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1. What is a vasectomy?
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A vasectomy is a safe, simple, quick and effective method
of contraception.
Figure 1 |
To understand what a vasectomy is, a little knowledge
of normal male anatomy is needed. As illustrated
in Figure 1, the testicles are continually producing
sperm even after a vasectomy. The sperm is stored
in the epididymis, located directly above the testicles.
Sperm moves from the epididymis through each vas
deferens to the prostate, located in front of the
bladder. When ejaculation occurs, sperm is expelled
from the penis.
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Figure 2 |
A vasectomy is a surgical procedure that disrupts
the flow of sperm through the vas deferens as illustrated
in Figure 2. The surgeon actually cuts through the
vas deferens and then places a clip or suture
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2. What is a vasectomy reversal?
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A vasectomy reversal is, a surgical procedure that restores
the flow of sperm through the vas deferens. It is usually
performed by an experienced microsurgeon using specialized
instruments, including an operating microscope. The sutures
used in vasectomy reversal are finer than human hair.
There are two types of vasectomy reversals: vasovasostomy
and vasoepididymostomy.
Figure 3a |
Figure 3b |
Figure 4a |
Figure 4b |
A vasovasostomy is the operation most frequently
performed for vasectomy reversal. It entails stitching
the cut ends of the vas deferens together as illustrated
in Figure 3a and 3b.
A vasovasostomy is the surgery of choice for vasectomy
reversal. However, if excessive inflammation or scarring
has occurred in the epididymis, sperm may be blocked from
getting to the vas deferens. If a blockage has occurred
in the epididymis, merely connecting the two cut ends
of the vas deferens (as is done in a vasovasostomy) will
not solve the problem. To bypass the blockage in the epididymis,
a vasoepididymostomy must be performed.
A vasoepididymostomy is performed by connecting
the vas deferens directly to the epididymis as illustrated
in Figure 4. One end of the vas deferens is stitched directly
to the epididymis.
More information regarding vasovasostomy and vasoepididymostomy
is provided in question 10.
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3. What are the success rates associated with vasectomy
reversal?
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Before the advent of microsurgical techniques, vasectomy
reversal procedures were only occasionally successful.
With the relatively recent advances in microsurgical techniques,
instruments and suture materials, success rates have greatly
increased.
Results of recent studies indicate that following microsurgical
vasovasostomy sperm appears in the semen in approximately
85 to 97% of men. Approximately 50 percent of couples
subsequently achieve a pregnancy.
Following microsurgical vasoepididymostomy, sperm
appears in the semen in approximately 65% of men. Approximately
20 percent of couples subsequently achieve a pregnancy.
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4. Is vasectomy reversal a common procedure?
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Current estimates are that about one percent of men who
have undergone a vasectomy will eventually want reversal
surgery.
About 500,000 men have vasectomies each year in the United
States. While the number of men requesting vasectomy has
remained approximately the same, the number of men requesting
vasectomy reversal has increased.
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5. Why do men want vasectomy reversals?
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The leading reason that men elect to have vasectomy reversal
is to father a child after remarriage following divorce
or death of a spouse.
Others seek vasectomy reversal after the death of a child.
A small percentage of men seek reversal for relief of
scrotal pain attributed to the vasectomy, a desire to
restore fertility independent of any change in marital
status, or because of religious beliefs.
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6. Can all vasectomies be reversed?
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From a surgical standpoint, it is rare that a vasectomy
cannot be reversed.
In the past, if the epididymis was blocked or a large
segment of the vas deferens was removed during the vasectomy,
a vasectomy reversal procedure was considered to be too
complicated and was unlikely to be successful. Today,
however, the development of new microsurgical techniques
has provided a way to bypass an epididymal blockage and
correct a shortened vas deferens. These new techniques
have led to improved pregnancy rates following vasectomy
reversal even in the most extreme cases.
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7. Does health insurance cover vasectomy reversal?
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It is important to check with your health insurance
plan to identify what costs of vasectomy reversal may
be covered.
The costs of vasectomy reversal will include: the surgeon's
fee, the hospital's fee for the use of the operating
room and ambulatory care facility, and the fee for anesthesia.
These costs can range from approximately $5,000 to $15,000.
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THE SPECIFICS OF MICROSURGERY
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8. How have microsurgical techniques improved results
of vasectomy reversal?
