Fertility Surgery

Overview

After initial assessment, surgery may be recommended to either investigate the cause of infertility for both men and women, or to overcome factor influencing their ability to conceive.

For women, a laparoscopy may be recommended to check tubal patency (checking your tubes are open), and also the condition of your uterus and ovaries.  

For men, where a semen analysis has determined poor sperm numbers, poor sperm morphology or lowered mobility, microsurgery may be recommended to determine the cause of the problem. 

Female Fertility Surgery

Fertility surgery for females involves a procedure called laparoscopy. During laparoscopic surgery, a thin hollow needle is inserted into the abdomen through a small cut in the abdomen (usually hidden inside the navel). Carbon dioxide gas is then passed into the abdominal cavity which inflates it and allows the organs to be easily inspected.

If necessary, special instruments may be inserted through four other small cuts, usually hidden in the pubic hair. These are used to perform any surgical treatment that may be necessary. When the surgery is complete, the instruments are removed and the carbon dioxide gas is released from the abdominal cavity. A stitch may be made to close each of the small cuts.

Laparoscopy is performed under general anaesthetic and takes approximately 1 to 2 hours to perform.

Your recovery will depend on the amount of surgery performed during the procedure, however it is recommended that you take one or two days off work following the procedure.

After your operation, you may experience some symptoms that may last for several days. These include:

• tiredness
• muscle pain
• mild nausea
• pain or discomfort at the site of the incisions
• cramps similar to period cramps
• a small amount of vaginal discharge or bleeding for a few days
• a sensation of swelling in the abdomen.

Paracetamol is usually sufficient to relieve pain and discomfort.

Male Fertility Surgery

High Ligation of the Varicocele:

A varicocele (swelling of the veins above the testis) can adversely impact on production causing low sperm numbers, poor sperm morphology or lowered mobility.  A small incision in the groin can cure the venous reflux into the scrotum allowing the testis to recover and produce better sperm.  After cure of varicocele one needs at least a week of convalescence and a follow up semen analysis at three months to assess whether new sperm is in the ejaculate.

Surgical Sperm Retrieval:

The condition of non obstructive azospermia (no sperm in the ejaculate) requires careful evaluation and a possible search for sperm in the testis.  This sperm can be used for Intracytoplasmic Sperm Injection (ICSI). Before retrieving the sperm it is necessary to check the genetic make up as some abnormalities of the Y chromosome (male chromosome) indicate that finding sperm is unlikely.  Furthermore, if genetic abnormalities are found, a couple must be counselled as the chromosome changes can be handed on to male offspring.

Microdissection of the testis is ultilised to more accurately find sperm in the seminiferous tubules.  This is also done as a day procedure and a few days convalescence is required.  Sperm that are retrieved can be used fresh (the same day) or frozen in liquid nitrogen for later microinjection.

Reversal of vasectomy:

This is done as a day surgery procedure utilising the operating microscope.  As the surgery involves very tiny sutures, a week at least must be set aside to aid healing and prevent injury to the especially small area of anastomosis.   Ejaculation must not occur for 2 weeks and no strenuous activity until discomfort and swelling have disappeared. A semen analysis to evaluate re-establishment of the sperm pathway should be done at 6 - 8 weeks following surgery.

Vasectomy:

 

Dedicated Male Infertility Clinic

IVFAustralia has recently incorporated a dedicated male infertility clinic as part of our service. This provides additional diagnostic, investigatory and surgical services, including microsurgery.  Your IVFAustralia fertility specialist may refer you to Dr David Golovsky for male infertility surgery where necessary.