A vasectomy reversal procedure bypasses the blockage created by the original vasectomy surgery. During the procedure we identify the scarred segment of the tube which carries the sperm - called the vas deferens. We examine the fluid coming from the testicle at that point and make a decision as to what kind of reconstructive procedure is necessary.
There are two basic types of reconstruction:
This procedure is performed if there is fluid coming from the cut end of the vas deferens during the initial parts of the surgery. This is the most commonly performed reconstruction and may have success rates (defined as return of moving sperm to the ejaculated post-operatively) over 90%. The reconstruction is performed using an operating microscope since the sutures used are so fine (9-0 or 10-0) that they are difficult to even see otherwise.
This is a highly complex microsurgical procedure, demands more surgical time, and has a slightly lower overall success rate. Generally, several years after the initial vasectomy, this procedure is performed when the obstruction moves "up-stream" toward the testicle within a structure called epididymis. The epididymal tubules are much smaller than the vas deferens and the reconstruction is more technically demanding. At Brigham and Women's Hospital, our fellowship trained surgeon is trained to determine if such a epididymal obstruction has occurred and perform the reconstruction using the most modern technique.
Approximately 6% of men in the United States who have a vasectomy want to go on to have more children for a variety of reasons. While there are many issues to discuss when a man considers his fertility after vasectomy, vasectomy reversal is almost always an option.
A vasectomy reversal is a microsurgical procedure to bypass the obstruction caused by the original vasectomy, and restore moving sperm to the ejaculate. The goal of the operation is to allow for natural conception and avoid in-vitro fertilization, if possible. The procedure is a very delicate one which can take at least 3 hours, utilizing many sutures which are finer than an eyelash. The procedure is performed under general anesthesia.
If the obstruction remains at the original vasectomy site, in a structure called the vas deferens, then re-connecting these two ends yields a success rate greater than 90%. At the time of surgery, we will discover whether the obstruction has moved "up-stream", away from the original vasectomy site itself, and into the epididymis. The epididymis is a structure made up of a single, highly coiled tube which carries sperm. A urologic surgeon, who has received specialized training in this process, works to determine where the blockage actually is and to bypass it.
The patient may go home the same day after the procedure. Since the new connection created is so small, it can take several months for it to mature. Therefore, we wait two to three months before checking a semen analysis.
Overall, the surgeon experience is very important. At Brigham and Women's Department of Urology, we offer microsurgical vasectomy reversal by a urologist who has completed a high-volume, dedicated fellowship in male infertility and microsurgery.
Other factors that can impact the success rate are the time from the initial vasectomy and certain physical examination findings. Certainly, the reproductive history of the female partner and her age are important factors to consider. We work closely with our colleagues in reproductive endocrinology and can help arrange timely evaluation for the female partner, if necessary.
A man who has undergone a vasectomy can alternatively opt to only have sperm cells removed directly from his testicle through a small incision in the scrotum. This procedure is called "sperm retrieval". Those sperm cells may only be used to conceive with his wife through in-vitro fertilization, or IVF.
Alternatively, sperm retrieval can be performed at the time of the vasectomy reversal. It adds almost no time to the procedure itself. The sperm cells removed can then be frozen, in a process called cryopreservation. Such frozen sperm can be considered as a "back up plan" should the couple have difficulties conceiving after the vasectomy reversal surgery.
A successful vasectomy reversal can result in a continuous supply of sperm so that the couple can conceive more than once, if desired. Vasectomy reversal is significantly cheaper than in-vitro fertilization. A successful vasectomy reversal can be considered a "cure" for the underlying condition, which is blockage of the flow of sperm.
Unfortunately, not all vasectomy reversal procedures are successful. During your consultation, we will discuss the specifics of your presentation. Occasionally, vasectomy reversal may only result in low numbers of sperm which do not move well. This may be due to secondary scar tissue after the repair or the presence of anti-sperm antibodies.
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