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Most surgeons attribute the increased success following
vasectomy reversal to the advent and skilled use of the
operating microscope (microsurgery).
The advantage of using an operating microscope is that
the ends vas deferens can be rejoined more accurately.
The diameter of the vas deferens is barely perceptible
to the human eye (.3 to .5 mm in diameter). As a result
the placement of sutures with the aid of optical magnification
(10 to 40 times) is far more accurate.
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Figure 5
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Microsurgical techniques for the correction of
epididymal obstruction (vasoepididymostomy) have
also led to improved pregnancy rates following vasectomy
reversal. A surgeon who has microsurgical expertise
can move from a vasovasostomy to an more complicated
vasoepididymostomy when the need arises.
There are two microsurgical techniques available
for vasovasostomy: A single layer approximation
and a multi-layer approximation. In the single layer
technique (as illustrated in Figure 5), the inner
and outer layers of the vas deferens are joined
with the same suture. Six to eight sutures are generally
used. Gaps in the outer layer of the vas deferens
may be present after the initial sutures are tied.
In this case, additional sutures may be used to
close these gaps. This is called a modified single
layer approximation.
In the multi-layer technique (as illustrated in
Figure 6), the inner and outer layers of the vas
deferens are each connected separately. Microsurgery
for vasoepididymostomy has made it possible to connect
the vas deferens precisely to a single epididymal
tubule with greater accuracy. As illustrated in
Figures 7a and 7b, the inner layer of the vas deferens
is precisely connected with sutures to a small opening
in a single epididymal tubule. The outer layer of
both the vas deferens and the epididymis are then
connected to obtain the final result. (Figure 7c)
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Figure 6
Figure 7a |
Figure 7b |
Figure 7c |
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9. Are the success rates for a multi-layer vasovasostomy
different from a single-layer vasovasostomy?
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Success rates for both single- and multi-layer vasovasostomy
are similar as long as microsurgical techniques are employed
by an experienced microsurgeon. In fact, according to
a recent report, success rates after a modified single-layer
closure was slightly better than a multi-layer closure
(57% vs 51 % pregnancy rates respectively). Many experienced
physicians believe that potential drawbacks to the multi-layer
vasovasostomy technique are the increased cost to the
patient (more sutures are needed), increased operative
time and longer anesthesia time.
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10. When would a surgeon perform a vasoepididymostomy
rather than a vasovasostomy?
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While a vasovasostomy is the first choice of treatment
for vasectomy reversal, vasoepididymostomy, the more complex
procedure, is required in approximately one third of cases.
Figure 8 |
At the beginning of the reversal surgery, the
surgeon isolates and excises the scarred ends of
the vas deferens. As soon as this is done, the cut
ends of the vas deferens closest to the testicles
are examined for sperm content and vas fluid quality.
Fluid is extracted from the vas deferens by syringe
(as illustrated in Figure 8) and inspected using
a laboratory microscope (as illustrated in figure
9). In general, if sperm is present in the vas fluid,
a vasovasostomy is performed. If sperm is not present
in the vas fluid, a vasoepididymostomy is performed.
Lack of sperm in the vas fluid usually indicates
rupture and blockage o the epididymal tubules induced
by the back pressure which forms after vasectomy.
A vasoepididymostomy merely connects the vas deferens
to the epididymis at a site which will allow sperm
to flow from the epididymis directly into the vas
deferens thereby bypassing the site of the blockage.
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Vas fluid quality, particularly clarity, is also important.
Usually, when sperm are absent, the vas fluid has a cheesy,
thick opaque appearance. When this occurs, a vasoepididymostomy
is needed. In some rare instances, however, the vas fluid
has a watery consistency and is clear in color. When this
occurs, even if sperm is absent from the vas fluid, a
vasovasostomy is performed. On average, two thirds of
these surgeries result in sperm in the ejaculate and one
third of couples will become pregnant.
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11. How do I select a surgeon?
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The skill and experience of the surgeon who performs
your reversal surgery is one of the main determinants
of your postoperative success.
It is a good idea to ask your potential surgeon whether
he or she can perform a vasoepididymostomy using an
operating microscope. During surgery, the surgeon needs
to be experienced in assessing the vas fluid quality,
evaluating signs of epididymal blockage, and determining
the best location for a vasoepididymostomy if needed.
A vasoepididymostomy is necessary in approximately one-third
of cases, and the need for it can only be definitively
determined during surgery.
