Generally the only fertility surgery performed on men is vasectomy reversal, since surgery in other circumstances is rarely useful. Rejoining the two cut ends of the vas deferens is technically difficult because of its small size and its many blood vessels. For this reason it should be undertaken by a highly trained micro-surgeon.
Even when technically successful, vasectomy reversal may not restore fertility because the immune system makes antibodies against sperm. Antibodies can interfere with the way sperm swim through the woman’s cervical mucus and can block fertilisation. About 50% of men who have a vasectomy reversal father a child without further intervention, although this depends on the number of years between the vasectomy and its reversal. It is not uncommon for sperm to reappear in the ejaculate after reversal but later, after a year or more, to disappear again due to scarring at the site of the operation.
One controversial area of male surgery is operating on the varicoceles, small varicose veins in the blood supply to the testes. Although they are more common in men experiencing infertility, they are also very common (incidence of around 15%) in men without any fertility problems. How they might influence fertility is still debated, a possibility is that varicocele may raise the temperature of the testes slightly. Research shows that the combination of smoking and a varicocele is particularly bad for fertility. Most well designed studies have failed to show any advantage to surgically repairing varicoceles.
Fallopian tube surgery for women
When to choose Fallopian tube surgery
For some types of damage to the Fallopian tubes, surgery may offer a similar chance of success as IVF. In addition to surgery to restore fertility, it is sometimes recommended before IVF to increase the chance of success.
When surgery is a possibility, the decision between IVF and surgery requires careful assessment by a doctor who has expertise in both fertility and surgery. The decision must take into account the type of damage, risk of ectopic pregnancy and the age of the woman. The woman will usually require a diagnostic investigation, such as laparoscopy or ultrasound, to assess the degree and type of damage before this decision can be made.
Damaged Fallopian tubes can cause fluid accumulation making the tubes swell up. These swollen fluid-filled tubes are known as hydrosalpinges and can be seen by ultrasound. Hydrosalpinges reduce the chance of IVF pregnancy probably by secreting fluid into the uterus which interferes with implantation. The removal of hydrosalpinges by surgery can double the chance of pregnancy with IVF.
Surgery is often the best option for reversal of sterilisation. In the last decade most female sterilisations have involved clips on the Fallopian tubes. If the tubes have not been damaged too much, surgery offers an 80% chance of pregnancy in women aged 38 or younger at the time of reversal.
What is involved in Fallopian tube surgery?
The surgery itself is performed using a laparoscope or a small incision in the abdomen. In some circumstances, an operating microscope is needed for the careful dissection and repair of damaged tissue. This is time-consuming and delicate work that requires extensive training in microsurgical techniques.
Advantages and disadvantages
Surgery has both advantages and disadvantages. If successful and you become pregnant after surgery, then there is every chance you will be able to become pregnant again and therefore surgery is a solution that offers the opportunity of a family not just a single pregnancy, unlike a single cycle of IVF. Also there is no need for treatment with hormones or other fertility drugs before surgery and the process is quicker. For older women, surgery is particularly advantageous as it offers a chance at pregnancy every month, even if the chance per month is low. On the other hand, the disadvantage of surgery is an increased risk of ectopic pregnancy, which is typically 10% following surgery.