If it was easy to get pregnant before the vasectomy…will it be easy to get pregnant after the reversal? Well…it depends.

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So…I hike a trail most every evening after work and on the weekends that takes about an hour. My vasectomy reversal coordinator Kathy get several calls a day about scheduling either a reversal or a free consultation about arranging for a reversal. Many of our patient live a long way away and ask, “Can I speak to the doctor by phone?”

Kathy routinely says, “Can he call you between 5 and 6 tonight?”

The interested couple most commonly says, “Yes. Perfect.”

So last night Kathy gives me two people to call who have an interest in reversing their vasectomy. The second patient I call asked the question, “My wife and I got pregnant very quickly. I mean one the first try. Does this mean that we’ll get pregnant just as quickly after the reversal?”

Good question and very similar to this common question, “Will the reversal surgery be like the vasectomy?”

Regarding the latter, the reversal takes approximately two and half hours, a vasectomy less than 15 minutes. So no a vasectomy is not like a reversal.

Regarding the former question: the issue is not that you and your partner are very fertile, the success of the reversal depends on the experience of the surgeon and the time interval since the vasectomy.

The perfect scenario? A short time since the vasectomy and a urologist who does reversals microscopically often. It does not hurt that the wife was fertile, that is good. For the male however the production of good sperm suitable for pregnancy decrease as time elapses since the vasectomy.

It was a good question and I hope this helps you understand the nuances of a microscopic vasectomy reversal. You might check out this internal site link.

Success rates.

Reversal consults are free. Leave a number or email and we’ll schedule an in office consultation or Dr. McHugh will call you while on his walk!

ICSI vs. Vasectomy Reversal in men with prolonged interval since vasectomy?

Even after prolonged obstructive intervals of 15 to 20 years, vasectomy reversal offers better or comparable success rates to intracytoplasmic sperm injection.

Article Reviewed: Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years. Kolettis PN, Sabanegh ES, et al: Urology 2002; 60 (November): 885-888.

Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years.

Kolettis PN, Sabanegh ES, et al:
Urology 2002; 60 (November): 885-888Objective: To determine the outcomes for vasectomy reversal performed after at least 10 years of obstruction. Methods: 74 vasectomy reversal procedures were performed in 70 patients after obstructive intervals of 10 to 24 years (mean, 14.5 years). These patients were retrospectively reviewed for patency and pregnancy rates. Results: The overall pregnancy rate was 37%. Patency rates for an obstructive interval of 10 to 15 years, 16 to 19 years, and >=20 years were 74%, 87%, and 75%, respectively. Pregnancy rates for these same periods were 40%, 36%, and 27%, respectively. Assuming a live delivery rate per cycle of 25% for intracytoplasmic sperm injection (ICSI), the delivery rate for vasectomy reversal would not be exceeded until an obstructive interval of at least 20 years.

Conclusions: The authors believe that even after prolonged obstructed intervals, vasectomy reversal offers better or comparable success rates to ICSI. Depending on their success rates at various medical centers, a threshold obstructive interval probably exists at which ICSI surpasses vasectomy reversal.

Reviewer’s Comments: This is, in my opinion, a clinically worthwhile paper. It clearly shows the pregnancy and delivery rates in patients who have undergone vasectomy reversal surpass the historical success rates of ICSI even after prolonged obstructive intervals. In addition, vasectomy reversal avoids the complication associated with multiple births, which is commonly seen after ICSI and is cheaper. In summary, even in patients with prolonged obstructive intervals after vasectomy, vasectomy reversal is probably more effective, cheaper, and less complicated than is ICSI. (Reviewer-George S. Benson, MD).

Additional Keywords: 10 infertility interval reversal vasectomy

Reprints: Division of Urology; University of Alabama at Birmingham; 1530 3rd Ave S, MEB 606; Birmingham, AL 35294-3296 (Peter N. Kolettis, MD).

