Vasectomy Reversal Procedure

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Vasectomy Reversal

Vasectomy Reversal

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery). This procedure is not effective in all cases, with the success rate depending on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. There is evidence that men who have had a vasectomy produce abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility.

In one study, vasectomy reversal was found to be 75% effective for reducing the symptoms of chronic post-vasectomy pain.

In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization.

Sperm Granuloma and Reversibility of Vasectomy.

Ninety-two consecutive patients who had undergone bilateral vasectomy 1 month to 28 years earlier were studied at the time of vasectomy reversal for sperm output, dilatation of the vas-deferens lumen, and sperm granuloma. Thirty-nine men had unilateral or bilateral sperm granuloma. The presence of of a sperm granuloma virtually assured normal sperm in the vas fluid no matter how long ago the vasectomy was performed. In the absence of a sperm granuloma, the interval since vasectomy had an important influence on the quality of vas fluid. The presence of a sperm granuloma was associated with significantly less dilatation of vas-deferens lumen at the testicular end. The site of the vasectomy and the amount of vas deferens removed did not influence sperm quality. A sperm granuloma on only one side resulted in normal spermatozoa in the vas fluid on that side, whereas the side without the sperm granuloma had abnormal spermatozoa or no spermatozoa in the vas fluid. It is concluded that when sperm granuloma follows vasectomy it vents the high pressure otherwise created by vasectomy and prevents disruption of sperm output in the vas fluid.
Source: Silber SJ.: Lancet. 1977 Sep 17;2(8038):588-9. Links

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“VV” vs. “VE”

Vasovasostomy (VV) and vasoepididymostomy (VE) are very different operations. Since the aim of VV is to reconnect the vas where it was severed at the time of vasectomy, it is a true “reverse vasectomy”. A VV can often be performed by lifting the vas tubes out of the scrotum through a small incision, just as they were lifted out at the time of the vasectomy. The vasectomy site will be either a gap or a nodule (lump), but either way, the objective is to freshen the ends on either side of the vasectomy site and suture them back together. Left and right sides can usually be repaired in turn through the same 1/2- to 1-inch vertical incision in the center of the scrotum, all under local anesthesia in a doctor’s office. The procedure is performed under magnification using optical loupes or a microscope, 10 -18 sutures are used on each side, and it takes 3-4 hours.

A VE is different in a number of ways. (1) Since the epididymis is attached to the testes, VE requires delivery of the testes, that is, the testes must be taken out of the scrotum while the connection between the epididymis and vas is made. This requires an incision larger than that needed for VV. (2) Also, the portion of the vas between the vasectomy site and the epididymis is not used, so the gap that must be bridged is longer, requiring that the upper section of vas be “mobilized” to provide the needed length. In order to do this, the surgeon must usually make two incisions, one left and one right, which can be extended up toward each groin to allow for dissection and loosening of higher portions of the vas. (3) Finally, the epididymal tubes are much smaller than the vas tubes. A microscope must be used, the connection between epididymis and vas (VE) is often not as strong as the connection between vas and vas (VV), and the success rate of VE is not as high as the success rate of VV. A VE is more technically demanding than a VV, and some surgeons who are excellent at VV’s may not perform VE’s frequently enough to be comfortable with them.

Most doctors would agree that delivery of the testes through bilateral (both sides) incisions is beyond the scope of an office environment and that general anesthesia and a formal operating room in a hospital or ambulatory surgery center should be used. In addition, since the success rate (return of sperm to the semen) with bilateral VE is only about 65%, one should consider using a surgical facility in which sperm can be harvested, evaluated and frozen at the time of the VE so that sperm is available for in-vitro fertilization if the VE fails. Saving sperm at the time of VV is much less practical for two reasons: (1) the sperm seen at the time of VV are usually not motile (active) and therefore not acceptable for freezing and in-vitro fertilization, and (2) the success rate of VV when sperm are seen coming from the lower end is very high.

VV VE
testes not seen must be delivered
gap length usually short usually long
incisions one, short, midline two, longer, left and right
magnification loupes or microscope microscope necessary
anesthesia local works fine general advisable
procedure location office or operating room operating room
sperm storage not practical advisable
fees surgeon surgeon, anesthesia, facility

Which men need a VE?

