Medical Options for the Treatment of Infertility

Surgical options are available to both men and women to up the chances of conception. Read on for descriptions of these procedures. Need more details? More information on these topics can be found on the American Society for Reproductive Medicines (ASRM) Web site or from your board-certified reproductive endocrinologist.

For Women

* Microsurgical tubal reanastomosis: Repair of tied, cut or burned Fallopian tubes
* Hydrosalpinx repair or removal: Some research studies suggest that removal of a hydrosalpinx is beneficial for fertility. (A hydrosalpinx is a water-filled ballooning of the Fallopian tubes.)
* Repair of cervical stenosis (blockage of the cervical opening to the uterus)
* Repair of corneal uterine blockage (blockage at entrance of uterus from Fallopian tube)
* Removal of endometriosis lesions (cells from the lining of the uterus that grow abnormally outside the uterus)
* Uterine fibroid (myomata) removal
* Removal of intrauterine adhesions due to Asherman's Disease

For Men

Vasectomy reversal

Every year, approximately a half-million American men undergo a surgical procedure to cut the vas deferens (vasectomy) to make them sterile. Another approximately 5,000 men a year undergo a second surgery to reconnect the cut vas deferens to restore fertility. The vas deferens is a tube that connects the epididymis (the sperm storage organ) of the testis to the prostate gland. Testicular sperm enters the epididymis where it "matures" and is stored prior to ejaculation. At ejaculation, sperm cells flow through the vas deferens to the prostate and become part of the ejaculate.

Two types of vasectomy reversal can be performed, depending on the condition of the vas deferens and epididymis. Freshly cut ends of the vas deferens can be rejoined (vasovasostomy), or the vas deferens can be joined directly to the epididymis (vasoepididymostomy). Your surgeon may decide on the best option at the time of the surgery when it is possible to clearly see the condition of the vas deferens.

What are the success rates for each procedure?

Rates of fertility post-surgery (defined as appearance of some motile sperm in the ejaculate) are on average 85-97% for two-layer vasovasectomy and 65% for vasoepididymostomy (Urology of Indiana). These rates are averages. Your personal success with these procedures may vary depending on other factors such as:

* Length of time between vasectomy and reversal: Generally speaking, the shorter the interval, the greater likelihood that the reversal will be successful.
* Length of vas deferens available for reconnection: The longer the tubing, the more likely a vas deferens to vas deferens joining is possible, with better outcomes for success.
* Degree of scarring or blockage in the epididymis: These factors may dictate the need for vasoepididymostomy, which is generally less successful than a simple vasovasostomy.
* The number of previous surgeries performed for reversal: More surgeries typically mean more scarring and poor outcomes.

Rate of conception for two-layer vasovasostomy is 56%, higher than the rate of conception post-vasoepididymostomy (23%). Note that these data are statistical averages. You and your partner's chance of conception are dependent on variables other than the success of the surgery so these rates shouldn't be extrapolated to an individual or couple's chance of conception. Other factors that affect your chance of conceiving after vasectomy reversal are:

* Your partner's fertility
* Your surgeon's expertise in both vasovasostomy and vasoepididymostomy because the decision of which surgery is most appropriate sometimes must be made during surgery
* Your willingness to use assisted reproductive technologies to maximize the use of available sperm cells
* Other hormonal imbalances you or your partner may have which may cause infertility
* Your willingness to use sperm banking after a successful vasectomy because the benefits of the reversal may not persist

Source: Urology of Indiana brochure on vasectomy reversal. For more information, call Urology of Indiana at 1-877-362-2778.

Varicocelectomy : Repair of a Varicocele

What is a varicocele? A varicocele is an abnormal swelling of the testicular veins around and above the testicle. Varicoceles can be found in about 15% of fertile men, but in about 40% of infertile males and are believed to contribute to infertility. A varicocele can inhibit proper drainage and temperature regulation of the testis, which in turn may decrease sperm quality.

How is a varicocele diagnosed?

A varicocele can be palpated during a physical exam in some cases. Suspected varicoceles can be confirmed by ultrasound visualization. Semen quality has been shown to increase in 50-90% of infertile men after surgical correction of the varicocele. Typically, the parameter of sperm motility shows the greatest improvement after a successful varicocelectomy.

Suggested readings from Urology of Indiana's brochure: "The Facts about Varicocele":

Nagler HM, Zippe CD: Varicocele: current concepts and treatment, In Lipshultz LI., Howards SS: Infertility in the Male, 2nd edition. Chicago: Mosby Year Book, pgs. 313-335. 1991.

Howards, SS: Varicocele. Infertil Reprod Clin N Am 3:429-441. 1991

Lipshultz LI, Howards SS: Male infertility, In Gillenwater JY, Grayhack JT, Howards SS, Duckett JW: Adult and Pediatric Urology, St. Louis: Mosby Year Book pgs. 1425-1477. 1991.

Semen banking prior to cancer treatment