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Having groin hernia repair? Men, think about your fertility.

Background: Hernia repair (also called herniorrhaphy) for groin (inguinal) hernia is a common procedure performed by general surgeons with roughly 750,000 performed yearly in the US.  The majority of routine groin hernia operations use synthetic (knitted polypropylene) mesh to patch the opening in the groin that allows the hernia to occur since there are low infection and recurrence rates.  The issue is that the spermatic cord which carries blood vessels and vas deferens (the tube that carries the sperm from the testicle) is located near where the hernia repair is usually done.  The spermatic cord is often placed on top of the mesh before closing.  Mesh can cause scar tissue to form, providing a strong “wall” to prevent future hernias from occurring, but this can also cause blockage of the vas deferens.

 

How big of a problem: Inguinal vasal obstruction (IVO) related to inguinal herniorrhaphy (open and laparoscopic cases) occurs from 0.3% to 7.2% of cases and is a frequently unrecognized cause of azoospermia in the male infertility patient.

13. Dam Wall

How it happens: Obstruction of the vas may occur due to direct injury during the hernia repair from tying off the vas, electrical injury, cutting, or compression of the vas which may occur with vascular injury to the vas. Most often, obstruction occurs over time following the hernia repair and may remain unnoticed until a man tries to have children unsuccessfully.

 

What you should do: Prior to hernia repair, men of reproductive age should understand possible risks of the mesh-related inguinal obstruction following groin hernia surgery and issues with future fertility.  Azoospermia (no sperm in ejaculate) can occur when hernia repairs are done on both left and right groin or with one-sided repair with the other testis having a fertility issue (obstruction or non-functioning) predating the hernia repair.

For men at risk who are having groin hernia surgery, sperm cryopreservation during hernia repair may be recommended.  Cryopreservation of sperm and in vitro fertilization and intracytoplasmic sperm injection (ICSI) results in similar high pregnancy rates as other causes of obstructive azoospermia.  During surgery, an opening in the mesh for the spermatic cord, or wrapping the vas deferens with a layer of fat or muscle to protect it from inflammation/scar caused by the mesh may help to preserve fertility.  Bottom line, men should let their doctor know if they may be interested in fertility in the future when having a groin hernia repair and discuss their options in detail.

 

 

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