Ah … that’s the big question. We know that the longer the interval in years between vasectomy and reversal, the greater the likelihood of a secondary obstruction in the epididymis. But some men have secondary obstruction after only two years and some do not have it after 30 years. Wouldn’t it be nice if we could determine with certainty which men need a VE before they have their surgery? Unfortunately, we cannot.

Physical Exam
There are a few clues on physical exam: (1) An epididymis that is very enlarged, firm, and tender is more likely to be obstructed than one which is small, soft, and non-tender. (2) A nodule (lump) at the vasectomy site may be “sperm granuloma”, a place where sperm leaking from the lower end of the severed vas are being recycled. If the inflammation needed to recycle sperm is taking place at the vasectomy site, it is not taking place upstream, thereby sparing the epididymis and reducing pressure within it. So a vasectomy site lump is a good thing, but not all lumps are granulomas … some are just knots of the suture or clips used during the vasectomy. (3) Some surgeons believe that high (away from the testes) vasectomy sites are a good sign … more vas on the testis side of the vasectomy site to absorb the back pressure.

Operative findings
When the vasectomy site is investigated and the lower end is freshened, the fluid that may drain from the lower end is an important clue. If the fluid contains sperm, the likelihood of an upstream obstruction is very low and the likelihood of sperm reappearance in the semen after VV is very high. If the fluid contains no sperm, especially if it is thick or creamy and packed with white blood cells (pus cells), the likelihood of an upstream obstruction is very high and the likelihood of sperm reappearance in the semen after VV is very low. No fluid at all is a relatively poor sign, and watery fluid, even though devoid of sperm, is a relatively good sign.

There are three approaches to vasectomy reversal:

(1) A surgeon may perform a bilateral VV through a single incision in the office or in a facility, regardless of the lower end fluid findings, because (a) most patients have good lower end fluid findings and do not need a VE, (b) some patients enjoy return of sperm to the semen and cause a pregnancy even when lower end findings are adverse, and (c) VV’s are technically less demanding and more likely to remain open than VE’s.

(2) A surgeon may perform all reversals under general anesthesia through two incisions in an operating room with a lab ready to accept sperm for storage. By delivering the testes, the surgeon can work with excellent exposure and go right to a VE on one or both sides he or she feels that fertility would be better with a VE.

The problem with approach number 1 is that when there is epididymal obstruction on both sides (which occurs about 17% of the time on average), the procedure fails and the patient has paid full fee for a procedure from which he has derived no benefit. In addition if the patient chooses to undergo a subsequent VE, the VV has caused some scarring and loss of upper end length in the process of trimming and suturing the upper end, making the subsequent VE more challenging and perhaps less likely to succeed.

One problem with approach number 2 is that all patients pay for the operating room and anesthesia when most would have achieved success in an office environment. When even the most liberal criteria for performing a VE rather than a VV are used (as was done in a recent study), 75% of men in an operating room had a VV on both sides and 8% of men had a VV on one side. Since the VV techniques used in the office and operating room are so similar, these 83% of patients may have enjoyed a return of sperm to the semen at a much lower cost, an important consideration for an operation not covered by most insurance carriers. Another problem with approach number 2 is that after the larger bilateral incisions patients may take longer to recover than after a single smaller incision and perhaps need more time before returning to work.

(3) A third approach is an attempt to address the problems above. Patients have their procedure in the office. The first step of the procedure is to explore one vas on the testis side of the vasectomy site through a small midline incision. This lower end is opened and the fluid evaluated. If findings are favorable, proceed with VV. If findings are very unfavorable (no fluid or thick fluid with no sperm), no connection is made and for that side the patient is charged an exploration fee much lower than a VV fee. The upper end is left unharmed, there is minimal scarring, and the patient can undergo a VE and sperm harvesting in an operating room at a later date. If the lower end fluid findings are equivocal (watery or thin fluid but no sperm), the patient and doctor can make a decision together about whether to proceed. Then the other side is managed the same way. Most patients, regardless of the interval between vasectomy and reversal, will have favorable findings on both sides, will have a VV on both sides, and will experience a return of sperm to the semen.

Approach number 3 makes the most sense for men whose intervals are short (less than 10 years) and who have no adverse physical findings. Why spend thousands of dollars for an operating room and anesthesia when the likelihood of success with an office procedure is so high? Approach number 2 may make sense when the interval is long. Approach number 1 has, for this practice, provided the results summarized in the page with Results Charts. However, since early 2005, this practice has utilized approach number 3.

