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