 

Vasectomy Reversal success rates depend on several factors…and yes a little luck!

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From VasectomyMedical.com

Vasectomy Reversal Failure Rates and Success Rates Vary With:

  • The vasectomy reversal technique used.
  • The years between the vasectomy and the reversal attempt.
  • The experience and skill of the vasectomy reversal doctor.

Some of the best vasectomy reversal success rates reported in the literature for vasovasotomy are a patency rate of 99% with a pregnancy rate of 64%, not including couples where the woman was infertile. This means that in the hands of the surgeon who quoted these rates, he was able to restore sperm flow in the vas tube 99% of the time, and this allowed a pregnancy rate of 64%.

Not every time that sperm flow returns to the vas is pregnancy guaranteed. The expected vasectomy reversal success rates results for vasoepididymostomy in the hands of the same surgeon are lower, reportedly at 65% patency rate and a 41% pregnancy rate.

Factors influencing the success rate of reversal surgery include the following:

  • Time interval since vasectomy-The length of time passed since the vasectomy greatly impacts vasectomy reversal failure, as seen on this chart:
Years Between Vasectomy Sperm Return Pregnancy Rate
Under 3 years 97% 76%
3-8 years 88% 53%
9-14 years 79% 44%
Greater than 15 years 71% 30%

As previously noted, with longer intervals between vasectomy and reversal, there is an increased vasectomy reversal failure rate due to epididymal blockage as well as rupture and obstruction of the epididymal tubules.

  • Sperm granuloma-Sperm granulomas at the vasectomy site are a favorable prognostic sign and increase the likelihood of vasectomy reversal success.
  • Anti-sperm antibodies-Post-operative, sperm-bound antibodies result in a lower pregnancy rate or higher likelihood of vasectomy reversal failure.
  • Quality of vasal fluid-The vasal fluid quality is checked before a decision is made whether to proceed with a vasovasostomy versus vasoepididymostomy when reversing the vasectomy. If no sperm are present in the vasal fluid the gross appearance of the vasal fluid can help in determining between a vasovasostomy versus vasoepididymostomy. Cloudy, water soluble fluid indicates the best case for eventual return of sperm to the semen (higher vasectomy reversal success rate). Thick white greasy toothpaste-like material indicates the worst prognosis (a higher vasectomy reversal failure rate).
  • Microsurgical Vasectomy Reversal Technique-The vasectomy reversal technique and the doctor`s judgment and experience are important factors for success. Given that choosing the vasectomy reversal doctor is one of the few choices controlled by the patient, it may become an important factor in determining the vasectomy reversal success rate.
  • Associated conditions-Any condition that impairs sperm production for example a varicocele may lower postoperative pregnancy rates (increase vasectomy reversal failure rate).

A vasectomy reversal consult is free and easy to schedule 24/7. Leave your number below and we’ll call with an appointment.

Listen to Vasectomy Reversal 101 Podcast While You Walk!

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The Nitty Gritty…

  • The cost is all-inclusive-$6,500.
  • The pre reversal consultation is free.
  • Performed in a practice owned and accredited surgery center.
  • General anesthesia performed by board certified anesthesiologist.
  • 200 reversals have been performed.
  • Overnight accommodations is free.
  • Usually takes two and half hours or less to perform.
  • Out patient.
  • Operating microscope and microscopic sutures and instruments utilized.
  • Success rates mirror national studies. (See success rates page.)

Vasectomy 101 Podcast by Dr. McHugh

Schedule consultation 24/7 by leaving your number and we’ll call you with appointment.

Thoughts of a vasectomy reversal couple…

This week I don’t have to go into work. We had Christmas Eve and Christmas Day with the munchkins and then they headed to their mom’s house for a week. We picked them up Monday morning and we have them until Wednesday morning when they get dropped off at school. Our break routines are always […]

via It’s Our Year — Not the Average Mama

What does the vasectomy site look like at the time of a reversal?