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AM I A GOOD CANDIDATE FOR A VASECTOMY REVERSAL?
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12. My vasectomy was done years ago. How does that affect
my chances for a successful reversal?
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While the length of time from vasectomy to reversal
surgery correlates with success, no interval is considered
too long to perform reversal surgery.
Data from the largest research study on vasectomy reversal
reveals progressively less favorable results as the
time from vasectomy to reversal increases. These are
the rates for 1,247 men studied who underwent vasovasostomy:
Years between
vasectomy
and reversal |
Sperm Return |
Pregnancy Rate |
| < 3 |
97% |
76% |
| 3 - 8 |
88% |
53% |
| 9 - 14 |
79% |
44% |
| > 15 |
71% |
30% |
These data nevertheless indicate that despite long periods
of time from vasectomy to reversal surgery (even greater
than 15 years), vasectomy reversal can result in successful
pregnancies.
One reason for lower success rates with longer intervals
between vasectomy and reversal surgery is the increased
rate of epididymal blockage as the time interval lengthens.
Rupture and obstruction of the epididymal tubule is caused
by increased pressure in the vas deferens and epididymis
below the level of the vasectomy site. If the epididymis
is blocked, vasoepididymostomy needs to be performed to
accomplish the reversal.
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13. Does the way my vasectomy was performed affect my
chances for a successful reversal?
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The site of the vasectomy is a factor in the outcome
of reversal surgery. A vasectomy can be performed close
to the testicle and epididymis or farther away as illustrated
in Figure 10.
Figure 10
A disruption of the vas deferens farther away from the
testicle will leave a long length of vas deferens (vas
remnant) and increase the chance of a successful reversal.
The shorter the vas remnant, as illustrated in Figure
11, the greater the chance of scarring and obstruction
in the epididymis necessitating a more difficult vasoepididymostomy.
Figure 11
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14. Can my doctor predict the outcome of my vasectomy
reversal by examining me before surgery?
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Your doctor will examine you before surgery by physically
palpating your scrotum to determine the firmness and size
of the testicles. If you have one or more shrunken testicles,
this may indicate irreversible testicular failure; therefore
surgery may not be able to restore fertility.
If your doctor encounters an engorged and perhaps firm
epididymis, this indicates that an epididymal blockage
may be present. While not definitive, these findings may
suggest that a vasoepididymostomy will need to be performed.
On the other hand, if the epididymis is not engorged,
a vasovasostomy is still not guaranteed.
Your doctor will also attempt to determine the length
of the vas deferens that has remained after vasectomy
(vas remnant) during the same scrotal examination. The
longer the vas remnant as illustrated in Figure 10, the
better the chance for vasovasostomy and future success.
The shorter the vas remnant as illustrated in Figure 1
1, the greater the chance that the epididymis will have
developed a blockage, necessitating a vasoepididymostomy.
In the rare event that a very long segment of the vas
deferens is missing , it is more likely that extensive
surgery will be necessary. On occasion, prior surgery
such as hernia repair can cause damage to the vas deferens,
resulting in a missing segment.
Lastly, disorders of the testicles such as varicoceles
(an engorgement of the veins surrounding the testicles
which cause damage) can be detected by your physician
by examining your scrotal contents. These disorders may
need to be corrected at a later date if vasectomy reversal
surgery alone does not lead to pregnancy.
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15. I've already had a vasectomy reversal with no success.
Does it make sense to try it again?
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A frequent cause of reversal surgery failure is that
a vasovasostomy was performed when, on the basis of
intraoperative findings, a vasoepididymostomy was indicated.
Some other reasons for vasovasostomy failure are inaccurate
approximation of the vas due to poor surgical technique,
and blockage from scarring as a result of disruption
of the blood supply. Success rates after repeat reversal
surgery are slightly lower than success rates after
first reversals, mainly because the duration of vas
obstruction is longer for repeat reversal surgery.
Comparison of Overall Results in First and
Repeat Reversals
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First Reversal |
Second Reversal |
Number of men
with sperm in semen: |
865 out of 1026
(86%) |
150 out of 199
(75%) |
Number of couples that
achieved a pregnancy: |
421 out of 808
(52%) |
52 out of 120
(43%) |
The large case study described above compared the results
of first and repeat vasectomy reversals. This study reported
that, following repeat reversals, sperm were present in
the semen of three-fourths (150 out of 199) of men postoperatively
and that pregnancy was reported in 52 out of 120 couples
(43%) who were evaluated for pregnancy. These results
are very similar to those of first reversals and many
men feel that these results are high enough to try reoperation.
