Yes, they can. Some surgeries carry a direct risk to fertility because of where they operate-close to the reproductive tract or the structures that control hormone signaling. Other surgeries affect fertility indirectly by altering blood flow, nerve function, or the immune response. The key is understanding which surgeries carry risk, how that risk works, and what you can do about it.
Let's walk through the most common ones.
Surgeries That Directly Affect Sperm Transport
The most straightforward way a surgery affects fertility is by physically blocking sperm from leaving the body. This happens when a surgeon operates near the vas deferens (the tube that carries sperm from the testicle to the urethra), the epididymis (where sperm mature and are stored), or the seminal vesicles (which produce fluid for semen).
Inguinal hernia repair is the most common example. About 800,000 hernia repairs happen in the U.S. each year, and a significant portion are in men of reproductive age. During the procedure, the surgeon pushes the protruding tissue back into the abdominal cavity and reinforces the abdominal wall. The vas deferens runs right through the inguinal canal-the same area the surgeon is working in. If the vas gets kinked, clamped, or scarred during healing, sperm can no longer travel from the testicle to the urethra.
A 2018 study in Andrology found that men who had undergone inguinal hernia repair had a 30% higher rate of low sperm count compared to men who had not. The risk was highest in men who had bilateral repairs (both sides) and in those who had open surgery rather than laparoscopic.
Varicocelectomy is a surgery designed to fix varicose veins in the scrotum that can impair sperm production. In skilled hands, the surgery improves fertility. But if the surgeon accidentally damages the testicular artery or the vas deferens during the procedure, sperm production and transport can be compromised. The risk is low-around 1-2% in experienced centers-but it exists.
Testicular torsion repair is another one. Torsion is a medical emergency where the testicle twists on its spermatic cord, cutting off blood flow. Surgery to untwist and fix the testicle in place is urgent. The surgery itself usually preserves fertility if performed within six hours. But if the testicle was already damaged from prolonged torsion, sperm production on that side may be permanently reduced.
Surgeries That Affect Hormone Production
Some surgeries don't block sperm transport but damage the organs that produce sperm and testosterone in the first place.
Orchiopexy for undescended testicles is one. This surgery moves a testicle that never dropped into the scrotum down into its proper position. It's usually done in childhood. The earlier it's performed, the better the outcome for fertility. But even after successful surgery, men who had undescended testicles have a higher risk of low sperm count and lower testosterone levels compared to men who didn't. The surgery helps, but it doesn't always fully restore function.
Testicular cancer surgery is a different situation. If one testicle is removed (orchiectomy), the remaining testicle usually compensates. Most men can still produce enough sperm and testosterone with one functioning testicle. But the cancer itself, plus any chemotherapy or radiation that follows, can suppress sperm production for months or years. Sperm banking before treatment is standard practice for a reason.
Prostate surgery is more common in older men, but some men in their 30s and 40s undergo procedures for prostatitis, benign prostatic hyperplasia, or prostate cancer. Transurethral resection of the prostate (TURP) and radical prostatectomy both carry risks to fertility. TURP can cause retrograde ejaculation (semen goes backward into the bladder instead of out the urethra) in about 65-75% of men. Radical prostatectomy removes the prostate and seminal vesicles entirely, making natural conception impossible without assisted reproductive techniques.
Surgeries That Affect Nerve and Blood Supply
The pelvic region is dense with nerves and blood vessels that control erection, ejaculation, and testicular function. Surgeries that aren't directly on the reproductive organs can still cause problems if they disrupt these structures.
Colorectal surgery, especially for ulcerative colitis, Crohn's disease, or colorectal cancer, can damage the pelvic nerves that control ejaculation. A 2017 review in Diseases of the Colon & Rectum found that up to 30% of men who underwent proctectomy (rectal removal) experienced some degree of ejaculatory dysfunction. Some of these men had normal sperm production but couldn't deliver it.
Spinal surgery, particularly lumbar fusion or discectomy at the L1-L2 level, can affect the nerves that control ejaculation and erection. The risk is low but real, and it's one reason surgeons are careful about nerve-sparing techniques.
Vasectomy is the one surgery that is intended to cause infertility. It cuts and seals the vas deferens. Vasectomy reversal is possible, but success rates drop the longer you wait. After three years, the pregnancy rate after reversal is around 75%. After 15 years, it's closer to 30%. The sperm quality also declines over time because of the immune response-your body starts making antibodies against its own sperm.
Indirect Effects: Anesthesia, Inflammation, and Recovery
Even surgeries that don't touch the reproductive system can temporarily affect fertility.
General anesthesia itself doesn't seem to cause lasting damage, but the stress response to major surgery can suppress testosterone production for days or weeks. A study in The Journal of Clinical Endocrinology & Metabolism found that testosterone levels dropped by about 30% in men within 24 hours of major abdominal surgery and took up to two weeks to return to baseline.
Post-surgical inflammation can also raise scrotal temperature, which impairs sperm production. The testicles need to stay about 2-3 degrees Celsius cooler than the rest of the body. Any condition that traps heat-swelling, tight bandages, prolonged bed rest-can temporarily lower sperm count.
Medications used during and after surgery matter too. Opioid painkillers suppress the hypothalamic-pituitary-gonadal axis, which controls testosterone production. Even short-term use can cause a measurable drop. Anti-inflammatory drugs like ibuprofen and naproxen, when used for extended periods, have been linked to reduced sperm quality in some studies.
What You Can Do About It
If you're planning a surgery and fertility is a concern, here's the practical playbook.
- Talk to your surgeon beforehand. Ask specifically: "Will this surgery affect my ability to have children?" If the answer is vague, ask for a referral to a urologist or reproductive specialist. Surgeons are not always thinking about fertility when they're focused on fixing the immediate problem.
- Consider sperm banking. If you're having any surgery that carries even a small risk to fertility, banking sperm is a low-cost insurance policy. The cost is about $300-$500 for collection and testing, plus $100-$300 per year for storage. Compared to the cost and stress of trying to conceive later with compromised sperm, it's cheap.
- Wait before trying to conceive. After any major surgery, give your body time to recover before trying to conceive. Most research suggests waiting at least three months-the length of one full sperm production cycle-to allow sperm quality to return to baseline.
- Get a semen analysis. If you've had a surgery that could affect fertility and you're trying to conceive, a simple semen analysis will tell you whether there's a problem. It's non-invasive, cheap, and gives you data instead of guesses.
- See a urologist. If you've had a vasectomy, hernia repair, or any pelvic surgery and you're having trouble conceiving, a urologist can check for blockages, nerve damage, and hormonal issues. Many of these problems are fixable.
The Bottom Line
Previous surgeries can affect male fertility, but most of the time they don't. The risk depends on the type of surgery, the surgeon's skill, and your individual anatomy. The surgeries most likely to cause problems are those that operate near the vas deferens, the testicles, or the pelvic nerves.
If you're concerned, the smartest move is to get informed before the surgery and get tested afterward. Most fertility problems caused by surgery are either preventable or treatable. But you have to know what you're dealing with.
Research cited in this post: Andrology (2018