Patient’s often ask, “What is your success rate?” The successful reversal is heavily influenced by the quality of the fluid at the testicular end at the time of the reversal and the time interval since the vasectomy. JM
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).
The essence of the below study is that it is reasonable and proper to perform a vasovasotomy (cut out the vasectomy scar and and reconnect good vas to good vas) when the fluid is not “favorable.” That indeed the vasoepididymostomy may be performed too often and unnecessarily and with less favorable results.
Indian J Urol. 2014 Apr-Jun; 30(2): 164–168.
This study suggests that VV (vasovasostomy) is the preferred method of reconstruction during vasectomy reversal (VR) when SHST (sperm heads and short tails) are present within the intravasal fluid.
The high patency rates in this cohort exceed the expected patency of EV (epididymovasostomy), despite poor fluid quality and longer occlusive intervals.
Our study adds further credence to the growing body of literature suggesting that VV is preferred in this subpopulation of men undergoing VR. Urologic microsurgeons may be reassured about performing VV in the setting of SHST irrespective of fluid quality and occlusive interval.
In the big scheme of things nope! However the picture shown above the vasectomy was done with clips. For the reversal surgeon this type of vasectomy is the easiest to find and usually is associated with a smaller segment to remove.
When the vasectomy has been done with fulguration alone (burning the inside of the severed vas) it be hard to find the actual site of the vasectomy. The defect is sometimes so small that the entire vas tube appears as if nothing has been done.
If a sperm granuloma has formed this is very easy to find and is a positive thing as the fluid is much better in this case.
Finally, a vasectomy should only be done if the couple is wanting “permanent” birth control. So a urologist doing a vasectomy in a way to make a reversal easier in my opinion is not the right attitude for either the patient or the doctor.
The question on vasectomy.com is about IVF however a microscopic reversal is also a reasonable option in this scenario.
It takes two to tango but only one testicle to conceive!