Fertility-enhancing male reproductive surgery: glimpses into the past and thoughts for the future

Joshua A. Halpern, Robert E. Brannigan, Peter N. Schlegel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Over the past few decades, there have been numerous paradigm shifts in male reproductive surgery, resulting from a combination of technologic advancements in both the operating room and the laboratory. The operating microscope transformed the field of male reproductive surgery, enabling novel techniques and higher precision for the treatment of male-factor subfertility. The subsequent widespread adoption of microsurgical approaches was largely responsible for the emergence of a cadre of highly specialized male infertility microsurgeons. The advent and evolution of in vitro fertilization/intracytoplasmic sperm injection was a concurrent story that further revolutionized the field. The ability to achieve fertilization and pregnancy with just a single sperm changed the ways in which male reproductive surgeons could approach a wide range of pathologies from obstructive to nonobstructive causes, culminating in the microdissection testicular sperm extraction procedure for the treatment of nonobstructive azoospermia. Here we review the recent advancements in fertility-enhancing male reproductive surgery for the treatment of four disease processes: varicocele, obstruction of the excurrent ductal system, ejaculatory duct obstruction, and nonobstructive azoospermia. While examining the great strides of the past, we look forward to exciting developments on the horizon.

Original languageEnglish (US)
Pages (from-to)426-437
Number of pages12
JournalFertility and Sterility
Issue number3
StatePublished - Sep 2019


  • Male infertility
  • ejaculatory duct obstruction
  • testicular sperm extraction
  • varicocele
  • vasectomy reversal

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine


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