There may be any number of reasons why
you have decided to consider a vasectomy reversal.
At the Center for Reproductive Health, we have a
friendly, experienced and highly professional team to help you arrive
at the right decision, whether it is a vas reversal or the
non-surgical approach called percutaneous epididymal sperm aspiration.
At this appointment the counseling doctor will explain the nature and
details of the operation and answer any questions you may have.
In
particular the doctor will try to ensure that you are making the
correct decision, bearing in mind your personal circumstances. It is
very difficult to provide accurate information about the success rate
of a vasectomy reversal.
The counseling
doctor and or the surgeon will of course be happy to expand on this
information as it applies to you. If you decide to go ahead an
appointment for the operation can be arranged without delay. There
will be some post-operative swelling and bruising, but healing is
rapid and you should feel much better after two or three days.
Nonetheless, it should be stressed that you must at all costs avoid
any strenuous activity for at least ten days after the operation and
it is also advisable to allow one or two weeks off work. Semen tests
are arranged at 12 and 16 weeks after the operation when we will make
an appointment for you to see the counseling doctor to discuss the
results. Post-operative care is very important and if at any time you
are concerned about the progress of your recovery, or you have any
questions, expert advice and help is always available.
There are several
ways of assessing men who are candidates for vasectomy reversal prior
to surgery. These include the history and physical examination and
determination of serum gonadotropin and
antisperm antibody (ASA) levels. In general, the prior
fertility history and the length of time since the vasectomy, along
with a careful examination establishing the testicular size and
consistency, the length of vasal defect, the presence or absence of a
granuloma at the vas site, and the condition of each epididymis,
provide adequate information to counsel the patient on the likelihood
of a successful outcome.
When there is an uncorrectable blockage to sperm,
which can
occur naturally or in some cases of vasectomy, sperm can be collected
from behind the blockage by a minor surgical procedure. Sperm can
usually also be collected from a small tissue sample taken directly
from the testis in cases of severe lack of sperm production. Either
way, the sperm are relatively few and immature but usually sufficient
to achieve fertilization by ICSI.
A large multicenter
study by the Vasovasostomy Study Group showed reduced patency
rates and reduced pregnancy rates with increasing length of time from
the vasectomy to its reversal. This resulted from a higher percentage
of men developing proximal obstruction due to rupture of the
epididymal tubule over time. Scarring and induration in the epididymis
may evidence this condition. A sperm granuloma, which results from
leakage of sperm at the vasectomy site, may protect against this
process by releasing pressure on the proximal structures.
An association
between the presence of ASAs and infertility has been well
established. With the disruption of the blood-testicular barrier
that occurs following ductal obstruction, ASAs can develop, and an
elevated level may be seen in up to 60% of men following vasectomy.
But from 2% to 30% of fertile men have elevated levels of
agglutinating ASA levels in the serum, and this elevation does not
always correlate with elevated levels in the semen. We therefore do
not routinely use serum ASA levels in decision-making when considering
vas reversal.
The highest success
rates for vasectomy reversal are achieved through a microsurgical
procedure that allows for an accurate mucosa-to-mucosa leak-proof
anastomosis that is free of tension and that preserves the blood
supply. Competence in microsurgery is a result of special training
in microsurgical technique, laboratory practice, and experience. In
the hands of a skilled surgeon, men who had their vasectomies from 3
to 8 years previously can expect post-vas reversal patency, as
demonstrated by finding viable sperm in the semen 90% of the time and
pregnancy rates of 50% in their partners.
To make an
appointment, please call us TODAY at
615-321-8899.
