Medical Surgical Techniques

Tubal Surgery

Tubal surgery may be necessary for women who have some form of tubal disease or previous tubal ligation. Tubal diseases may block sperm from fertilizing the egg. Tubal problems may be a factor in up to 20-25% of infertility cases. Indications for tubal surgery have decreased due to the high success of in vitro fertilization (IVF).

Artificial Insemination

Artificial insemination is the process of injecting washed sperm into the womb or placing them near the cervix to increase a woman’s chances of becoming pregnant. This procedure is done when sperm have lower than normal activity, and may have difficulty reaching the uterus.

Assisted Hatching (AH)

AH is a technique we use to potentially increase implantation rates. AH occurs after you have already made embryos through IVF or ICSI. It is not associated in any way, with fertilization or fertilization rates.

As part of IUI, IVF or ICSI, we may decide to create a small opening in the outer layer (zona pellucida) of a fertilized egg (embryo) before it is inserted into the womb. This opening allows the embryo to become more ‘sticky’ and helps it emerge from its shell more easily as it continues to divide, so it will successfully attach to your uterus.

Some patients have a thick zona pellucida, but more commonly, we identify a zona with normal thickness but find it very difficult to hatch. However, one cannot determine if AH is of benefit until it is performed on the embryo.

AH is usually used for women 38 or older, women with an elevated FSH, patients with previously failed IVF without AH, unexplained infertility, or thick zona pellucida identified during IVF.

Blastocyst

A fertilized egg (zygote) divides repeatedly as it travels down the fallopian tube to the uterus. The zygote is a solid ball of cells, but transforms into a hollow ball of cells called a blastocyst. The wall of the blastocyst becomes the outer layer of membranes that surround the embryo and together with an inner layer that develops (amnion) they form the amniotic sac. Embryo Day 5 embryo transfers are also known as Blastocyst Transfers. Day 5 transfers allow for improved successes while at the same time reducing the risk of multiple pregnancy.

Frozen Embryo Transfer (FET)

Embryos that are cryopreserved during a previous IVF cycle can be replaced after a spontaneous ovulation or a medicated cycle.

Donor Insemination

Donor Insemination is when a woman with healthy eggs receives donor sperm for fertilization.Insemination is the process of inserting washed sperm into the vagina or uterus. The sperm of the selected donor is placed near the cervix or directly into the uterus. Sperm from a sperm bank (frozen), or from a known donor can be used.

This is in contrast to egg donation, which is when a woman receives eggs from a female donor, which have been fertilized in vitro by her partner’s sperm.

Sperm Wash

A sperm wash is used as both a diagnostic and therapeutic tool. In diagnosis, the procedure is used to assess the volume and quality of the sperm, which affects its ability to fertilize an egg. And because sperm washing isolates the highest quality sperm, or even a single ‘best’ sperm, is used to improve the chances of conception for treatments such as IUI, IVF or ICSI.

Male Infertility Treatments

Treatment of Poor Sperm Motility and Low Sperm Counts

The number one reason for male factor infertility isn’t due to a blockage of passageway – rather, it is low sperm count and motility. IUI is offered to couples where there are small variations in the seminal parameters and when there are severe abnormalities IVF and ICSI may be considered reasonable alternatives.

Therapeutic Donor Insemination (TDI)

TDI is the treatment of infertile couples with a male factor infertility issues and the use of donor sperm for artificial insemination.

Infertility Treatments That Require Consultation With a Urologist

Varicocele Repair

Varicocele repair is not always necessary. The semen analysis of men with a varicocele may show any or all of the following: an increased number of abnormally shaped sperm, decreased motility, or a decrease in sperm concentration.

Varicoceles that are only detected using special tests such as ultrasound, doppler studies, and venograms have been proven to result in increased pregnancy rates. There may be slight improvement of sperm morphology (a better count and motility) following a varicocele repair. A lack of research in this area means it is unclear whether having a varicocele repair, even with improved sperm morphology actually improves pregnancy rates.

Treatment of a varicocele is focused on tying off or blocking the varicose veins, and includes three options depending on the individual situation: Open Surgical Approach

  • Requires general anaesthetic and a few days off work
  • 1 small incision about 3-cm long is made in the lower part of the abdomen
  • Varicocele is located
  • Veins are carefully separated from tissues and tied

Laparoscopic Method

  • Requires general anaesthetic and a few days off work
  • 3 small incisions 1-2 cm long each are made in the abdomen
  • A laparoscope is passed through one incision for viewing
  • Varicocele is located and veins are carefully separated from tissues and tied

Percutaneous Technique

  • Requires light sedation, local anaesthesia
  • Most men are back to work the day after this procedure
  • A small tube is placed through the skin into a large vein in the neck or groin
  • The tube is passed through the system of veins to those located around the testicles
  • A coil (stainless steel) is released to completely block the enlarged veins from the inside

Some men have an improved semen analysis within 6-12 months of repair, and the opportunity to conceive may be increased.

Treatment of Sperm Obstructions

Vasectomy Reversal

Vasectomy is the leading cause of sperm obstruction. With the use of modern microsurgery accurate reversal can be achieved in many cases.

Epididymovasostomy

This is a microsurgical procedure that can be used to bypass a particular type of block in the epididymis and is successful in up to 60% of cases.

Microepididymal Sperm Aspiration (MESA) or Testicular Sperm Extraction (TESE)

MESA or TESE is used to retrieve sperm cells from the epididymis or from a biopsy of testicular tissue. A single ejaculation of semen may result in only a few hundred sperm that are actually capable reaching a released egg in the fallopian tube. For men who are unable to ejaculate or who produce no sperm at all due to a blockage or testicular disorder, or for those who have had an irreversible vasectomy, MESA or TESE in combination with ICSI makes fertilization possible with just one sperm for one oocyte.