Male Fertility Microsurgery in Bangkok

Male Fertility Microsurgery in Bangkok

Microsurgical vasectomy reversal and surgical sperm retrieval — vasovasostomy, vasoepididymostomy, TESE and micro-TESE — performed under the operating microscope at Bangkok Hospital Headquarters.

ဆေးဘက်ဆိုင်ရာ သုံးသပ်ချက်ကို ဆရာဝန် ဒေါက်တာ ဆိုအာဝီ ဝီရာဆိုပွန် (MD) မှ ပြုလုပ်ထားပါသည် — ဘုတ်လက်မှတ်ရ ဆီးလမ်းကြောင်းအထူးကု၊ သုတေသနပညာရှင်နှင့် ကုသရေးကြည့်ရှုလေ့လာသူ၊ စကော့ ဆီးလမ်းကြောင်းဌာန၊ ဘေလိုယာ ဆေးတက္ကသိုလ်

When Sperm Cannot Reach the Ejaculate

Male factors are involved in more than half of infertile couples, and a significant share of those men have no sperm in the ejaculate at all — a finding called azoospermia. It sounds final, and it is frequently reported to patients as though it were. In most cases it is not.

Azoospermia divides into two very different problems. In obstructive azoospermia the testis is producing sperm normally but the pathway out is blocked — by a previous vasectomy, by infection, or by injury. In non-obstructive azoospermia production itself is impaired, but sperm are often still being made in small pockets of tissue that cannot be found without a microscope.

Both are addressed surgically, and the operations differ. Establishing which one you have is the first job of the consultation. How to read a semen analysis report →

Who This Is For

• Men who have had a vasectomy and now want children again
• Men with azoospermia — no sperm found on semen analysis, whether obstructive or non-obstructive
• Couples told that donor sperm is the only option, who want that conclusion tested properly first
• Men with a blockage after infection, hernia repair, or scrotal surgery
• Couples preparing for IVF who need surgically retrieved sperm for ICSI

Before Assuming Surgery Is the Answer

Two things are worth settling first, because both are common and neither needs an operation on this list.

If you are taking testosterone, that alone can be the cause. Testosterone therapy suppresses the body’s own signal to the testes and can reduce sperm production to zero — a fact many men are never told when treatment starts. It is often reversible after stopping, and where fertility matters there are alternatives that raise testosterone without shutting down sperm production. Testosterone therapy and fertility →

And a couple is not infertile after a few months of trying. The natural chance of conception is roughly one in five per cycle even when everything is normal, so a run of unsuccessful months is expected rather than diagnostic. What the monthly chance of pregnancy actually is → A varicocele, hormonal problems, and medication effects are also worth excluding before microsurgery is considered.

The Procedures

All are performed under general anaesthesia using an operating microscope — magnification is what makes the difference between a join that stays open and one that scars closed.

1 — Microsurgical Vasovasostomy (Vasectomy Reversal)

The two cut ends of the vas deferens are rejoined under the microscope. With microsurgical technique, sperm return to the ejaculate in the large majority of men. The time since the vasectomy is the single biggest factor on the surgical side — results are best within five years, and fall gradually after ten to fifteen. What decides whether a vasectomy reversal works →

Two honest caveats. Sperm returning to the ejaculate is not the same as a pregnancy, and the two figures quoted in the literature are always different — the second depends heavily on the female partner. And the join can scar closed months later even after an initially good result, which is why semen analysis is repeated rather than done once.

2 — Microsurgical Vasoepididymostomy

Where back-pressure has caused a second blockage in the epididymis, rejoining the vas to itself achieves nothing — the vas must instead be joined directly to the epididymal tubule, a structure a fraction of a millimetre across. This is the most technically demanding operation in male fertility surgery and is performed by relatively few surgeons.

It also cannot reliably be planned in advance. The decision is made during the operation, on the fluid found at the cut end of the vas. Because both operations are available here, the surgery can proceed to whichever the anatomy turns out to require — rather than stopping and referring you elsewhere partway through.

3 — TESE (Testicular Sperm Extraction)

Sperm are taken directly from testicular tissue through a small scrotal incision, for use in IVF with intracytoplasmic sperm injection (ICSI). Appropriate where obstruction is the problem and sperm production is normal.

4 — Micro-TESE (Microdissection TESE)

For non-obstructive azoospermia — the group most often told that nothing can be done. Under high magnification the seminiferous tubules are inspected directly, and the wider, more opaque tubules most likely to contain sperm are selected. This finds sperm in a meaningful proportion of men in whom conventional biopsy would not, while removing far less tissue and better preserving testosterone production.