Chances of a successful reoperative reversal may be predicted
by the sperm content of the intraoperative vas fluid sampled
at the time of the first reversal. If sperm was present
in the vas fluid during the initial vasovasostomy and
the individual fails to produce sperm in the ejaculate,
obstruction at the site of vas reapproximation may exist
and the patient may need to repeat the vasovasostomy.
If, on the other hand, sperm were absent in the vas fluid,
the patient likely required a vasoepididymostomy during
the first procedure and will likely require a vasoepididymostomy
if the reversal surgery is repeated.
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16. Is in-vitro fertilization (IVF) a better option for
me than vasectomy reversal?
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Recent medical and surgical advances have created many
options for infertile couples. Choice of infertility treatments
usually depends on weighing the likelihood of conceiving
with a specific treatment versus other more complex and
costly treatments. IVF is a relatively new technique that
can help couples initiate a pregnancy who might not otherwise
be able to conceive through natural methods. IVF involves
incubation of human eggs and sperm in a culture dish.
For fertilization to occur, the egg must have optimal
maturity and the sperm must function normally. Once a
fertilized egg develops into an embryo it is transferred
back into the female.
Assisted fertilization techniques like IVF are appropriate
for men with severe sperm function defects or for men
in whom no cause of infertility can be found. Pregnancy
rates, however, are very low with routine IVF and are
usually coupled with gamete micromanipulation which requires
special preparation of the egg and sperm. Intracytoplasmic
sperm injection (ICSI) is the most useful micromanipulation
technique developed so far to enhance IVF fertilization
rates in patients with severe male factor infertility
This procedure involves the direct injection of a single
sperm into an egg.
For men who have undergone a vasectomy, sperm is obviously
absent from the ejaculate. Therefore, since the IVF/ICSI
procedure requires sperm, sperm must be retrieved from
the testicle or epididymis through a minor surgical procedure.
The procedure for obtaining sperm is less complicated
than reversal surgery, but entails local anesthesia, and
insertion of a needle into the scrotum (into the testicle
or epididymis) to obtain sperm.
The cost of one cycle of IVF can range from $8,000 to
$15,000 depending on the array of infertility factors
involved and whether sperm retrieval procedures for the
man is necessary. Currently, the national birth rate for
IVF, as reported by The Society for Assisted Reproductive
Technology, and its parent organization, the American
Society for Reproductive Medicine, is only 28.9 percent
per cycle.
Because of the expense, lower pregnancy rates, and potential
side effects from hormonal therapy for the female partner,
reversal surgery, and in most cases, repeat reversal surgery
are options of first choice for vasectomized men. IVF
is an option to consider if vasectomy reversal is unsuccessful,
rather than as an alternative to surgery.
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17. We don't plan on trying to conceive right away. When
would be the best time for me to have a vasectomy reversal?
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Even if you plan to postpone attempts to conceive,
for most couples, it is probably best not to delay the
reversal procedure.
Keep in mind that the average time interval from a vasectomy
reversal until pregnancy is 12 months, and it takes
24 months postoperatively until the highest percentage
of pregnancies is achieved.
Also, the longer the interval between vasectomy and
reversal, the less the chance that pregnancy after reversal
would occur. This should be understood in context. In
other words, although many successful reversals are
done several years after vasectomy, when you have the
option, sooner is better.
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18. Do I need any tests before surgery?
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No special preoperative tests are needed before a vasectomy
reversal other than the standard lab tests required by
some hospitals, ambulatory surgery facilities or anesthesiologists.
For men more than 40 years old, an EKG is usually required.
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19. Do tests for anti-sperm antibodies or follicle stimulating
hormone levels help predict the success of my surgery?
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Measurement of serum antisperm antibodies appears to be
of little prognostic value with regard to male fertility
potential.
Anti-sperm antibodies are proteins that can inhibit the
movement and function of sperm. Some research indicates
that anti-sperm antibodies may decrease the chances for
pregnancy after reversal surgery, however, studies have
found little correlation between preoperative testing
for anti-sperm antibodies and pregnancy.
