Varicocele ligation

Varicocele Ligation

 

Varicocele is the abnormal dilatation of the pampiniform plexus within the spermatic cord and is frequently associated with male infertility.

 

The goal of surgery is to obstruct the refluxing venous drainage while maintaining arterial inflow and lymphatic drainage.
The procedure is rather simple, it involves filling the abdominal cavity with medical grade CO2 upto 15mm Hg.A telescope is passed through a tiny hole made in the abdomen. The spermatic vein is identified and separated from the surrounding structures. The vein is then clipped with titanium clips. The procedure takes about 15- 20 minutes to complete and the patient can be discharged the very same day.
Sperm Retrieval Techniques

 

In situations where semen sample shows no sperm (azoospermia), there are several techniques employed to retrieve the sperm directly from the testes. Two main types of azoospermia are non-obstructive and obstructive.Males with non-obstructive azoospermia have some defect in the sperm formation. Males with obstructive azoospermia have reasonable sperm production capacity but there is a blockage to the transport of sperm. Success rates for ICSI for patients with non-obstructive azoospermia are generally lower than with obstructive azoospermia. Men with normal FSH, testicular size, ejaculatory volume might be OA. Men with NOA of unknown origin should be tested for Karyotyping and Y- Chromosome micro deletion.

 

Some of the causes of obstructive azoospermia (blockage between the epidydimus and ejaculatory duct).
  • Vasectomy
  • Post infectious disease (mumps)
  • Surgery (scrotal,inguinal ,abdominal areas)
  • Cystic fibrosis
  • Absence of Vas deferens (mutation of CFTR gene)
  • Prostratic cysts
  • Young’s Syndrome
At Indigo Womens Center we provide you with the highest chances of pregnancy from all sperm retrieval techniques , thanks to the experience our reproductive medicine specialist and our embryologists can deliver. We have successfully retrieved viable sperm from over 5,000 azoospermic patients.

PESA:

A 1CC syringe is inserted into the epididymis and aspirated(for sperm) under local anesthesia or general anesthesia. Patients who had a vasectomy are strong candidates for PESA.

 

MESA: 

An open surgical sperm retrieval procedure that uses an operating microscope to locate the tubules of the epididymis precisely, so that large numbers of sperm can be extracted.

TESA:

A 1CC syringe is inserted into the testes and aspirated(for sperm) under local anesthesia or general anesthesia. Patients who had a vasectomy are strong candidates for TESA.

TESE:

A surgical procedure involving making an incision on the scrotal sac, directly visualizing the testes using magnification, a small incision is made on the testes and the testicular tissue is retrieved. This testicular tissue is inspected under the microscope by the embryologist. It is recommended that atleast 2 biopsies are taken because spermatogenesis has a heterogeneous distribution in the testes.

 

Micro-TESE:

It is similar to TESE but is done under magnification. This technique is based on the consept that seminiferous tubules with sperm are larger in diameter and whiter than those without spermatogenesis (sperm production). Unlike TESE, a larger incision is required and the testes is inspected thoroughly.

 

These procedures have greatly reduced the need for donor sperm. Serum Inhibin- B levels and seminal plasma proteins (TEX101 and ECM1) can also help indicate presence of sperm in the testes and can predict the outcome of the surgical aspiration.
All sperm retrieved via surgical extraction are either cryopreserved for later use or simultaneously completed on the day of egg collection for ICSI.

 

Complications of the procedure include low risks of bleeding (1%) and infection (1%) that accompany scrotal surgery in general, and the potential that a scar will form in the lumen vas deferens and block it later (5%).
After completion of the procedure, the man is shifted to the recovery ward and will be discharged the same day.