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There are several things about the picture above. First of all, the vas deferens has been isolated and is ready to begin the vasectomy reversal procedure proper. There are basically three parts to a vasectomy reversal.

  1. First you have to dissect out the  vas deferens and identify the vasectomy site. In the case above this was easy. You see in the middle of the picture a conglomeration of clips which were used to do the vasectomy. I like it when clips have been used. The area is much easier to find and there is less damage to the vas deferens.
  2. Secondly, the vasectomy site is excised and fresh vascularized vas deferens are delineated and prepared to reconnect.
  3. Finally the actual reversal. The microscope is brought into the operative field and after having approximated the two ends…the reversal is performed under the microscope using microscopic suture, usually 12-14 on each side.

Another interesting finding in the above picture is the sperm granuloma. On the right side of the clips you see a bulge before the vas narrows. This finding is a positive sign of success and that the fluid will be favorable. In this case the vasectomy had been done 5 years previously and the fluid noted upon transection showed a mildly cloudy fluid which with microscopic evaluation showed whole sperm.

So even before the reversal procedure with the microscope even started there where several positive findings the will contribute to a reversal success and pregnancy.

Considering a vasectomy reversal? We do them all the time and the consultation is free. Make an appointment 24/7 by just leaving your number and we’ll contact you. 

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What is the effect of a vasectomy on the male? All you’d ever want to know.

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From: Spermatogenesis. 2012 Oct 1; 2(4): 273–278.

Effects of Vasectomy and Vasectomy Reversal in Humans

Vasectomy is performed by transection of the vas deferens with suture, clips, cautery or a combination of these in the scrotal portion of the vas. This transection disrupts the mucosal, muscular, and adventitial components of the vas deferens, including the autonomic nerves that mediate vasal secretory function and peristalsis. Vasal obstruction results in increased intraluminal pressures within the testicular remnant of the vas deferens. The increased pressure may have physiologic effects on epithelial cell morphology, cellular ultrastructure, and gene expression in the vas deferens and epididymis. Moreover, sperm cannot traverse the intentionally obstructed vasal lumen, and as such they accumulate and die within the testicular remnant of the vas deferens and the epididymis. A resultant local inflammatory response occurs in reaction to dying sperm, which has significant downstream sequelae, including a systemic cellular and humoral immunologic response that may impair testicular and sperm function.The clinical importance of this response is not clear in humans. Vasal transection and occlusion cause significant, independent pathophysiologic sequelae that may or may not be reversible by microsurgical bypass of vasal and/or epididymal obstruction during vasectomy reversal in humans.

Perhaps the most relevant study on the effects of vasal transection during vasectomy on vasal innervation was conducted by Dixon et al. in 1987.8 This group utilized immunohistochemical staining and electron microscopy to evaluate the intramural autonomic innervation of the human vas deferens after vasectomy. Vasal segments were harvested during vasectomy reversal and compared with nonobstructed vasal segments acquired at the time of initial vasectomy. They found that there were marked decreases in the noradrenergic innervation of the testicular vasal remnants in previously vasectomized men. These findings imply that vasal peristalsis, which is mediated by sympathetic autonomic activity, may be irreversibly impaired after vasectomy unless significant regeneration of autonomic nerve fibers occurs in the months and years following vasectomy reversal. Unfortunately, no studies have adequately assessed the regenerative capacity of vasal intramural nerves in humans after vasovasostomy or vasoepididymostomy.

