Among the most exciting treatment developments are microsurgical approaches to repair dilated varicose scrotal veins, which improves semen quality. Like all surgical procedures there can be complications. Your physician can inform you of them and their likelihood.

• Retroperitoneal (or abdominal) approach - This conventional "open" varicocelectomy is best suited to men whose previously attempted varicocele or hernia repair resulted in significant groin scarring.
• Laparoscopic varicocelectomy - While this minimally invasive technique can be used successfully to isolate and repair vessels, it’s accompanied by a 6 to 15 % recurrence rate due, in part, to the preservation of a series of fine veins that may dilate with time and cause recurrence. In addition, laparoscopy must be performed by an urologist experienced in the procedure, which is a limitation.
• Microsurgical varicocelectomy - Many specialists prefer this operation, which uses the optical magnification of a high-powered microscope to provide direct visual access to veins and arteries. Through a mini-incision in the groin, the doctor separates and preserves testicular arteries, while identifying and ligating both large and small veins that could dilate in the future. While technically demanding, microsurgical varicocelectomy virtually eliminates the most common surgical complications. The scientific literature has reported a high pregnancy rate of 43% for couples after one year and 69% after two.
• Percutaneous embolization - This non-surgical approach is aimed at occluding the varicocele after it’s viewed with a specialized X-ray technique. The procedure uses a flexible tube inserted into the groin to place a blocking agent that helps obstruct the center of the vessel. This minimally invasive technique is often less painful than surgery, but it requires a physician with experience in interventional radiologic techniques and so is performed in the radiology department.
• Microsurgical vasovasostomy - This procedure is designed to restore fertility by reconnecting the severed vas deferens in each testicle. The procedure, which should clear the way for sperm to leave the body, can be accomplished through various approaches, all performed in an outpatient hospital or ambulatory surgical settings under general anesthesia, spinal epidurals or sometimes with localized numbing and sedation. In more than 90% of patients, sperm returns in the semen, yielding pregnancy in more than 50% of cases.
• Transurethral resection of the ejaculatory duct (TURED) - When properly diagnosed, ejaculatory duct obstructions can be managed surgically by passing a cystoscope into the urethra and opening the offending blockages. Resecting the duct triggers release of sperm into the ejaculate in about 50% to 75 % of men. But there can be complications — recurrent blockages, incontinence and even retrograde ejaculation due to bladder injuries. Also, pregnancy rates are only about 25 %.
• Vasoepididymostomy - The most common microsurgical procedure for treating epididymal obstructions, vasoepididymostomy is also one of the most difficult of all treatments for male infertility. Surgeons must have excellent skills and extensive experience to perform this procedure. When successful, however, an opened channel is restored in 50 to 70%of cases; pregnancy rates vary from 25 to 57%.

Male infertility factors can usually be corrected in an outpatient procedure using general anesthesia or intravenous sedation. While postoperative pain is usually mild, postoperative recovery and follow up varies.

After varicocele repair, your doctor should perform a physical examination to see if the vein is completely gone. Semen should be tested about every three months for at least one year or until pregnancy. If your varicocele returns, or you remain infertile after the repair, ask your doctor about assisted reproductive techniques (ART). These high-tech procedures are often successful in circumventing the same problem to produce a pregnancy.

While vasectomy reversals cause only mild postoperative pain, expect an out-of-work recovery of four to seven days. The chance for pregnancy depends on many factors, most importantly, the age and fertility status of your female partner and the number of years between your original vasectomy and this procedure. The longer you wait, the less likely you will have a successful reversal.

