Surgical Options

The options depend on whether the defect is obstructive or non-obstructive azoospermia. In this topic we are going to explore surgical options for male factor infertility.

The table below explains the difference between obstructive and non-obstructive:

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Vasectomy Reversal

Both sperm retrieval with ART and microsurgical reconstruction are options. The decision by couple based on their preferences after their needs and characteristics identified:

• If female partner has normal fertility potential, couple may choose to undergo microsurgical reconstruction
• If female partner already needs IVF, consider aspiration with ICSI

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Obstructive Azoospermia

Surgical techniques can be needle aspirations. No substantial differences in ICSI success rates when either cryopreserved or fresh sperm used, so sperm retrieval and cryopreservation can be done prior to VOR.

• If number of sperm presumed to be low, then will be performed day of VOR as sperm may not survive the freeze/thaw process.

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Micro-TESE

• Recommended as the surgical sperm retrieval procedure
  for men with NOA (2020).
  • 1.5x more successful than non micro-surgical
    extraction
• Open biopsy of testis
• Tubules containing sperm look fuller under the
  microscope
• Uses principle that sperm production might only occur in
  small areas of the testis

For more information, please reference “Male Infertility with Dr. Natan Bar-Chama”, retrieved from hyperlink