What does sperm look like under a microscope after vasectomy reversal?

Sperm-egg

Several times a month a patient, who has had a reversal,  will drop off a specimen to see if there are any sperm present. This evaluation takes just a minute to do. If sperm is present it means that the reversal mechanically is open and has been successful. This evaluation however doesn’t count the sperm, that would require a full semen analysis which is done through the hospital lab and quantitates the actual number of sperm present. For the purposes of seeing if the reversal “worked or not” the in office check for sperm is sufficient. If there are no sperm and it has been three months post reversal this may either means that reversal is not open but probably more likely that the testicles have not “picked up the ball” and started producing sperm yet. It can take four to twelve months for the sperm to be produced in numbers sufficient for conception. The time to producing sperm by the testicles post vasectomy is large part dependent on the interval between the vasectomy and the reversal. It is always a “drum roll” moment when the specimen is dropped off for me to evaluate and always rewarding to see sperm moving about so excited to be set free and get to work.

The following is not a post reversal sample but it shows what you want to see in the ejaculate after a reversal. It is also interesting how the maker of the video created the project.

 

Can a vasectomy reversal be done under local anesthesia?

Just because something can be done doesn’t mean that it is the way you’d want it done.

Yes. The scrotal skin and the nerves that innervate the testicles and vas deferens can be infiltrated with short and long acting anesthetics for very good control of pain. Oral medicines similar to what is used in “sedation dentistry” can be used as a sedative to further make non general anesthesia possible for a vasectomy reversal.

Why doesn’t everyone do it this way? Because the procedure usually lasts 2-3 hours some patients might not be comfortable lying still for that long. As well, because the operative microscope magnifies the operative field so much, small movements dramatically change the area seen and the focus settings. This in turn results in the surgeon having to readjust the microscope and in turn make procedure last longer. One might add that the occasional adjustments hamper the surgeon’s ability to do a quality repair of the vasectomy.

Another reason that a patient and the doctor might prefer local anesthesia with oral sedation is cost. Having general anesthesia must be done in a facility and that in it self adds an expense and then there is the anesthesiologist and the supplies necessary for general anesthesia.

The advantage to the patient with general anesthesia is that he is put to sleep and then wakes up and the procedure is done. For the surgeon he has had the advantage of not being concerned or dealing with a patient moving and having to readjust the microscope.

So in the end it becomes about patient and surgeon preference, and cost. At Northeast Georgia Urological Associates we believe we have the best of both worlds.

Because we own our center the added costs for a facility and anesthesia is minimized resulting in a very cost effective reversal without compromising safety and comfort by utilizing a  board certified anesthesiologist in an accredited surgery center.

If Dr. Phil did a vas reversal…you can too!

Most common reason for a vasectomy reversal?

Obviously there are a lot of reasons for a man choosing to reverse a vasectomy. The two most common reasons are:

  • The male is divorced, has had children and a vasectomy. He then remarries a younger woman who has not had children and wants to have children. Often times the discussion regarding the male undergoing the inconvenience and expense of a reversal  and his willingness to have it done, occurs before the couple is married.
  • A couple with several children decide after vasectomy they’d like to have more children. Interesting enough, in my practice, this reason for having a reversal is increasing.

Regardless of the reason we at Northeast Georgia Urological Associates look forward to helping you with a new addition to your family.

As a side note, the other day a patient told us that another doctor could tell him what he’d charge for a reversal but could not tell him what the hospital would be charging. In fact, the doctor told the patient to call the hospital to find out the costs. Because we own our Surgery Center we will be able to tell you exactly what the total cost will be and because we don’t use a hospital our costs are lower than most reversal centers.

 

Post vasectomy pain syndrome-Myth?

This real phenomenon in my experience happens rarely, but it happens. There are reports that show that doing a reversal has been dramatically beneficial.

The reversal surgeon however cannot assure that there will be resolution of symptoms if a reversal is done. This should weigh heavily in the decision making process of the patient wanting to pursue this.

I will mention that I performed a reversal on a man who wanted children but also felt he had PVPS. He wrote me after the procedure stating that he had had complete resolution of his pain and was very pleased.

Here are several links on the discussion of this:

Wikipedia

PubMed Article

CMRM Article

Review of literature-Note those patients that did not improve with reversal.

 

Are vasectomies reversible?

Yes…but that doesn’t mean it will work!

This is a common question by the person wanting a vasectomy. I often explain that yes they are reversible but that is not the entire issue. As explained elsewhere, there are many factors involved in a “successful” reversal to include the health of the couple, who does the reversal and the time between the reversal and the vasectomy.

Urologists always tell the vasectomy couple that they should consider the procedure permanent. We mention that it can be reversed but the success rates vary and that they should not depend on that.

If there is any doubt  about wanting another child you probably are not ready to nor should you have a vasectomy.

A good option for some is to bank sperm. The fee for this varies but is around $300 a year.

A funny memory for me… awaiting our third child my wife informed me that she did not want anymore children and that she had arranged for her tubes to be tied after the delivery. I asked, “What if you change your mind and we do want another one in a few years.” (I was one of five boys and had always wanted a large family.)

“John we can adopt. My body is done with having babies.”

Well…there you go. Having three children now all over the age of thirty I understand the wisdom of her decision.

How wonderful is this?

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!
Sincerely,
Marly and Robert Kapish

image

Why doesn’t the average urologist do vasectomy reversals?

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!

The Semen Analysis after a Vasectomy Reversal-Meaning.

Sperm-egg

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 major factors in a successful vasectomy reversal. John McHugh M.D.

  

  1. The age of the male.
  2. The age of the female.
  3. The time since the vasectomy.
  4. The quality of the sperm from the testicular end of the transected vas at the time of the reversal procedure.
  5. The technical quality of the reversal procedure itself and the experience of surgeon.
  6. Some degree of luck for all of these factors to come together and result in pregnancy.

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

%d bloggers like this: