Therapy options

This application helps to propose an appropriate fertility therapy method and to find the most suitable clinic worldwide based on the price, duration and legislative options of the treatment in various countries.

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Groin surgery treatments

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Testicular sperm extraction (TESE) is the process of removing a small portion of tissue from the testicle under local anesthesia and extracting the few viable sperm cells present in that tissue for intracytoplasmic sperm injection (ICSI).

The testicular sperm extraction process is recommended to men who cannot produce sperm by ejaculation due to azoospermia, such as that caused by primary testicular failure, congenital absence of the vas deferens or non-reconstructed vasectomy.

The introduction of the technique of intracytoplasmic sperm injection to achieve fertilization, especially using surgically retrieved testicular or epididymal sperm from men with obstructive or non-obstructive azoospermia, has revolutionized the field of assisted reproduction. Testicular sperm retrieval techniques associated with intracytoplasmic sperm injection have reduced the need for donor sperm and given many azoospermic men the chance to become biological fathers.

The extraction of the testicular parenchyma for sperm search and isolation was first described in 1995. For conventional TESE, a standard open surgical biopsy technique is used to remove the testicular parenchyma without the aid of optical magnification. This procedure is usually carried out without delivering the testis. Briefly, a 2-cm transverse incision is made through the anterior scrotal skin, dartos and tunica vaginalis. A small self-retaining retractor can be used to ensure proper exposure of the tunica albuginea. A 1-cm incision is made in the albuginea, and gentle pressure is applied to the testis to aid the extrusion of the testicular parenchyma. A fragment of approximately 5x5 mm is excised with sharp scissors and placed in sperm culture media. Single or multiple specimens can be extracted from the same incision. Alternatively, individual albuginea incisions can be made in the upper, middle and lower testicular poles in an organized manner for the sampling of different areas. The testicular specimens are sent to the laboratory for processing and immediate microscopic examination. The tunica albuginea is closed with a running, non-absorbable suture.

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How can Groin surgery affect fertility

First of all, men with inguinal hernia should consider the risk of complication which results from hernia repair.  The inguinal obstruction which may follow groin hernia surgery leads to fertility problems in the future. If the surgery is done on both sides left and right obstruction of spermatic cord could cause azoospermia- condition, when there is no sperm in ejaculate. Smaller probability of azoospermia is associated with only one sided surgery. Spermatic granuloma formation, vas and epididymal epithelium dysfunction and testicular atrophy, unilateral or bilateral are the most common consequences. Bilateral testicular damage leads to the formation of sperm autoantibodies and sympathetic orchiopathia. 

Men should consider sperm cryopreservation before they undergo the groin surgery. Cryopreservation allows to do in vitro fertilization and intracytoplasmatic sperm injection, if any fertility problems will appear after the surgery.  

Inguinal hernia
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