The difficulty in testing for anti-sperm antibodies before
reversal surgery is that only serum (blood) antibodies
can be tested, which do not accurately predict the antibodies
that may be found in the semen after the operation. Because
of these difficulties, most surgeons do not find anti-sperm
antibody testing to be useful.
Follicle-stimulating hormone (FSH) is not routinely assayed
in men requesting vasectomy reversal.
FSH is a hormone produced in the pituitary gland that
stimulates the testes to produce sperm. An elevated FSH
level suggests reduced sperm production and testicular
failure, and can indicate that there is less possibility
of obtaining a good sperm count after surgery. Men who
have a history of fertility prior to vasectomy rarely
have an elevated FSH level. On the other hand, if serum
FSH is low or normal, it does not necessarily mean sperm
production is normal.
It is not unreasonable to measure serum FSH preoperatively
in men who have never fathered a child, in men who have
abnormally small testicles, or in men whose vasectomies
were performed many years prior to reversal surgery.
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20. Should my wife undergo any tests before I have my
vasectomy reversal?
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Your wife should undergo a gynecological exam to ensure
adequate fertility potential.
For older couples or those whose family history indicates,
genetic counseling may also be helpful.
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EXPECTATIONS FOR THE DAY OF SURGERY
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Add content to your paragraph here.
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21. Will I be able to go home the day of the surgery?
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The surgery may be performed either in an ambulatory surgery
center or hospital, generally on a day-surgery basis.
In most cases, the man arrives in the morning and leaves
the hospital the same day.
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22. What type of anesthesia is used?
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Vasectomy reversal may be performed with local, regional
or general anesthesia, depending on the preference of
surgeon and patient.
General anesthesia is commonly used because it affords
maximum patient comfort considering the length and nature
of the surgery.
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23. How long will the surgery take?
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Microsurgical vasovasostomy averages 2 to 3 hours, while
vasoepididymostomy may take as long as 5 hours. The patient
is then observed in the recovery room for an additional
3 more hours.
The length of surgery depends on the type of procedure,
the amount of scarring present from prior surgery, the
presence of and degree of inflammation, and the ease with
which sperm can be identified in the vas deferens or epididymal
tubule.
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24. Where are the incisions made?
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A vasectomy reversal is usually performed through incisions
in the front of each side of the scrotum.
The incision is vertical (up and down) so that it can
be extended if more length is needed. If there is difficulty
in locating the site of the vasectomy, if the vasectomy
was performed at a very high scrotal level, or if a long
segment of the vas deferens was removed, it may be necessary
to extend the scrotal incisions up to the lower inguinal
(abdominal) region.
If a prior hernia procedure was performed, inadvertent
blockage of the vas deferens may have occurred. If this
is the case, an incision into the site of the prior hernia
repair may be necessary.
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25. What are the complications that can occur?
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Normal signs and symptoms after surgery include: slight
swelling, bruising or discoloration of the scrotal area.
These generally do not require a doctor's attention. A
sore throat, headache, nausea, constipation and general
"body ache" due to the anesthesia and surgery may also
be present. These symptoms usually resolve within a few
days.
Severe complications that require additional surgery are
rare. Postoperative complications that require prompt
attention are wound infections and severe scrotal hematoma
(black and blue bruised scrotum). A wound infection is
present if you develop a fever or if your incision becomes
warm, swollen, red, or painful. A hematoma is present
if excessive bleeding under the skin occurs and is accompanied
by a throbbing pain and a bulging of the incision site.
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26. How much pain can I expect after surgery?
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Discomfort after vasectomy reversal varies from patient
to patient. In general, pain may be similar or slightly
more severe than the pain experienced after the original
vasectomy. Pain medication such as codeine is prescribed
and is usually only necessary for one to two days after
the surgery, after which acetominephin (such as Tylenol)
or ibuprofen (such as Motrin or Advil) is all that is
needed. To decrease the pain and swelling after surgery,
ice packs are recommended, which are placed on the scrotum
for approximately ten minutes every half hour for the
first post-operative day. A scrotal support is worn for
four weeks after the surgery to decrease discomfort and
lessen swelling. Normal strenuous activity can be resumed
four weeks after the surgery if indicated by your physician.
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WHAT HAPPENS AFTER THE SURGERY?
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27. How soon can I have sex after surgery?
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It is generally best to wait three weeks after the surgery
before resuming any type of sexual activity.
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28. How long after the surgery will it take for sperm
to re-appear?