Despite the paucity of anatomic and histologic data in the literature concerning vasal nerve recovery after vasectomy reversal, a study by Shafik et al. did provide further insight regarding vasal autonomic nerve function after vasectomy and vasectomy reversal.9 Shafik utilized transcutaneous electrovasography (EVG) to record the velocity, frequency and amplitude of nerve conduction in the vas deferens in 22 healthy men, 20 vasectomized men, and 18 men after vasectomy reversal. In normal, fertile men there was minimal temporal or individual variability in vasal conduction frequency, amplitude and velocity. In contrast, vasectomized patients exhibited lower conduction frequency and amplitude in the testicular vasal remnant and irregular, described as aberrant “vasoarrhythmic” conduction patterns. One to seven years after vasectomy reversal 7 of 22 patients had successfully conceived. Interestingly, 4 of these 7 patients had a normal electrovasographic evaluation during follow-up while 3 had decreased conduction frequencies and amplitudes but did not exhibit any vasoarrhythmia. This is in contrast to the 11 patients who failed to conceive, all of whom demonstrated electrovasographic evidence of vasoarrhythmia. Notably, the likelihood of abnormal vasal conduction studies was correlated with the interval of vasal obstruction prior to vasectomy reversal. This study suggests that nerve conduction recovery may be variable after vasectomy reversal, and seems to depend upon the interval of vasal obstruction.

Significant changes also occur in epithelial cell ultra-structure within the vas deferens after vasectomy, most of which are thought to result from changes in the intraluminal pressure after vasal ligation (increased pressure in the testicular vasal remnant and decreased pressure in the abdominal vasal remnant). Andonian et al. documented this phenomenon by comparing the ultra-structural features of the abdominal and testicular vasal remnants after vasectomy (harvested at the time of vasectomy reversal) to vasal segments harvested from fertile men undergoing vasectomy.10 Transmission electron microscopic analysis of vasal segments from healthy fertile men revealed the presence of many apical cytoplasmic protrusions from epithelial principle cells into the vasal lumen. Some of these protrusions remained attached to the principle cells by a stalk, whereas others were self-contained within the lumen of the vas deferens, suggesting a secretory process. The cytoplasmic protrusions, termed “apical blebs,” contain ribosomes and endoplasmic reticulum. Interestingly, these investigators observed a marked reduction in the number of apical blebs within the testicular remnants of the vas deferens in vasectomized patients undergoing vasectomy reversal. In addition, they observed dramatic luminal narrowing, epithelial cell flattening, reduction in organelle density, and absence of apical blebs on the abdominal vasal remnant. These findings are suggestive of de-differentiation of vasal epithelium within the abdominal vasal remnant in the absence of contact with seminal plasma. Whether or not these ultra-structural changes are clinically relevant and reversible with vasovasostomy or vasoepididymostomy remains to be determined.

Morphological changes are also apparent in the human epididymides after vasectomy. Older studies of cellular morphology and ultra-structure in the epididymides of vasectomized animals have demonstrated vacuolization and increases in the number and size of lysosomes within epididymal epithelial cells11,12 as well as segmental thinning of the epithelial lining of the vas deferens and epididymis near sites of luminal distension.13 In humans, dilatation of the entire epididymal tubule has been documented, with the most pronounced increase in luminal diameter noted in the cauda. Moreover, the height of the epididymal epithelium is altered by vasectomy. In normal men, maximal epididymal height occurs in the corpus of the epididymis. After vasectomy, however, the maximal height of the epididymal epithelium occurs in the caput.14 Alternations in the height of the epithelial cell layer in the epididymis after vasectomy suggest the presence of complex molecular biological effects of vasectomy on gene expression, as epithelial cellular volume and height are thought to be indicative of underlying RNA translational and protein secretory activities.

Indeed, recent analyses of the human epididymal transcriptome using microarrays have confirmed that vasectomy causes significant alterations in epididymal gene expression. Sullivan et al. characterized the epididymal transcriptomes within each region of the epididymis in both normal and vasectomized men.15Cluster analysis of nearly 3000 genes demonstrated that expression of 1363 genes did not differ based on vasectomy status, whereas 911 genes were expressed only in normal epididymides, and 660 genes were only expressed after vasectomy. Interestingly, three of the differentially expressed genes have well-established roles in sperm maturation during epididymal transit (NPC2, CRISP1, and DCXL).

