubules and looks for live sperm. We recommend some time off work following the procedure, as there will be some pain and bruising.
Testicular sperm retrieval can be a successful approach for couples where the male partner has few or no sperm in his semen. There is always a possibility that no viable sperm will be found. Also, remember that poor semen quality may have a genetic basis and could be passed on to any male children. You should discuss this possibility with your doctor.
Fertility surgery for women
A laparoscopy may be recommended to check your tubes are open (tubal patency) and investigate the condition of your uterus and ovaries. It can also for following conditions:
- Tubal microsurgery
- Removal of fibroids
- Correction of uterine abnormalities
In this keyhole surgery, a small incision is made in the abdomen. A video camera is fitted to an endoscope (a thin telescopic instrument) so the specialist can view the images on a video monitor.
If any surgical treatment is needed, special instruments are inserted through four other small cuts, usually hidden in the pubic hair. When the surgery is complete, the instruments are removed and the carbon dioxide gas is released from the abdominal cavity. A stitch closes each of the small cuts.
This procedure is performed under general anaesthetic and the surgery usually takes one to two hours. Your recovery will depend on the amount of surgery you need, but we recommend you take one or two days off work following the procedure.
After your operation, you may experience some symptoms over the next few days, such as tiredness, muscle pain, mild nausea, pain or discomfort at the site of the incisions, cramps, a small amount of vaginal discharge or bleeding or a sensation of swelling in the abdomen.
Treatment for endometriosis
If your Fertility Specialist believes you may have endometriosis, they might be able to remove the endometriosis and associated scar tissue at the time of the diagnostic laparoscopy. You could also have hormone treatment to suppress your menstrual cycle and inhibit the growth of endometriosis.
Sometimes this treatment may be all you need in order to fall pregnant. If not, IVF may be a good treatment option.
Surgery for fallopian tubes
We can diagnose damage to your tubes during a laparoscopy. If this damage could affect the success of your fertility treatment, you may have tubal surgery to remove scar tissue before you begin IVF.
Some types of tubal surgery may be performed through the laparoscope, while other procedures (such as tubal surgery) may require microsurgery.
If tubal surgery does not result in a successful pregnancy – or the damage to the tubes and other pelvic organs is so severe as to make surgery unlikely to be successful – IVF may give you the best chance of success.
Microsurgery procedures include reversing sterilisation, re-opening of blocked tubes and removing scar tissue around the uterus, tubes and ovaries.
Microsurgery involves specialised operative techniques, including the use of an operating microscope. Surgeons trained in microsurgery use these skills and techniques for the repair of very small structures or obstruction, in the fallopian tubes.