Retrieved sperm are used for ICSI at the fertility centre of your choice; the retrieval is timed and coordinated with the embryology team. It is important to go in knowing that micro-TESE does not always find sperm — when it does not, that is an answer rather than a failure of technique, and the couple’s options are discussed before the operation rather than after it.

Recovery, and What Is Not Normal

Scrotal swelling, bruising and discomfort for one to two weeks are expected after any of these operations, and heavy lifting and sex are avoided for a few weeks. Seek care the same day for fever or chills, a rapidly enlarging or tense scrotum, spreading redness, or pain that worsens rather than settles — these suggest bleeding or infection rather than ordinary healing.

What Is Not Performed Here

TESA and PESA — needle aspiration techniques — are not used. Surgical sperm retrieval is performed by TESE and micro-TESE instead, which give better yield in the situations where retrieval is genuinely needed. IVF and ICSI themselves are carried out by an assisted reproduction unit; Dr. Soarawee performs the male-side surgery and coordinates the timing with them.

Browse all men’s health patient guides →

မေးလေ့ရှိသော မေးခွန်းများ

Q1: Is a vasectomy reversal or IVF with sperm retrieval the better choice?

It depends on the couple rather than on the man alone. Reversal restores the natural pathway and can lead to more than one pregnancy with no further procedures, but takes months to show a result. Sperm retrieval with IVF and ICSI gives a per-cycle chance without waiting, but commits the couple to IVF. Time since vasectomy, the female partner’s age and fertility, and how many children you hope for all weigh on the decision.

Q2: I was told I have no sperm at all. Is there anything that can be done?

Often, yes. Azoospermia is not one condition. If the cause is a blockage, reconstruction or sperm retrieval can both work. If sperm production itself is impaired, micro-TESE finds sperm in a meaningful proportion of men, because production is frequently patchy rather than absent — small areas of active tissue exist that cannot be located without an operating microscope. It does not succeed in every man, and that is discussed before surgery.

Q3: Could my testosterone treatment be the reason I have no sperm?

Very possibly. Testosterone therapy suppresses the signal from the brain to the testes and can reduce sperm production to zero, which surprises many men because it is the opposite of what they expect from a hormone associated with masculinity. It is often reversible after stopping, though recovery takes months. If fertility matters to you, say so before starting testosterone — there are alternatives that raise your own production instead of replacing it.

Q4: How soon will I know whether the reversal worked?

Sperm return gradually rather than immediately. Semen analysis is repeated at about one, three and six months after surgery, and a disappointing result at one month is not a failed operation. Most of the information arrives over the first six months. Repeat testing also matters because a join can scar closed later even after an initially good result.

Q5: What is the difference between TESE and micro-TESE?

TESE takes tissue from the testis without magnified selection and suits obstructive azoospermia, where sperm production is normal. Micro-TESE uses an operating microscope to inspect the tubules and select the areas most likely to contain sperm — which matters when production is impaired, and has the added advantage of removing much less tissue.

Q6: Do you perform TESA or PESA?

No. Needle aspiration techniques are not used here. Surgical sperm retrieval is performed by TESE or micro-TESE, which give a better yield in the situations where retrieval is genuinely required.

Q7: What should I watch for after the operation?

Scrotal swelling, bruising and discomfort for one to two weeks are normal, and heavy lifting and sex are avoided for a few weeks. Seek care the same day for fever or chills, a rapidly enlarging or tense scrotum, spreading redness, or pain that worsens rather than settles, as these suggest bleeding or infection.

Q8: Can I have a telemedicine consultation before travelling?

Yes, through Bangkok Hospital, and for patients coming from abroad it is often the sensible first step — semen analyses and hormone results can be reviewed and a plan discussed before you book flights. Telemedicine is arranged in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only. Examination, scrotal ultrasound and surgery all require an in-person visit.

Q9: How much does the surgery cost?

Pricing is quoted by the hospital rather than by Dr. Soarawee. For Bangkok Hospital Headquarters, email the Urology department at bhquro@bdms.co.th. For Samitivej Sriracha, call the department line on 088-022-1445.

သင်၏ တိုင်ပင်ဆွေးနွေးမှုကို ချိန်းဆိုပါ

Bring any previous semen analyses and hormone results if you have them — they shorten the road considerably.

Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. Samitivej Sriracha is in-person only.

This page is provided for patient education only and is not medical advice. It does not address any individual case and is not a substitute for consultation with a qualified physician. It does not create a doctor-patient relationship. Dr. Soarawee does not provide medical assessment, advice, diagnosis or prescriptions through personal messaging channels, direct messages or social media.