• Anejaculation - A relatively uncommon disorder, anejaculation — or the absence of any semen — can occur as a result of spinal cord injury, previous surgery, diabetes, or multiple sclerosis. It may also be caused by abnormalities present at birth as well as other mental, emotional or unknown problems. Medical therapy with drugs is usually the first line of treatment, but if that fails, the next step is either rectal probe electroejaculation (RPE) or penile vibratory stimulation (PVS).
• Congenital adrenal hyperplasia (CAH) - A rare cause of male factor infertility, CAH involves congenital deficiencies in certain enzymes, resulting in abnormal hormone production. CAH is usually diagnosed by demonstrating excess steroids in the blood and urine. When treated successfully with hormone replacement, sperm production increases.
• Genital tract infection - It’s rare that acute genital tract infections can be linked to infertility, but it does happen in approximately 2% of men suffering from reproduction problems. The problem is usually picked up following a simple semen analysis where white blood cells are found. White blood cells generate excess oxidants — reactive oxygen species (ROS) — known to harm the fertilizing potential of sperm. But an infection need not be acute to cause reproductive problems. While antibiotics are generally prescribed for full-blown infections, they are not warranted for lesser inflammations since they can be occasionally harmful to sperm production. In those cases, non-steroidal anti-inflammatories are usually recommended.
• Hyperprolactinemia - This condition of excessive production of the hormone prolactin by the pituitary gland has been implicated in both infertility and Erectile Dysfunction. Treatment of hyperprolactinemia is based on the cause of the increased secretion. If medications are the root, they should be discontinued immediately. Medical therapy may consist of medications to bring prolactin levels to normal.
  Hypogonadotropic hypogonadism: Hypogonadotropic hypogonadism refers to the failure of the testicles to produce sperm due to a hypothalamic or pituitary disorder. It’s the cause of infertility in a small percent of patients and can exist at birth or be acquired. It’s also known as Kallmann's syndrome.
  When hypogonadotropic hypogonadism is suspected, doctors usually order an MRI along with serum prolactin concentrations to rule out pituitary tumors. If levels of the prolactin are excessive but there is no mass, treatment will consist of lowering prolactin concentrations before proceeding with gonadotropin replacement therapy. During treatment, blood testosterone levels and semen analyses are obtained. Chances for pregnancy are excellent, since resultant sperm are essentially normal.
• Immunologic Infertility - Since the early 1950s, when scientists first demonstrated that some cases of infertility were linked to immunologic causes, much research has focused on this area. While oral steroids to decrease significant antisperm antibody have been advocated, this treatment is rarely successful. In vitro fertilization with ICSI is now the treatment of choice for immunological male factor problems.
• Reactive Oxygen Species (ROS) - A relatively new interest area in male infertility, ROS refers to small molecules present in many bodily fluids, such as seminal white blood and sperm cells. Because of their already high polyunsaturated fatty acid content, human sperm membranes are particularly sensitive to ROS-related damage. Recent studies have demonstrated an increase in the presence of these molecules in the semen of infertile men. Several compounds have been used to detoxify or "scavenge" ROS. The most effective of these, vitamin E (400 IU twice daily) is a very effective antioxidant. Pentoxifylline, a medication employed occasionally to decrease the thickness of blood, has also been shown to decrease sperm oxidant production, but is used much less frequently than vitamin E.
• Retrograde ejaculation - Defined as an abnormal backward flow of semen into the bladder with ejaculation, it can be caused by problems that are: anatomic (e.g., previous prostate or bladder neck surgeries); neurogenic (e.g., diabetes, spinal cord injury, and previous surgery); pharmacologic (e.g., anti-depressants, certain anti-hypertensives, and medication used to treat BPH, prostate enlargement); and idiopathic (other unknown problems).

Non-specific male infertility factors are often unexplained or ill-defined unlike specific conditions such as retrograde ejaculation or genital tract infection. However, because these procedures often involve the body's hormonal activities, they are just as troublesome to both the treating physician and the patient. In many cases, empiric therapy — designed to address hormonal imbalances — is used.

The treatment of male infertility is constantly evolving and advancing. Innovative, new treatments are being discovered and standardized at an impressive rate. Your physician can go into greater details as to the many possible causes of male infertility and the current and most promising treatments for them.