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The first semen analysis is obtained one or two months
after the surgery and again at two to three month intervals,
either until sperm counts and motility are normal, or
pregnancy occurs.
Three months after a vasovasostomy the semen analysis
often reveals a good sperm count with poor motility. After
6 months the count is usually stable or slightly improved
and the motility is significantly improved. After a vasoepididymostomy,
sperm usually takes longer to appear in the ejaculate,
and in most cases takes at least 4 to 6 months to appear.
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29. Is there any chance that my sperm count will decline
after an initially successful vasectomy reversal?
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Studies have shown that, following initially successful
reversal surgery, where good sperm counts and motility
have been obtained, a significant number of men subsequently
experience significant deterioration in sperm counts.
Approximately 10 percent of men following successful vasovasostomy
and approximately 20 percent of men following successful
vasoepididymostomy will experience deterioration in sperm
counts when followed for at least two years after surgery.
A decline in sperm counts after successful surgery can
be caused by the formation of scar tissue which can occur
from sperm leakage at the reversal site or from a disruption
of the blood supply at the site of the surgery.
In light of the 10 to 20 percent of patients that deteriorate
after successful surgery, sperm banking should be a consideration,
particularly after a vasoepididymostomy.
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30. How soon can I expect a pregnancy to occur after my
vasectomy reversal?
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The average time from reversal surgery to conception is
12 months. Studies indicate that pregnancies after reversal
surgery can occur from one month to 82 months after reversal
surgery. Most pregnancies occur within 24 months of reversal
surgery.
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31. What are my options if the surgery is unsuccessful?
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About 14 percent of men with vasovasostomies and 40 percent
with vasoepididymostomies have no sperm in their semen
after surgery. After vasovasostomy, sperm is usually present
in the semen after two months and should certainly be
present within six months. After vasoepididymostomy, sperm
usually appear in the semen during the first six months,
although they may not appear for as long as 12 to 15 months.
If sperm are not present in the semen by six months after
vasovasostomy or by 12 to 18 months after vasoepididymostomy,
then the reversal surgery is considered a failure.
If surgery is unsuccessful you can consider reoperation
(see question #14) or assisted reproductive techniques
such as in-vitro fertilization (IVF) with intracytomplasmic
sperm injection (ICSI) (see question #15). For a man who
has no sperm in the ejaculate after reversal surgery,
sperm for IVF/ICSI can be obtained through a minor surgical
procedure (sperm retrieval) which extracts sperm directly
from the testicles and/or epididymis.
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GLOSSARY
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Antisperm antibodies
Immunological substances that can inhibit sperm movement
and function.
Epididymis
Tightly coiled, very small tubes covering the back and
sides of the testis, where sperm collect after leaving
the testis.
Follicle stimulating hormone (FSH)
A pituitary hormone that stimulates the testes to make
sperm.
ICSI
Intracytoplasmic sperm injection. An in-vitro fertilization
procedure that requires the direct injection of a single
sperm into an egg.
IVF
In-vitro fertilization. A fertility procedure where
human eggs and a suspension of sperm are incubated together
in a culture dish (test-tube). Once embryos are formed,
they are placed back into the uterus of the female.
Microsurgery
Surgery using optical magnification provided by an operating
microscope.
Prostate gland
Located below the bladder, the gland where the ejaculatory
ducts, the two vas deferens and the urethra join.
Semen
The combination of sperm and glandular fluid released
by the urethra when a man ejaculates.
Suture
The material (thread) used during vasectomy reversal
surgery.
Scrotum
The sac that contains the testicles, epididymis and
vas deferens.
Testes
Located in the scrotum, the male reproductive glands
which produce sperm.
Urethra
The tube running from the bladder to the penis that
carries urine and semen.
Vas deferens
The tubes that carry sperm from the testicle and epididymis
to the urethra.
Vas remnant
The length of the vas deferens from the epididymis to
the site of the vasectomy.
Vasectomy
A surgical procedure that provides infertility by blocking
the transport of sperm from the epididymis to the urethra
via the vas deferens.
Vasoepididymostomy
A surgical procedure to reverse the effects of vasectomy
by connecting the vas deferens to the epididymis to
bypass obstruction in the epididymis.
Vasovasostomy
A surgical procedure to restore fertility by reconnect
the ends of vas deferens that were severed when vasectomy
was performed.
