Thank you Dr. McHugh! After our 3rd child was born my husband and I thought we were done having children and opted to have a vasectomy. Well, about a year later we both realized that we were not done having children and wanted to try for one more. I researched urologists in the area that performed vasectomy reversals and Dr. McHugh really stuck out to me. My husband had his consultation and agreed that he was a great doctor and felt really comfortable with him. My husband had his VR done October 30, 2014 and I was pregnant 4 months later. We couldn’t believe it and we were so ecstatic! Our perfect little girl, Layla Anne Kapish was born November 3, 2015 at 8lbs 6oz. Now with two girls and two boys she really completes our family and we couldn’t imagine life without her. If you are considering a vasectomy reversal, Dr. McHugh is the one you should see. We HIGHLY recommend him! Thank you so much again to him and all of his staff. INCREDIBLE!
Marly and Robert Kapish
Most urologists do a vasectomy once or twice a week. They can be done in the office and usually take fifteen minutes or so to do. We call that in the business a “bread and butter” procedure. In other words, a vasectomy is something that most urologists do often and well. (I might add that some urologists do a better job than others in this procedure-that is true for most surgical specialties.)
Since only about 1 in 6 men who have had a vasectomy will, at some point due to a change in his circumstances consider a reversal, several factors come into play that dissuades the urologist from agreeing to perform the procedure.
- Fewer numbers of available men wanting the procedure for the average urologist to become proficient in performing it.
- The procedure takes around 2-3 hours to perform and done looking through a microscope throughout the procedure.
- It is not covered by insurance-some patients want a reversal but can’t afford it.
- There is a steep learning curve in doing the procedure well and in a timely fashion.
- There are expected results by the patient who will be inconvenienced, undergo a surgical procedure and at an expense not covered by his insurance. (When a general surgeon removes the gallbladder, well he removes it…it is not like some function will be expected beyond that. The reversal couple rightfully expect and hope that there will be sperm in the ejaculate after the reversal. This is a lot for the average urologist who would much rather just send the patient desirous of a reversal to someone “Who does them all the time.” Let him or her deal with all the expectations and potential of having put someone through all this and then no sperm in the ejaculate.)
- The procedure requires special instruments, an operating microscope, and special suture. The local hospital may or may not have all this and if they do, then the patient has the added expense of the hospital fees making the patient pay at a premium for the “set up” and by a urologist who does the procedure infrequently.
- Not all physicians are comfortable or have the skills to use microscopic suture and to sew and tie suture under the microscope. Without this skill set, the 2-3 hour procedure can last much longer with less acceptable results.
- So…that the average urologist doesn’t do this procedure is a good thing and how it should be. If they aren’t comfortable with the procedure and logistics of it they shouldn’t be doing it.
It is a fair question for the patient to ask their doctor, “Do you do this procedure commonly?” “How many have you done?”
At Northeast Georgia Urological Associates we have an accredited surgery center appropriately equipped for this procedure, we are approaching 130 reversals done and our patency rates compares favorably with studies in the medical literature.
On top of that-we enjoy performing the procedure, the hopeful couples, and the happy results.
We look forward to working with you!
I saw a patient recently on whom I performed a reversal around a year ago. He and his wife have not achieved pregnancy. He showed me the report of a semen analysis which showed around 50 million sperm with a motility of over 50%. Although 60-150 million sperm is considered normal, most urologists feel that any count above 20 million is suitable to achieve pregnancy. Motility should be over 45% (i.e. 45% of the sperm under the microscope are observed to be moving forward). Other parameters such as morphology (how the sperm look) are less important.
From the perspective of the surgeon who performed the procedure, any sperm in the ejaculate indicates that the reversal was successful and now it is up the the male to begin to produce the quality of sperm necessary to achieve pregnancy. As well, there is the added dynamics of the female ability to have a child. As a rule, when there is no pregnancy between a couple without the history of a vasectomy, the problem is about 50/50 male to female. The point is that even if the post reversal male has adequate sperm, pregnancy still requires other factors to be in place as well.
In the above scenario, the good sperm count and motility is a very good start and indicates a good reversal. And it makes the point about couples understanding the difference between patency (presence of sperm after a reversal) and pregnancy. There is usually a 10-15% differential between the two.
Pregnancy is a many splendored thing-Pregnancy after a reversal is a multi-factorial thing.
- The age of the male.
- The age of the female.
- The time since the vasectomy.
- The quality of the sperm from the testicular end of the transected vas at the time of the reversal procedure.
- The technical quality of the reversal procedure itself and the experience of surgeon.
- Some degree of luck for all of these factors to come together and result in pregnancy.