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Microsurgery in Male Infertility
In addition to the varicocoele (varicocele), there are some other conditions in male infertility that can be treated successfully with microsurgery too. The following other microsurgical operations are being routinely performed at the Andromeda Andrology Center, Hyderabad, India, by Dr. Sudhakar Krishnamurti:


Microsurgical Vaso-vasostomy (vasectomy reversal, vaso-vasal anastomosis, VVA, micro VVA):

If a patient has undergone vasectomy, and wants it reversed for some reason, excellent success rates can be provided microsurgically, at a center of excellence. With the rising divorce and remarriage rates in society worldwide, and an increase in geriatric sexuality, this operation is being performed more frequently than ever before. Also, people are more aware about the possibility of a surgical reversal, and thus come to the male infertility microsurgeon first, without going to other infertility centers where only TESA/ TESE (TEsticular Sperm Aspiration/ Extraction ) - ICSI (Intra-Cytoplasmic Sperm Injection) can be performed. A microsurgical vaso-vasostomy may also be required when the vas deferens is blocked due to other injury or disease, e.g. tuberculosis (TB), filariasis, etc.. These are common in tropical countries.

There are various techniques of microsurgical VVA available. These are outside the scope of a detailed discussion on a FAQ site such as www.varicocoele.com.



Microsurgical Vaso-epididymostomy (vaso-epididymal anastomosis, VEA, micro VEA):

Sometimes, the sperm conduction block is in the epididymis, not in the vas. The epididymis is the structure that connects the testis to the vas deferens. It is a long, convoluted tubule that nourishes the sperms during transit and allows for their maturation. To bypass such a block, the tubule of the epididymis is anastomosed (joined microsurgically) to the vas deferens using a variety of complex techniques.

Microsurgery of the epididymal tubule is generally conceded to be the most demanding and technically challenging of all microsurgical operations across all branches of surgery.



Microsurgical TESA/ TESE:

This is a procedure in which the male infertility microsurgeon uses the operating microscope to obtain sperms from the testis for an ICSI procedure. Multiple biopsies or aspirates may be obtained. Sometimes, the testis is incised open and a micro-dissection is performed before obtaining the best sperms from the best sperm-producing areas. These sperms are then transferred to a container and handed over to the reproductive biologist/ embryologist/ gynaecologist for further management.



Microsurgery for impotence (erectile dysfunction, ED):

Occasionally, vascular or vasculogenic impotence (ED), arterial or venous, may require to be treated microsurgically, e.g. in young men who have had pelvic fractures or bicycle injuries causing impotence.

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