Unfortunately, no studies have directly examined the impact of vasectomy reversal on gene expression in epididymal fluid or tissue, as the only candidates for such a study would be the rare patients who desire a vasectomy subsequent to successful vasectomy reversal. However, RNA and protein detection studies in semen after vasectomy reversals have suggested that some of the alterations in epididymal gene expression that result from vasectomy may not be reversible.15 The clinical significance of such studies remains to be determined.

Vasectomy with subsequent vasectomy reversal may also be associated with detectable alterations in sperm DNA integrity. Sperm DNA integrity testing has emerged as a valuable measure of sperm quality that is predictive of natural conception, pregnancy outcomes after intrauterine insemination, and pregnancy loss after in vitro fertilization cycles.16,17 The most commonly utilized assay is the sperm chromatin structure assay (SCSA), which is a flow cytometric method that sorts sperm according to their susceptibility to DNA strand breaks upon exposure to a denaturant.

A study by Smit et al. sperm looked at DNA fragmentation with the SCSA in ejaculated semen after vasectomy reversal in 70 men. They demonstrated that sperm DNA fragmentation was increased in the vasectomy reversal patients when compared with proven fertile controls (30% vs. 15%, p < 0.001). The increase in sperm DNA fragmentation was correlated with lower sperm concentrations, lower sperm motility, and a lower percentage of morphologically normal sperm.18 Interestingly, however, there was no relationship between sperm DNA fragmentation and the likelihood of pregnancy after vasectomy reversal. Though the clinical significance of sperm DNA integrity testing after vasectomy reversal remains unclear, this supports the notion that vasectomy likely causes a myriad of molecular biological sequelae, including sperm DNA damage, which may be irreversible in some cases.

Other factors have been isolated and suggested to be associated with infertility after vasectomy reversal, including antisperm antibodies,19,20 granuloma formation21and persistent mechanical partial obstruction,22which may occur despite partial patency and sperm in the ejaculate. Epididymal function, as discussed above, has been widely studied, as has epididymal dysfunction, which is believed by many to be one of the major factors contributing to infertility after vasectomy reversal when post-surgical patency has been established by demonstrating sperm in the ejaculate. Proteins isolated in epididymal fluid harvested at the time of vasectomy reversal, such as GTPase proteins in the Ras/RAB family and Syntenins, likely play a critical in sperm maturation23 and irreversible changes in protein synthesis despite microsurgical vasovasostomy or vasoepididymostomy may play a large role in infertility despite patency after vasectomy reversal.24,25

How long to pregnancy after vasectomy reversal?

From Vasectomy.com

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Although vasectomies should be viewed as a permanent form of birth control, there may be certain circumstances in which a man desires to have his vasectomy reversed. If this is the case, questions might arise about how long it takes for a vasectomy reversal to result in pregnancy.

There are no definitive answers. Research indicates that, if a reversal is successful, it can take anywhere from three months to several years for couples to get pregnant. Up to 75 percent of all vasectomy reversals ultimately lead to natural pregnancies, with over half occurring in the first two years.

However, there are several factors that impact whether conception will occur and how quickly:

  • Type of vasectomy reversal procedure: The type of vasectomy reversal procedure a man has will impact reversal success and pregnancy outcomes. Men who have a vasovasostomy — the shorter and simpler of the two types of reversal procedures — tend to have higher success rates than those who have undergone a vasoepididymostomy. The vasoepididymostomy is a more complicated procedure, and is performed when a surgeon believes that the vas deferens tube is blocked closer to the testicle, in a coiled part of the vas deferens known as the epididymis. Because patients who have had a vasoepididymostomy tend to have longer periods of impaired sperm motility, it tends to take longer for their partner to conceive.
  • Time since the vasectomy procedure: The amount of time between the original vasectomy procedure and the vasectomy reversal also affects the length of time it will take to conceive. In general, higher success rates have been reported when the reversal is performed closer to the original vasectomy procedure, especially if less than five years. After 10 years of a vasectomy, pressure within the vas deferens can cause a rupture or blockage in the epididymis. This blockage requires the micro-surgeon to perform a more difficult vas-to-epididymis reconstruction, which causes the success rate to decrease.
  • Maternal and Paternal Age: If a woman is over 35, her hormone levels and ovulation cycles may be harder to predict; if a man is over 50, the quality or concentration of his sperm may slightly decrease. Both of these can increase the amount of time to conception. Talk to your urologist about which alternative methods for conception, such as in vitro fertilization, might be an option.