Whichever approach is used, vasectomy reversal takes about 3-4 hours. Postoperatively, a dressing is held in place with an athletic supporter. A small soft drain may be left in the scrotum for one to two days to allow egress of blood and thereby prevent swelling.

Vasectomy Reversal

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How Much Does it Cost

The cost of a vasectomy reversal varies among physician practices, states and the type of procedure used. It is not inexpensive. But you may have options to help fit your family budget.

Unlike a vasectomy, most insurance plans do not cover the cost of reversal surgery, which can range from about $5,000 to $13,000. Although this is usually an elective, fee-for-service procedure, there are ways to make this expense more affordable.

Consider alternative financing options.
A reversal may be a good first option for a couple to consider because it is less expensive, more natural, and potentially more effective, than assisted reproductive techniques (ARTs) such as aspirated sperm and the additional cost of in vitro fertilization attempts.

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Vasectomy Reversal

Vasectomy Reversal — Men Can Also Change Their Minds!

By Antony Wilton

Prior to undertaking a vasectomy reversal, it is important to discuss with your doctor all aspects of the operation and your personal situation, to pinpoint significant issues that will impact upon the ultimate result.

The extent of the period from vasectomy to reversal is an important factor, as success rates are known to diminish the longer the break has been. This is due to the increased probability of pressure injury sustained in the epididymis or even a blockage within it.

Your doctor will be interested in any history of complications that may have occurred after the the vasectomy such as scrotal hematoma or any post operative epididymis infection. Your partners reproductive potential will also be assessed and you must realise that if you were was having difficulty with conception before your vasectomy, this situation is unlikely to change after vasectomy reversal. Also, your specialist will try to procure your surgical notes relevant to your vasectomy to determine, if possible, how your vasectomy was actually carried out.

For instance, depending whether the vasectomy was performed high up on the tube or quite low down near the epididymis, could have an effect on the difficulty of the reversal surgery. Your physician will also analyse your physical make up to get a superior understanding of what he will encounter during the reconstruction.

Small spongy testes can suggest impaired sperm manufacture and project a poor result.
An enlarged or uneven epididymis can mean secondary epididymal impediment that may require a vasoepididymostomy. On the other hand, an incidence of a sperm granuloma is a satisfactory diagnosis as these sperm granulomas allow for the venting of high pressure away from the epididymis, and subsequently allowing protection from pressure induced harm.

If you have a sperm granuloma your prognosis is good irrespective of the period since the vasectomy took place.

When a very harmful vasectomy has been undertaken, it is conceivable that large portions of the vas have been excised or cut out. This may mean that extensions of the incisions may be required to establish a tension free reconnection leading to more complicated surgery. Naturally, if a satisfactory outcome is obtained by re establishing sperm flow in the man, a successful pregnancy can only be obtained providing the female is also capable of giving birth.

The woman should organize for a gynecological examination to guarantee that she is able to conceive. How near she is to menopause can be also be an issue because of the time that it may take for sperm flow to be re established in the man following a successful vasectomy reversal.

These are just some of the considerations that need to be taken into account before undertaking a vasectomy reversal.

Author Antony Wilton discusses important mens issues on his site
Vasectomy Reversal
His regularly updated blog can be found at
Vasectomy Reversal Blog

Article Source: http://EzineArticles.com/?expert=Antony_Wilton
http://EzineArticles.com/?Vasectomy-Reversal—–Men-Can-Also-Change-Their-Minds!&id=157596

Esperanza to hold mens health fair (The San Angelo Standard-Times)
In honor of National Mens Health Week, Esperanza Health & Dental Centers in San Angelo is hosting a mens health fair from 10 a.m. to 1 p.m. Saturday at the YMCA, 353 S. Randolph St.

Basics of Vasectomy Reversal

After vasectomy, sperm are still made by the testes, but since the vas tubes have been blocked, they cannot exit in the usual way. On each side, sperm can still enter the epididymis (the very long coiled tube behind the testis where sperm normally become mature) and the lowermost portion of the vas tube upstream from the obstruction imposed by the vasectomy. After vasectomy, the very fine tubes of the epididymis can become blocked. There are two possible explanations for this.

