Today, exciting advances in male infertility have introduced innovative therapeutic options that offer men, including those with no sperm in their ejaculate due to genetic conditions, a greatly improved chance to conceive their own biological offspring. The NYU Fertility Center is associated with urologists who can provide expert male fertility treatment.

As part of the diagnosis process, men receive a complete evaluation, including a fertility history, physical exam, blood testing, and semen analysis. The latter includes an assessment of sperm count (number per millimeter), motility (movement), and morphology (shape), as well as an analysis of the thickness of the ejaculate and the sperms ability to liquefy.

Surgical treatment of male infertility is performed onsite in our surgical suites on an outpatient basis and may include the following procedures:

Testicular Biopsy
A tissue sample that contains seminiferous tubules (which produce sperm) can be useful in evaluating the cause of male infertility. Results of the biopsy can indicate correctable problems with the testis or if the testis is normal, which suggests other sources of the infertility. The procedure is done using local anesthesia on an outpatient basis.

Vasectomy Reversal (Vasovasostomy)
This simple and effective procedure using microsurgical techniques can even correct some previously failed vasectomy reversals. By removing scarring and reconnecting the inner and outer layers of the vas, sperm are once again able to travel out of the epididymis and into the ejaculate. This provides a very high success rate and one of the best chances for natural conception.

Epididymal Repair (Vasoepididymostomy)
In some cases a vasectomy, infection, trauma, or congenital causes lead to the leakage of sperm and testicular fluids into the surrounding tissues, causing an obstruction or scarring of the epididymal tubule. When this happens, our reproductive specialists can use this microsurgical technique to stitch the inner and outer layers of the vas directly to the epididymis and its inner tubule at a point above the obstruction.

Microsurgical Sperm Aspiration (MESA and TESE)
These procedures are used to obtain sperm that can then be used in conjunction with IVF and Intracytoplasmic Sperm Injection (ICSI). They are generally used in cases where the man has a vasectomy, there is a congenital absence of the vas, or there is epididymal scarring. Even when little or no sperm is found in the epididymal tubules, or when there is no epididymis, testicular sperm can be retrieved and injected directly into the egg through the ICSI procedure.

Microsurgical Epididymal Sperm Aspiration (MESA)
This technique is performed under local anesthesia and used when infertility is caused by blockage. Our reproductive specialist uses an operating microscope to isolate the epididymis, then retrieve fluid from an epididymal tubule. The fluid is processed in the laboratory to ensure that sperm is present, and then the tubules are carefully closed microsurgically. The sperm is either used immediately or frozen. No further invasive procedures are necessary for future attempts at pregnancy.

Testicular Sperm Extraction (TESE)
Performed under local anesthesia, this procedure involves the removal of a small piece of testicular tissue through an incision in the testes. In the laboratory, the tissue is processed to extract sperm, though the process usually results in fewer specimens. Since the specimens are more difficult to work with and do not freeze as well as specimens collected via MESA, this approach is reserved for severe cases where it is the only method possible for dealing with poor sperm.

Varicocele Repair
When varicose veins (varicoceles) around the testes have enlarged and possibly produced too much heat to the area, this procedure can be performed to tie-off these veins and potentially improve sperm quality. This type of microsurgery is very controversial, as many men with the condition do not have significant infertility problems and the procedure itself must be done with great caution to avoid testicular damage. The procedure is performed under general or local anesthesia through a small incision in the lower abdomen or upper scrotum.