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Fertility microsurgery can help people pursue pregnancy when a previous sterilization procedure or a blockage prevents sperm and eggs from meeting.
At the Infertility Center of St. Louis, Dr. Sherman Silber uses reproductive microsurgery to reconnect delicate reproductive structures and retrieve sperm for fertility treatment. His work includes microsurgical vasectomy reversal, tubal ligation reversal, and sperm retrieval for use with in vitro fertilization, or IVF.
For patients considering these procedures, understanding the surgeon’s experience is an important part of choosing care. Dr. Silber brings decades of surgical practice, research, and innovation to the treatment of male and female infertility.
What is fertility microsurgery?
Microsurgery is a surgical technique that uses a powerful operating microscope, specialized instruments, and exceptionally fine stitches to work on structures that are difficult to see with the naked eye. In reproductive surgery, these structures include the tiny channels that carry sperm and the inner openings of the fallopian tubes.
Magnification allows the surgeon to see and align these delicate tissues during a repair. The goal depends on the procedure. Reversal surgery aims to restore a pathway for natural conception, while sperm retrieval provides sperm that may be used to fertilize eggs through IVF with intracytoplasmic sperm injection, or ICSI.
Dr. Silber’s expertise in reproductive microsurgery
Dr. Sherman Silber is the director of the Infertility Center of St. Louis and a pioneer in reproductive microsurgery. His contributions include the development of microscopic vasectomy reversal and advances in sperm retrieval for men with no sperm in their ejaculate. His surgical work also extends to tubal ligation reversal and ovarian transplantation.
Dr. Silber attended medical school at the University of Michigan and completed postgraduate training at Stanford University, the University of Melbourne, and the University of Michigan. His career combines patient care with research and teaching, including collaborations with international reproductive medicine teams.
He has authored medical textbooks, books for patients, and more than 250 peer reviewed scientific papers on infertility and reproduction. Recognition as one of the “Giants in Reproductive Medicine” at the IVF Worldwide Online Congress reflects his contributions to fertility treatment.
This background matters because reproductive microsurgery requires more than magnification. It requires an understanding of reproductive anatomy, precise surgical technique, and the experience to address complex blockages or previous unsuccessful repairs.
Microsurgical vasectomy reversal
Men who want children after a vasectomy may consider microsurgical vasectomy reversal. This procedure aims to restore the passage of sperm into the semen by reconnecting the reproductive ducts. Depending on the findings during surgery, the repair may involve reconnecting the divided ends of the vas deferens, called a vasovasostomy. When an additional blockage exists in the epididymis, the small coiled tube next to the testicle, a different repair called a vasoepididymostomy may be needed to bypass that obstruction.
Dr. Silber’s experience includes both approaches and repeat surgery for patients whose previous reversal was unsuccessful. Recognizing and addressing an additional blockage is an important part of planning an effective repair. Reopening the sperm pathway and achieving pregnancy are different outcomes, and pregnancy also depends on the fertility of both partners.
Fertility Microsurgery for tubal ligation reversal
Women who want to become pregnant after having their tubes tied may be candidates for tubal ligation reversal. Using microsurgery, Dr. Silber reconnects the remaining healthy sections of the fallopian tubes to create a passageway where sperm and an egg can meet. The microscope helps him identify the small inner openings and align sections that may have different diameters. Fine stitches hold the repaired sections together.
Whether reversal is appropriate depends partly on how the original sterilization was performed and how much healthy tube remains. Remaining tubal length can affect the chance of pregnancy even when the reconnection is technically successful. Patients can discuss reversal and IVF with Dr. Silber to understand their options. Pregnancy cannot be guaranteed, and a pregnancy following tubal reversal requires attention to the possibility of an ectopic pregnancy.
Microsurgical sperm retrieval for IVF and ICSI
Some men produce sperm that cannot reach the ejaculate because of an obstruction. Others have impaired sperm production. The absence of sperm in the semen is called azoospermia. Sperm retrieval may offer a way to obtain sperm directly from the epididymis or testicle. Procedures include microsurgical epididymal sperm aspiration, or MESA, and testicular sperm extraction, or TESE.
Retrieved sperm can be used with ICSI, in which a single sperm is injected into an egg during IVF. Dr. Silber helped develop these approaches, expanding treatment options for male infertility.
Explore your fertility microsurgery options
Patients travel to the Infertility Center of St. Louis from across the United States and abroad. Whether you are considering sterilization reversal or treatment for male infertility, a consultation can help you understand the available options. Call (314) 887-8715 to discuss microsurgery with our team.