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Vasectomy Reversal YNN article

Dr. Andrew McCullough is interviewed by Marcie Fraser of Capital Region YNN about Vasectomy Reversal.

Vasectomy Reversal

Vasectomy reversal restores fertility by reconnecting the ends of the vas deferens, which is located in each side of the scrotum, or by connecting the vas deferens to the epididymis. This procedure can be accomplished through various approaches, including microsurgery, to help restore the passage for sperm to be ejaculated out of the urethra.

After successful vasectomy reversal, sperm are present in your semen again and you may be able to get your partner pregnant. There are many reasons to reverse a vasectomy, such as remarriage following a divorce, or starting a family after the loss of a wife or a child. Regardless of your reason, there are now advanced methods to restore your fertility.

By arming yourself with the latest information, you can make informed decisions with your doctor.

Are All Vasectomy Reversals The Same?

Vasectomy is a straightforward surgery and an effective form of birth control - but surgery to undo a vasectomy is more involved and doesn't always work. The surgery is more difficult than the original vasectomy because the tube that carries sperm from each testicle to your semen (vas deferens) must be sewn back together or attached to the epididymis.

Reversals are generally performed as an outpatient procedure or ambulatory surgery procedure. The operation is usually performed under a general anesthetic with the use of a surgical microscope. The choice will depend on the preference of the surgeon, the patient and the anesthesiologist.

Once you are anesthetized, the urologist will make a small incision on each side of the scrotum and remove the scarred ends of the vas deferens at the point of blockage created by the prior vasectomy.

Once the vas deferens has been opened, the surgeon will do a naked-eye inspection of the fluid that comes out as well as examine a drop of the fluid under a microscope. This is an important part of the operation because it helps your doctor determine what type of surgery you need to restore the flow of sperm.

Doctors can perform this surgery in one of two ways:

  • Vasovasostomy - With this procedure, the surgeon sews the severed ends of the vas deferens back together. However, sometimes this isn't possible and a more complex surgery is needed to restore the flow of sperm.
  • Vasoepididymostomy - This surgery attaches the vas deferens directly to the epididymis, the coiled tube on the back of each testicle where sperm matures. A vasectomy can cause blockages or a break in the vas deferens or the epididymis. This surgery is used when a vasovasostomy won't work because sperm flow is blocked. The vas deferens is connected to the epididymis above the point of blockage. This procedure is more complex due to the very small size of the tubes inside the epididymis and has a much lower success rate. This also usually requires a larger incision to complete the procedure.

If the fluid contains sperm and plenty of clear fluid, surgery to reconnect the ends of the vas deferens - a vasovasostomy - is likely to work.

Fluid below the vasectomy site that is thick or pasty, or that contains no sperm or partial sperm, can be a sign that there is scar tissue blocking the flow of sperm. If the urologist does not find sperm in the fluid sample, it may be because the original vasectomy resulted in back-pressure that caused a break in the epididymal tubules. In this case, attaching the vas deferens directly to the epididymis - a vasoepididymostomy - may be the best option.

Microsurgical Vasectomy Reversal

Recovery from vasectomy reversal should be relatively swift and usually comfortable. Any pain that might be experienced after surgery can be controlled with oral medications, and about 50% of men experience discomfort that is similar to the level that they had after their original vasectomy. Another 25% report less pain than that accompanying their vasectomy, and the remaining 25% say the pain is somewhat greater than after the vasectomy.

The reassuring news is that pain is usually severe enough to require medication for a few days, and then you will return to normal. Most patients are back to their normal routine and life work within a week. We usually wish you to refrain from heavy activity for approximately 2-4 weeks, depending on the degree of swelling after the procedure. If your job requires strenuous work, you should discuss with your urologist the earliest time that you can return to work. You should wear a scrotal supporter or jock strap for several weeks and should be restricted from having any sexual intercourse for at least two weeks.

It takes on average one year to achieve a pregnancy after a successful vasectomy reversal. Some pregnancies do occur in the first few months after the reversal, while others do not occur until several years later. One of the main factors influencing pregnancy rate is the obstructive interval, which is the time from your original vasectomy to the time of reversal. Rates of returning of sperm to the semen and the subsequent pregnancy rates are highest when the reversal is performed within 1-3 years after the original vasectomy. Lowest success rates occur if the vasectomy reversal is performed greater than 15 years after the original procedure. The urologist will usually check a semen analysis every 6-8 weeks after the procedure until your sperm count either stabilizes or a pregnancy occurs. Unless a pregnancy occurs, a sperm count is the only way to determine surgical success. Usually, sperm will appear within a few months after the reversal procedure and it may take from 3-15 months to appear after a vasoepididymostomy. In either case, if the reversal is successful, the patient should remain fertile for many years.

The possibility of subsequent pregnancies is the advantage of this procedure over other sperm retrieval techniques for in vitro fertilization. Only approximately 5% of patients who have sperm appear in the semen after vasectomy reversal later develop scarring in the reconnected area which could cause other blockage.

Frequently Asked Questions (FAQ)

Who performs vasectomy reversals?
Urologists are the surgical specialists who frequently perform vasectomy reversals. In our practice, Dr. White performs most of the microsurgical vasectomy reversals.

Can all vasectomies be reversed?
Almost all vasectomies can be reversed, however, if the repair was performed during the repair of an inguinal hernia, there may be much more difficulty reconnecting the ends of the vas deferens. In similar fashion, mesh-type hernia repairs may also make vasectomy reversal much more difficult.

Is age a factor in conceiving after vasectomy reversal?
Your age should not influence the result of your vasectomy reversal. Most men can either produce sperm from their testicles for many years after their partners have entered menopause and are no longer ovulating. In fact, a woman's fertility starts declining in her mid-30's with significant impairment beginning around the age of 37. If female age is a factor, your partner should check with her gynecologist to see if she is still ovulating before you consider reversal surgery. Abnormal results from simple blood tests to measure hormone levels on the third day of her menstrual cycle would indicate a significantly lower chance of fertility. Your female partner should have an appropriate evaluation from either her gynecologist or a reproductive endocrinology specialist.

Are there alternatives to vasectomy reversal?
Yes. Your doctor can obtain sperm from the testicle or epididymis by either needle aspiration or an open biopsy procedure, but the sperm are not useful for simple, inexpensive office procedures such as artificial insemination. Instead, sperm obtained by these surgical methods require much more complicated assisted reproductive technology such as IVF (in vitro fertilization), or ICSI (intracytoplasmic sperm injection). Most of these procedures are not covered by regular insurance plans.

If a vasectomy reversal fails, should I consider a repeat reversal?
The success for repeat reversals are generally 10% lower than for first reversals. For these types of complicated procedures, we usually suggest that you are seen by a specialty center where these types of procedures are performed on a regular basis.

How expensive is vasectomy reversal?
Costs vary widely and depend on 3 factors. The surgical fee, 2) the hospital operating room fees, and 3) the anesthesiology fee. Generally, the cost for a vasectomy reversal can range from $5,000 to $12,000 or more. We are happy to discuss financing and costs of the procedure with you and your insurance company.

Will a vasectomy reversal relieve pain in the testicle developed after my vasectomy?
It is fortunate that only a very small percentage of men develop severe testicular pain after vasectomy. Because such situations are rare, there are a few reports of groups of patients who undergo vasectomy reversals to relieve pain in the testicle, however, there are few published reports. Most of these small series indicate the majority of patients who undergo vasectomy reversal do have some pain relief, however, no one can guarantee that vasectomy reversal will improve the pain. We are happy to discuss any of these procedures with you in consultation, and would be happy to schedule an appointment for your visit.

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