What It Boils Down To

There is no perfect way to predict when, or if, a couple will be able to get pregnant after a vasectomy reversal. But talking to a doctor can help couples understand their own personal chances of success, which obstacles may stand in the way of conception, and whether a reversal is the right choice.

Reviewed December 4, 2012, by Larry Lipshultz, MD – Urologist

References:

Busato, W.F. (2009). Vasectomy reversal: A seven year experience. Urologia Internationalis, 82(2), 170-174.

Graham, S.D., & Keane, T.E. (2009). Glenn’s urologic surgery. Philadelphia, PA: Lippincott Williams and Wilkins.

Labrecque, M., Durfresne, C., Baone, M.A., & St-Hilaire, K. (2004). Vasectomy surgical techniques: A systematic review. BMC Medicine, 2, 21-32.

Palkhivala, A. (2006). Vasectomy reversal: Data point to choice of technique. Urology Times, 43(2), 23, 41.

Most common reasons to “regret” a vasectomy.

From Family Practice Notebook

Risk factors: Regretting Vasectomy

  1. Age under 30 years (12.5 times more likely to request vasectomy reversal)
  2. Few children (but men with no children are less likely to request reversal)
  3. Relationship not stable
  4. Religious affiliation prohibiting vasectomy
  5. Pressure from partner to have procedure
  6. vasectomy performed during time of personal crisis
  7. Lack of discussion with partner regarding vasectomy
  8. Hope vasectomy will solve sexual and marital problems
  9. High interest regarding reversibility issues
    1. Vasectomy Reversal
    2. Sperm banking

In my experience the male does not regret having a vasectomy-he wants to have it reversed because something has changed in his life.

The most common reason for a reversal is divorce and remarrying a younger female with no children. The second most common reason is that a couple with children desire more.

Vasectomy Reversal-What a Woman Wants to Know.

From Vasectomy.com

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The decision to reverse a vasectomy should be considered carefully by each couple. As a woman, you may have special concerns that are difficult to express.

Vasectomy reversal (and the microsurgery involved) raises questions for both men and women. Although men need to be forthcoming about any questions, concerns and fears they share with their physician, it is just as important for women to be informed and reassured about the procedure. You may be surprised to know that many women share the apprehensions about reversal surgery that you may have.

Candid questions, correct information, and the assurance of an experienced urologist are the keys to feeling more comfortable and sure about the decision you and your spouse have made to have a vasectomy reversal. Make a list of the questions that concern you most before meeting with your doctor.

Here are some of the questions women commonly ask:

“This is my first marriage– and his second. Will my spouse’s older age affect the health of his sperm or our babies born after his reversal?”

Generally speaking, a man who has healthy sperm can reasonably expect to father a healthy child. A man’s age does not affect fetal development the way a woman’s does. But time does have an impact on successful conception.

The longer the amount of time between a man’s vasectomy and his reversal, the less potent he may become. This is why: After a vasectomy, unreleased sperm collect in the testicles before being absorbed by the body. The body responds to the unspent sperm with a reaction that can affect, to some degree, sperm quality and health. Over time, this reaction can gradually reduce the mans sperm count, and impair sperm motility.

A successful reversal that results in pregnancy is proof that the man has a healthy, adequate sperm count. The course of pregnancy that follows a vasectomy reversal should be as normal as any other pregnancy. A vasectomy reversal merely restores sperm to the seminal fluid. It should not affect the health of an unborn baby in any way, no matter how old the man is at the time of his reversal.

