Vasectomy Reversal Procedure

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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

Vasectomy Reversal

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.

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Vasectomy Reversal

Vasectomy and its Microsurgical Reversal

In our series the overall pregnancy rate after vasovasostomy in an unselected group of early patients was 71%. Recovery of fertility correlated with the return of normal sperm counts and with the quality of vas fluid on the testicular side of obstruction at the time of vasovasostomy. The three most important factors in our group influencing return of fertility after vasovasostomy were a meticulous microscopic technique for reconnection, the duration of time the vas deferens has been obstructed, and the presence or absence of a sperm granuloma at the site of vasectomy. The presence of a sperm granuloma at the site of vasectomy virtually ensured the presence of good quality sperm in the vas fluid at the time of vasovasostomy. If all three of these factors are favorable, vasectomy may be reversible for more patients.
Source: Silber SJ.: The Urololic Clinics of North America. 1978 Oct;5(3):573-84.

Vasectomy and Pregnancy

By Inder Walia

Post Vasectomy fertilization is a possibility! Renewed patency is bliss for some and an impediment for others. The risk is low but cases of pregnancy after vasectomy have been recorded. Several studies conducted to map the incidence of pregnancy after vasectomy vary by a few numbers. One study revealed only 3 cases of pregnancy out of 3,178 vasectomized men who were tested. The point to remember is that even if no sperm is found in a semen analysis post vasectomy reversal, it does not completely rule out the presence of motile sperm, which may later contribute to pregnancy.

The reasons behind pregnancy after vasectomy could be technical error, the reopening of the occluded passageway that carries sperm or the presence of residual motile sperm in the seminal vesicles even after vasectomy. The restoration of the sperm channel may happen early or late. An early recanalization (spontaneous reconnection of the vas deferens) may be detected in the post-vasectomy specimens. However, late recanalization is said to occur when several post vasectomy specimens do not show any sperm, which is discovered years after when the pregnancy has already occurred.

The above discussion relates to natural vasectomy reversal, which may not always come as a pleasant surprise! Thus, it is recommended to continue using contraceptives such as birth control pills for at least six months post vasectomy. This is because a minimum of twenty ejaculations after vasectomy have been found to contain viable sperm. On the other hand, there are couples, which after vasectomy may be desirous of more children and that chance pregnancy may not happen to them. Thats where the Vasectomy reversal procedure by a specialist comes into the picture!

Vasectomy reversal pregnancy rates are defined by factors such as the success rate of complicated epididymal surgeries that have to be conducted on most reversals. Besides, the sperm count, quality and fertility has also been noticed to decline progressively with the years after vasectomy. However, reversals performed even 20 or more years after vasectomy have known to succeed after epidiymal surgeries. Besides, new techniques of microsurgical epididymal surgery are contributing to an increase in the success rate of pregnancy after vasectomy reversal.
There are several success stories of pregnancies after vasectomy that have brightened the lives of several people. Success rate varies with the methodology used, the experience and expertise of the vasectomy doctor and the years between vasectomy and the reversal attempt. It takes an average of 12 months, and at the most 2-3 years between vasectomy reversal and the pregnancy to occur. Thus, if you decide to have another child years after vasectomy, youve got hope. So do millions of people across the globe who want to grow their families. Vasectomy reversal helps you achieve the delight, happiness and pleasure of parenthood!

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Vasectomy Reversal

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Vasectomy Reversal

Vasectomy-Reversal-Overview-Things To Know

By Inder Walia

Excellence in the medical field is represented now and again, when health is restored, lives are saved, new lives are brought forth and more. Some call it miracles, some call it magic and some just ascribe it to the advancement of medical science. Today Vasectomy reversal is possible! Nothing less than a miracle, it is a gift of science to mankind.

Vasectomy is the most effective long-term contraceptive method. It is conducted in the first place when an individual makes the decision of not wanting to father any more children in his remaining life span. However, different reasons such as remarriage, untimely demise of a child, desire to become a father etc, may trigger the need of vasectomy to be reversed. Twenty years ago the idea would have been unthinkable. However, today it is not only possible but millions of people find their lives enriched by the squeals of little babies, thanks to vasectomy reversal!

Before going in for a vasectomy reversal, it is advisable to be armed with a thorough understanding of the procedure, various surgical techniques, vasectomy risks, post vasectomy complications and recovery details. The procedure of conducting a vasectomy reversal is called a vasovasoctomy in medical terms. This is a kind of outpatient microsurgery conducted usually by a urologist, under the influence of local, spinal, epidural or general anaesthesia.

The first point to consider when deciding upon the micro-surgical reversal technique of vasovasostomy is the selection process of a vasectomy reversal doctor. Surgeons with extensive training in microsurgery and who perform many vasectomy reversals each year, obtain the best results.

Now to answer the main question- how is vasectomy reversal conducted? Vasovasostomy is essentially a two-step procedure. The first thing the surgeon needs to ascertain is the availability of sperm by examining a drop of fluid removed from the testicular end of vas deferens. Depending on the kind of sperm found, the appropriate type of microsurgical reconstruction needs to be performed.

The second step is to meticulously place sutures to sew the two ends of vas deferens. The channel within the vas deferens, which carries the sperm flow, is only 0.2 to 0.3 millimetres in diameter, which is roughly the size of a pinpoint. Thus, the procedure is to be carried out under a microscope that makes for better visualization, magnifying structures 20 times their actual size. This helps avoid imprecise suture placement. To ensure a leak proof connection, one-layer, two-layer or even three layer sutures may be drawn.

The majority of men who undergo vasectomy have epididymal blowouts, which are caused due to build up of pressure in the epididymis, the tube that carries sperm from the testicles to the vas deferens. The increased pressure results in a leak. The procedure used to suture epididymal blowouts is called Microsurgical Vasoepididymostomy.

Vasectomy reversal has been known to have successfully worked for patients up to 30 years following vasectomy with pregnancy occurring as early as a few months post reversal. If a vasectomy reversal is not successful due to scarring at the surgery site or imprecise suture placement or any other reason, it does not entail a complete loss of hope to reverse vasectomy. Redo vasectomy reversals have been conducted all over the world with considerable success.

Vasectomy reversal is a lifeline that has brought hope, joy, and laughter into several hearths and homes, and it shall continue to do so until science comes up with a new technology to replace this one. Till then, vasovasostomy is every vasectomized mans best bet to become fertile again.

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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).

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Vasectomy Reversal

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.