How long out of work if you have a vasectomy reversal? Ga Vasectomy Reversal.

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Medical aphorism: “The art of getting away with it.”

Patients who are considering a vasectomy reversal usually have a busy life. They to a person don’t like being out of work and even if they did their employer probably won’t view a reversal as medically necessary. So a common question is how soon can I go back to work and how soon to resume working out? Well…this is where “getting away with it” comes in.

Since a reversal is a procedure which usually takes a bit over two hours, the incision on each side is open for about an hour each and this lends itself to bruising and scrotal swelling. A patient can physically go back to work in three to four days but because of the nature of the procedure and the fact that the scrotum is a dependent structure (hangs down) and is potential space (not tight like the skin over your arm) it is prone to bruising and swelling.

So the answer…you can “get away with” three to four days but:

  • The longer you are off your feet and elevate the scrotum the less swelling and bruising you’ll have
  • The two incision are less than an inch long and closed with absorbable suture and the incisions take about two weeks to heal.
  • Being up and about probably won’t hurt the repair of the vasectomy site inside or the healing process on the outside but extra swelling may slow the process and may make you more uncomfortable.
  • We recommend no strenuous activity or sex for three weeks.
  • Having said all of this I have had patients who told me they planned to go to work “a desk job” the next day
  • And I have had a patient he had sex the night of the procedure-of note he came to the office the next day all “swollen up” and yet he and his wife were pregnant in three months.  Go figure!

The last guy…he was practicing the art of getting away with it and got away with it. But…not everybody does.

I tell patients the “company policy” is off your feet as long as possible, the more you’re off your feet the less swelling and bruising, and no sex or strenuous activity for three weeks. However just like in companies, the company policy is rarely adhered to or enforced…it is a template of what is desirable.

 

Does steroids given pre and post vasectomy reversal improve the chances of pregnancy? A good question.

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An antisperm antibody test looks for special proteins (antibodies) that fight against a man’s sperm in blood, vaginal fluids, or semen. The test uses a sample of sperm and adds a substance that binds only to affected sperm. Semen can cause an immune system response in either the man’s or woman’s body.
Br J Urol. 1981 Dec;53(6):654-9.

Reversal of vasectomy: the effects of sperm antibodies on subsequent fertility.

Abstract

Antisperm antibodies were measured in serum and seminal plasma in 130 males before and after vasectomy reversal and the occurrence of pregnancy was analysed in the partners of 77 who were followed for more than one year. Sperm-agglutinating antibodies were found in the serum of 79% of patients; seminal plasma antibodies were present in only 9.5% before reversal and this rose to 26% afterwards. Pregnancies occurred in the partners of 53% of those men who were trying to produce children. A pregnancy was significantly less likely when the pre-operative serum antisperm antibody titre was 512 or more, but no decrease in fertility was seen with titres below this. Several pregnancies were produced by patients with seminal plasma antibodies, but numbers and follow-up are too small to permit detailed analysis.

A randomised controlled trial of peri-operative steroids showed that they produced no benefit.

The antisperm antibodies associated with vasectomy reversal appear to differ fundamentally from those occurring in naturally subfertile males.

Vasectomy Reversal Success Depends on Three Big Things…Read On!

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The three things…The surgeon, the quality of fluid at the time of the procedure, and the years since the vasectomy…and a little luck.

Time to Sperm Appearance Can Be Predicted After Vasectomy Reversal

Urology – November 30, 2007 – Vol. 23 – No. 08

After vasectomy reversal, motile sperm observed intraoperatively at the testicular vas, undergoing vasovasostomy, and an obstructive interval of <=8 years predict shorter time to appearance of sperm in the ejaculate.

Article Reviewed: The Kinetics of the Return of Motile Sperm to the Ejaculate After Vasectomy Reversal. Yang G, Walsh TJ, et al: J Urol; 2007; 177 (June): 2272-2276.

The Kinetics of the Return of Motile Sperm to the Ejaculate After Vasectomy Reversal.

Yang G, Walsh TJ, et al:
J Urol; 2007; 177 (June): 2272-2276

Objective: To study the time to appearance of sperm in the ejaculate for men undergoing vasectomy reversal. Design: Retrospective chart review of men who had undergone bilateral vasovasostomy, bilateral epididymovasostomy, or a combination of vasovasostomy on 1 side and epididymovasostomy on the other. Participants/Methods: 150 men whose records included intraoperative findings with type of reversal performed, record of sperm presence or absence, and associated fluid findings from each testicular vas deferens. Results: Presence of motile sperm in vasa was associated with a shorter time to postoperative presence of sperm observed in the ejaculate: 95% of men with motile sperm in the intraoperative vasal specimen were observed to have sperm in the ejaculate by 6 months after vasectomy reversal compared to 76% of men without motile sperm in the intraoperative specimen (P =0.04). Features correlated with a shorter onset to the observation of sperm in the ejaculate within the first 3 months after vasectomy reversal included an obstructive interval of <=8 years and vasovasostomy rather than epididymovasostomy. Patient age did not affect time to the observation of sperm in the ejaculate after vasectomy reversal.

Conclusions: Motile sperm observed intraoperatively at the testicular vas, undergoing vasovasostomy, and an obstructive interval of <=8 years predict shorter time to the appearance of sperm in the ejaculate after vasectomy reversal.

Reviewer’s Comments: The similarity with previous studies by other investigators of time to sperm seen in the ejaculate, with an average of 3.2 months for vasovasostomy and 6.3 months for epididymovasostomy, provides excellent counseling information for couples considering vasectomy reversal. (Reviewer–Craig S. Niederberger, MD).

 

Can you achieve pregnancy after reversing only one testicle?

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The above logo is a microbrewery  company in our city and I thought the name lends itself to introduce this blog’s message. I should have been asked to be an investor!

Actually this question comes up often to the urologist. Patients lose a testicle for several reasons to include: chronic epididymitis, orchitis, undescended testicle, testicular cancer, trauma, and chronic pain. In the majority of cases having only one testicle does not affect fertility or male hormone production.

The reason we mention this here is that it does become an issue for the couple desiring a reversal in the male with one testicle. Can you reverse the vasectomy on one testicle and have success? Yes. Do you have a better chance of success after a reversal if you have two testicles? Yes.

Although the one testicle can produce the quality and quantity of sperm for pregnancy after a reversal, having two testicles results in a higher likelihood of success because there are two chances that the anastomosis (the repair of the vas deferens) remain open, two chances of having good fluid in the proximal (testicle side of the vas), and the benefit of two testicles contributing to the semen quality.

It is not unusual at the time of a reversal to have very good quality fluid on one side because of a sperm granuloma on that side, and on the other side the fluid is of poor quality i.e. cloudy with sperm parts and no whole sperm.

So…if we had our druthers, we’d want to begin with two testicles to work with, however it is reasonable to have a reversal if the patient only has one testicle. Of note we often times give a price discount because we only have to one side.

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).

 

Helping couples achieve the new addition to their lives with microscopic vasectomy reversal.