“Will a vasectomy reversal affect a man’s ejaculation?”

Sperm is only a tiny portion of the seminal fluid that is released at ejaculation. Just as a vasectomy does not change the volume, color, or consistency of the ejaculate, neither does a vasectomy reversal. Sperm are impossible to detect in seminal fluid without the use of a microscope. The quality, intensity and duration of a mans orgasm and ejaculate will not change after a reversal.

“How long will it be until my spouse and I can resume sex?”

Physicians usually advise that it is best to wait three or four weeks following the reversal procedure before returning to sexual activity. It will take additional time before sperm returns to the ejaculate.

“Does the vasectomy reversal procedure leave scars?”

Despite the greater complexity and time involved in a vasectomy reversal procedure, there is usually no lasting or noticeable difference to the feel or appearance of the scrotum.

“How soon can I expect to get pregnant?”

If reversal is successful and healthy sperm rejoin the seminal fluid, it may take 12 months, on average, to achieve pregnancy. The range, from reversal to conception, is between one and 82 months. Most couples achieve pregnancy within a year.

“Can I and should I be examined and tested for fertility first, before we decide on a reversal?”

Since many couples consider reversal surgery a costly matter, women often do choose to consult with their own physicians or fertility specialists first, to determine whether there is any question or doubt about the woman’s ability to conceive and complete a healthy pregnancy.

“How long will my husband be in pain, and what can I do to help?”

You can expect your husband to experience some degree of discomfort and swelling in the first three to five days following reversal surgery. A gradually decreasing ache in the scrotal region will follow and may last for three to four weeks. His attention to doctors orders during the recovery process, lots of ice and rest, and your tender loving care will be the best medicine for your husband.

“Does a vasectomy reversal make you more, or less, susceptible to sexually transmitted diseases?”

Vasectomy and vasectomy reversal surgery do not protect couples from the risk of transmitting or contracting a sexually transmitted disease. These diseases are transferred in body fluids, such as saliva or semen. Both men and women should use condoms if any potential risk of sexually transmitted disease exists.

“How old is ‘too old’ for a couple considering vasectomy reversal?”

All women lose the ability to conceive by late middle age. Women over the age of 40 may experience difficulty conceiving with assisted reproductive techniques (ART).

Men can remain potent and father children even after the age of 70. However, a man may not want or be able to parent a new child at a later stage of life. The older you are, the fewer the years that you have left in which to raise an infant to adulthood. And older couples often have more health problems as they age.

“My husband does not want more surgery-he says that sperm aspiration is easier and just as effective as vasectomy reversal. Is it?”

A vasectomy reversal, performed under general anesthesia, is virtually painless, more natural and more likely to result in pregnancy than an assisted reproductive technique (ART) that begin with sperm aspiration as the first step. Besides a lower rate of success, ARTs have much higher costs, involve a greater number of complex, uncomfortable procedures, and take considerably more time than that required to perform a comparatively simple and safe reversal.

In a straight comparison, reversal surgery is preferable to ART and should be considered first, unless conception and pregnancy cannot be achieved any other way.

“What if we just want one child. Would not sperm retrieval and in vitro fertility be more efficient?”

Not necessarily. The rate of multiple order births–twins or triplets–is several times higher with in vitro fertility than with natural conception following a vasectomy reversal. The risk of having twins with IVF is 20 to 50 percent depending on which IVF center one is treated at.

In Summary:

  • A vasectomy should be considered permanent, so have reasonable expectations about the success of reversal surgery. Be informed and discuss all your options with your spouse and your physician.
  • Some men or couples may not be well suited or economically prepared for a vasectomy reversal or second family, particularly if either partner is over the age of 40 or in poor health. Vasectomy reversal microsurgery is often evaluated as a first course option; generally preferable to assisted reproductive techniques for many couples.