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REFERENCES
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Belker AM, Thomas AJ Jr, Fuchs EF, Konnak JW, Sharlip
ID. Results of 1,469 microsurgical vasectomy reversals
by the Vasovasostomy Study Group. J Urol 1991; 145:505-51
1.
Thomas AJ Jr, Pontes, JE, Rose NR, Segal S, Pierce JM
Jr. Microsurgical vasovasostomy: immunologic consequences
and subsequent fertility. Fertil Steril 1981;35:447-50.
Linnet L. Clinical immunology of vasectomy and vasovasostomy.
Urology 1983;22:101-14. Silber SJ. Microscopic vasectomy
reversal. Fertil Steril 1977;28:1191-1202.
Thomas AJ Jr. Vasoepididymostomy. Urol Clin North Am
1987;14:527:38.
Bronson R. Cooper G, Rosenfeld D. Sperm antibodies:
their role in infertility. Fertil Steril 1984;42:171-83.
The American Fertility Society Guideline for Practice:
Vasectomy Reversal. The American Fertility Society 1992.
Goldstein M. Surgery of male infertility and other scrotal
disorders. Campbell's Urology, 6th ed. Edited by PC
Walsh, AB Retik, TA Stamey and ED Vaughan, Jr. Philadelphia:
W.B. Saunders Co., vol. 3, chapt. 87, pp 3114-3149,
1992.
Jarow JP, Sigman M, Buch JP, Oates RD. Delayed appearance
of sperm after end-to-side vasoepididymostomy. J Urol
1995; 153:1156.
Lee HY. A 20-year experience with epididymovasostomy
for pathologic epididymal obstruction. Fertil Steril
1987;47:487.
Witt MA, Heron S, Lipshultz Li. The post vasectomy length
of the testicular vasal remnant: a predictor of surgical
outcome in microscopic vasectomy reversal. J Urof 1994;
151:892-894.
Matthews GJ, Schlegel PN, Goldstein M. Patency following
microsurgical vasoepididymostomy and vasovasostomy:
temporal considerations. J Urol 1995; 154: 2070-73.
Belker A. Repeating the Vasectomy Reversal. Contemporary
Urology Sept 1993, 54-66.
Fisch H, Goluboff E. Simplified One-Layer Vasovasostomy.
Current Surgical Techniques in Urology; Oisson CA, ed.
Delaware, MPI, 1993.
Fuchs EF Restoring fertility through epididymovasostomy.
Contemporary Urology,
December 1991, 27-38.
Goldstein M. Surgery of Male Infertility. W.B. Saunders
Co., 1995.
Gvakharia M, et al. Treating male-factor infertility
with ICSI. Contemporary Urology,
September, 1995, 58-67.
Lamb DJ, Stockton JD, Lipshultz LI. New roads to fertility.
Contemporary Urology, January 1991, 32-41.
Neumann PJ, Gharib SD, Weinstein MC. The cost of a successful
delivery with in-vitro fertilization. NEJM 1994: 239-43.
Sharlip ID. What is the best pregnancy rate that may
be expected from vasectomy reversal? J Urol 1993: 1469-71.
Sigman M. A guide to assisted reproductive techniques.
Contemporary Urology, March 1991, 31-39.
Dr. Harry Fisch is currently Director of the Male Reproductive
Center and directs urologic microsurgery in the Department
of Urology at Columbia-Presbyterian Medical Center in
New York. Dr. Fisch received his medical degree from
the Mount Sinai School of Medicine, Urologic training
at the Albert Einstein College of Medicine in New York,
and specialized training in Male Infertility and miicrosurgery
at The Baylor College of Medicine in Houston, Texas.
Produced by:
Center for Biomedical Communications
Columbia Presbyterian Medical Center
Design:
Richard V Miller
Medical Illustration:
David Rosenzweig
Cover Illustration:
Mike Quon
Editor:
Clare Karten
The Male Reproductive Center
Department of Urology
Columbia Presbyterian Medical Center 944 Park Avenue
New York, NY 10028 Telephone: 212-879-0800
Copyright @ Harry Fisch, MD All rights reserved
No part of this publication may be reproduced, stored
in or introduced into a retrieval system, or transmitted
in any form,or by any means (electronic, mechanical,
photocopying, recording or otherwise), without the prior
written permission of the copyright owner.
Vasectomy Reversal, Vasectomy
reversal NY, varicocele, male infertility, varicocele
surgery
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