In many couples with infertility the cause of the problem is the male partner and even where there are problems with the woman there can be additional male factors that warrant investigation and treatment. We work closely with the Assisted Conception Unit at University College London Hospital, offering investigation and treatment of the male partners. When there are no sperm in the ejaculate (azoospermia) it may be possible to offer reconstructive surgery though such men require careful investigation often with exploratory surgery. It is important that such surgery is performed by a surgeon who can perform microsurgical reconstructive surgery should this be necessary.

In some cases reconstructive surgery is not possible, or desired, and in those cases an alternative approach is to surgically retrieve sperm from the man for use in an assisted conception cycle (“test tube baby”). This can either be performed at the same time as eggs are retrieved from the woman or in advance and the sperm frozen for future use. It is possible to combine reconstructive surgery with sperm retrieval. Clearly these various permutations require detailed consideration and discussion between the couple and clinicians with experience of all forms of treatment.

Vasectomy Reversal

In many cases the lack of sperm in the ejaculate is because the man has previously had a vasectomy but later regretted this due to a change in circumstance. Vasectomy reversal surgery normally has a good chance of success if carried out by a suitably skilled surgeon. It is however essential that the surgeon offer a microsurgical approach as this will result in a better chance of success and will sometimes be essential. As with other causes of azoospermia men who have undergone previous vasectomy may prefer to have sperm retrieved for use in assisted conception either instead of or in conjunction with attempted reconstructive surgery.

The chances of success will vary according to a range of factors such as the duration since the original vasectomy and the age of the female partner. In order to decide on the best form of treatment a couple need to be seen by a specialist who can examine the male partner and give the chances of success for the various forms of treatment based on his individual history.