The role of urological surgery in male infertility

In 50% of involuntarily childless couples a male infertility associated factor is found together with abnormal semen parameters. Surgical management of male infertility has advanced significantly over the last decade. This improvement in operative intervention is due in part to advancements in assisted reproductive technologies and associated new sperm retrieval techniques, an increased awareness among vasectomised men that they may still have their own biological offspring after a vasectomy reversal, and a more scientific understanding of the effects of varicoceles on spermatogenesis as well as the introduction of innovative techniques in their surgical repair. We describe various investigations to determine the underlying aetiology for male infertility and surgical techniques to improve semen parameters and sperm delivery, including microsurgical procedures which are technically challenging and demand specialised skills and andrological expertise.