In the epididymis, white blood cells in the normal testicular circulation ingest and recycle the trapped sperm. This increased white blood cell activity is a chronic inflammation by definition. Inflammations can lead to scarring, and scarring in a very fine tube like the epididymis can cause obstruction. For example, inflammation of the liver (hepatitis) can cause scarring of the liver (cirrhosis); inflammation of joints (arthritis) can cause scarring with stiffness and decreased range of motion. The longer the duration of the inflammation, the greater the likelihood of scarring and obstruction, and this can occur in the epididymis, just as it can in any organ.

An alternative explanation for obstruction in the epididymis after vasectomy is that pressure increases upstream from the vasectomy site and can cause a “blowout” in the fine tubes of the epididymis, resulting in leakage of sperm and local inflammation and blockage.

Whatever the explanation for the obstruction in the epididymis (scarring or blowout), its likelihood is roughly proportional to the number of years that have gone by since the vasectomy. After an interval of only 1-3 years, the epididymis is rarely blocked, but after an interval of 20 years, the likelihood of secondary obstruction may be over 30%. Fixing the vas where it was divided at the time of the vasectomy (vasovasostomy or “VV”) will not correct the secondary obstruction upstream in the epididymis. That requires a more elaborate procedure called a vasoepididymostomy or “VE”, in which the portion of the vas tube above or “downstream” from the vasectomy site blockage is connected to the portion of the epididymis “upstream” from the secondary obstruction.

June 11-17: International Men’s Health Week (PR Newswire via Yahoo! Finance)
Next week marks the 13th year of International Men’s Health Week, celebrated annually during the week preceding and including Father’s Day to honor the importance of men’s health and wellness.

Vasectomy Reversal - Things You Should Know

By Inder Walia

Vasectomy reversal is conducted with an aim to restore fertility in the life of couples that want to explore the joys of parenthood. Vasectomy is considered the most reliable and safe contraceptive method that prevents more pregnancies every year than any other method of birth control. However, with changing times, attitudes, priorities, and financial and emotional circumstances also undergo transformation. One may later in life, feel the need to get a vasectomy reversal. A reversal scores higher than all other available options because its more natural, less expensive and potentially more effective!

It is critical to garner all information regarding vasectomy reversal before deciding to take the plunge! The following are a few pointers to quickly walk you through all that you need to know about vasectomy reversal.

What exactly is vasectomy reversal? Reverting of Vasectomy is a microsurgical procedure that can backtrack vasectomy. It involves the single or multiple suturing of the two severed ends of vas deferens, the tubes that carry sperm from the epididymis to the prostate. This allows for the renewed flow of sperm through the vas deferens in the male reproductive tract. This sperm goes on to become part of the semen ejaculated at orgasm and thus brings about the ability to father children. This medical procedure is known as a “vasovasostomy. If there is a blockage due to the increased pressure in the epididymis, it must be bypassed in an alternate form of surgical procedure known as a “vasoepididymostomy.

The cost of Vasectomy Reversal- It is a good idea to investigate the total expenditure of a vasectomy reversal, which may be anywhere from $4,000 to $20,000. Unlike vasectomy, most insurance companies do not cover the reversal procedure. The asking price may vary among physicians, states, and according to the methodology used. For instance, the services of a vasectomy reversal expert in the US may cost you an average of $10,000. The same would cost you $5000 in Canada. This is all inclusive of the three fees applicable for a vasectomy reversal, which are the surgical fee, the anaesthetic fee and the hospital fee. It is however possible to lessen the charges by opting for an operation at an outpatient surgical centre instead of a hospital. That may reduce the price of a vasectomy reversal to anywhere from $2500 to $4000. Furthermore, in case of a vasoepidiymostomy, the overall cost of the reversal will mount, as this procedure is more complex and time-consuming.

How successful is Vasectomy Reversal? Vasectomy reversal is quite successful! The success rates again vary in accordance with factors such as the duration after vasectomy, experience, expertise and the course of action or approach of your surgeon towards vasectomy reversal. A recent study focussed on vasectomy reversal and conducted on over 1000 couples revealed that if the duration after vasectomy was less than three years, 75 percent of couples achieved a pregnancy, if three to eight years, 50 percent, nine to 14 years, 40 percent and over 14 years post vasectomy, 30 percent of couples achieved a pregnancy. The overall pregnancy rate was 52 percent. Repeat vasectomy reversals were less winning with only 40 percent of pairs accomplishing a pregnancy. In addition, success rates vary from surgeon to surgeon, some boasting of as much as a 97% success rate of a straightforward vasectomy reversal.

