Varicocele RepairRepair of a varicocele (varicocelectomy) in men with infertility problems is a common surgical practice. The procedure involves tying off the swollen and twisted veins. Recovery takes six days and most men cannot resume full activity for about three weeks.
A non surgical technique called varicocele embolisation may eventually prove to an effective and less painful treatment for varicoceles. It involves inserting a narrow tube through a small incision in the neck or leg. Tiny steel plugs are passed through the catheter that block off the affected veins. It takes 15 to 45 minutes under local anaesthetic.
Studies are conflicted over whether repair of varicoceles actually improves fertility in many men. For example, although one 1998 study comparing four different surgical approaches reported that in all groups sperm concentration significantly improved, another study reported that counseling was as effective as varicocele repair in achieving pregnancies. Some experts believe that surgery may be useful in some younger men, but because the condition may be progressive IVF, procedures are probably more effective for older men. Others also argue that the procedure is not at all beneficial for improving fertility in men whose varicoceles are too small to be detected without imaging techniques.
Miscellaneous Surgical ProceduresObstructions in the area of the ejaculatory ducts have been successfully treated by excising or scraping the area where the prostate gland surrounds the urethra. Undescended testicles of young boys may be repositioned surgically to prevent later infertility. It is important to diagnose this condition and perform the operation before age two to prevent the destruction of most of the sperm–producing cells, which occurs if the testicles remain in the abdomen.
Physical or Structural AbnormalitiesCryptorchidism is a failure of the testes to descend from the abdomen into the scrotum during foetal life. It is associated with mild to severe impaired sperm production. In one study, even one undescended testicle may impair fertility. In cryptorchidism, the testes are exposed to the higher degree of internal body heat, but this may not totally explain the damage in germ–cell production when it occurs. Some men are born with structural problems, such as blockage in the epididymis or ejaculatory ducts, or other problems that later affect fertility. One center reported that 2% of men seeking treatment had no vas deferens. The genetic disease cystic fibrosis, for example, is associated with this abnormality. Victims of Klinefelters syndrome carry two X and one Y chromosomes (the norm is one X and one Y), which causes destruction of the lining of the semi niferous tubules in the testicles during puberty, although most other male physical attributes are unimpaired.
Kartagener’s syndrome, a rare disorder that is associated with a reversed position of the major organs, also includes immotile cilia (hair–like cells in lungs and sinuses, which also form the tails of the sperm). Germ cells may also be affected by this condition. In the very rare condition, anorchia, a man is born without any testes. Syringomyelia, a disease of the spinal cord, results in no ejaculate at all (aspermia). Hypospadias, a birth defect in which the urinary opening is on the underside of the penis, increases the risk for low sperm count later on and if not surgically corrected can prevent sperm from reaching the cervix.