Complications- Though rare, there may arise some difficulties following vasectomy reversal. These include the oozing of blood from the corners of the scrotal incision, which usually stops within 12 hours following the procedure. Some patients may incur a large bruise that settles with time and rest. Also, there are chances of an infection that is quite painful, accompanied by the scrotum acquiring a red colour. Immediately contact your vasectomy reversal doctor in case of any of the above complications!

Choosing your Vasectomy reversal expert- The reversal surgery is specialized and technical and demands extensive training in microsurgery and an experience of conducting several reversals throughout a year. Skill, experience and expertise are major factors that have a bearing on the success of vasectomy reversal. Other than that, ensure that your surgeon not only has had formal fellowship training but also is licensed to practise in your state or province. Confirm that your micro surgeon /reversal specialist performs the reversal using an operating microscope, and 2-layer closure with 10-0 nylon sutures. It would also be wise to check out the surgeons statistics for number of reversals per year, number of successes, complication rates and whether or not he has a university appointment.

Pregnancy after vasectomy Reversal- The statistics for pregnancy post vasectomy, as mentioned above, are quite encouraging! After vasectomy reversal a couple may attain pregnancy within a couple of months. The standard duration is at least a period of 12 months. Most pregnancies occur with in a period of two years after the reversal.

Armed with the above knowledge, it is now time to make your decision. It is best not to delay vasectomy reversal because even if you do not plan a child for the next one or two years, it must be borne in mind that post vasectomy reversal pregnancy takes an average time of twelve months. In addition, the more you delay, the more affected are your chances of attaining patency. Hope this information helps you make an informed decision about your and your familys future!

Inder Walia

For all the Vasectomy related questions, please visit www.vasectomyreversalnews.com.

Article Source: http://EzineArticles.com/?expert=Inder_Walia
http://EzineArticles.com/?Vasectomy-Reversal—Things-You-Should-Know&id=413070

Vasectomy Reversal

Sperm Granuloma and Reversibility of Vasectomy.

Ninety-two consecutive patients who had undergone bilateral vasectomy 1 month to 28 years earlier were studied at the time of vasectomy reversal for sperm output, dilatation of the vas-deferens lumen, and sperm granuloma. Thirty-nine men had unilateral or bilateral sperm granuloma. The presence of of a sperm granuloma virtually assured normal sperm in the vas fluid no matter how long ago the vasectomy was performed. In the absence of a sperm granuloma, the interval since vasectomy had an important influence on the quality of vas fluid. The presence of a sperm granuloma was associated with significantly less dilatation of vas-deferens lumen at the testicular end. The site of the vasectomy and the amount of vas deferens removed did not influence sperm quality. A sperm granuloma on only one side resulted in normal spermatozoa in the vas fluid on that side, whereas the side without the sperm granuloma had abnormal spermatozoa or no spermatozoa in the vas fluid. It is concluded that when sperm granuloma follows vasectomy it vents the high pressure otherwise created by vasectomy and prevents disruption of sperm output in the vas fluid.
Source: Silber SJ.: Lancet. 1977 Sep 17;2(8038):588-9. Links

What is the Success Rate…

Nationwide vasectomy reversal success statistics are readily available. The most commonly cited article is the report of the Vasovasostomy Study Group which appeared in the Journal of Urology in March, 1991 (J Urol 145:505-511, March,1991; you can review or copy the article at your local hospital medical library). The single most important parameter determining success is the number of years since vasectomy. Within the first 3 years after vasectomy, reversal results in sperm recovery in over 97% of cases. From 3 to 8 years, about 91%; from 9 to 14 years, about 82%; and beyond 14 years, about 69%. Pregnancy rates (without fertility assistance) also drop slowly with time (from about 80% in the 3-year group to 35% in the >15-years group).

How Much Down Time to Expect

Patients must use greater caution following vasectomy reversal than following vasectomy, even more so following VE vs. VV . Depending on the surgeon’s protocol, patients may return to work 4-21 days following the procedure.

Vasectomy Reversal

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