In addition to the skill of the surgeon, the character of the fluid at the time of the reversal, and years since the vasectomy…the age of the female is an important factor in achieving pregnancy.
What Affects Pregnancy, Patency Rates After Vasectomy Reversal?
Urology – October 30, 2015 – Vol. 33 – No. 4
The Silber grading scale appears to dictate pregnancy rates after vasectomy reversal with increasing female age being a negative predictive factor.
Article Reviewed: Impact on Pregnancy of Gross and Microscopic Vasal Fluid During Vasectomy Reversal. Ostrowski KA, Polackwich AS, et al: J Urol; 2015;194 (July): 156-159.
Background: The examination of the vasal fluid at the time of vasectomy reversal has implications for surgical decision making with effects on patency and pregnancy rates. The Silber grading system characterizes these findings and has been used to help surgeons with the decision to perform vasovasostomy (VV) or the more technically challenging vasoepididymostomy (VE).
Objective: To determine both intraoperative and patient factors that affect pregnancy rates after vasectomy reversal.
Design: Retrospective review of prospectively maintained database.
Methods: This paper reviewed the results of a single surgeon series that encompassed >30 years of vasectomy reversals. Vasal fluid was characterized as opalescent, creamy, pasty or clear and intraoperative light microscopy was used determined if sperm parts were present or motile. Univariate and multivariate analysis examined the data set for significant factors that affected pregnancy rates.
Results: 2947 vasectomy reversals were included in the analysis. Pregnancy status was only known for 31% of these cases. Bilateral VV was performed 83% of the time and most patients fell into a Silber 1 to 3 classification. No factors met statistical significance for increasing the pregnancy rate, although the presence of motile sperm was almost significant (P =0.075).
Negative predictive factors for pregnancy were identified on multivariate analysis with increasing female age and the findings of either no sperm (odds ratio [OR], 0.08) or sperm heads only (OR, 0.46) on microscopy decreasing pregnancy rates. Rarely were sperm parts identified when pasty fluid was encountered.
Conclusions: The findings from this paper echo the findings of the Vasovasostomy study group, with the Silber grading system essentially dictating pregnancy rates.
Reviewer’s Comments: The decision to perform VV or VE can be a difficult one and is based on many factors including findings from the vasal fluid, time since vasectomy, and surgeon skill level. Few papers have examined this decision-making algorithm since the landmark paper by the Vasovasostomy study group in 1991. While most microsurgeons prefer VV to VE due to increased patency and pregnancy rates, the need to perform a VE is generally encouraged when pasty fluid or no sperm parts are found in the vas at the time of reversal. These findings are interesting and are another important addition to the literature. Unfortunately, despite the authors’ efforts, relatively few predictive factors were found. Their findings do somewhat parallel those published by the Vasovasostomy study group, wherein the Silber grading system appears to correlate with pregnancy rates. The authors identified sperm heads only (Silber 4) or no sperm (Silber 5) as negative predictors with motile sperm (Silber 1) almost achieving statistical significance as a positive factor.(Reviewer–Charles Welliver, MD).
All methods of performing a vasectomy include removing a segment of the vas deferens and then doing something to close the two ends of the divided vas. Whether this is done by using electrocautery, clips, suture, or interposing tissue, the ability to remove the damaged areas of he vas ends and do the reversal is not impaired.
In general about an inch of the damaged ends of the vas tubes and scar tissue is removed at the time of a microscopic reversal. There is plenty of “play” in the vas above and below the vasectomy site to perform the reversal without tension.
Vasectomy Reversal Remains More Cost-Effective Than IVF
Urology – October 30, 2008 – Vol. 24 – No. 11
Vasectomy reversal is more cost-effective than sperm aspiration and in vitro fertilization for obstructive azoospermia.
Article Reviewed: A Decision Analysis of Treatments for Obstructive Azoospermia. Lee R, Li PS, et al: Hum Reprod; 2008;23 (September): 2043-2049.
Background: Management of post-vasectomy obstructive azoospermia is either vasectomy reversal or sperm aspiration with in vitro fertilization (IVF) intracytoplasmic sperm injection (ICSI). The cost of IVF and issue of multiples has broad implications for public health policy and allocation of resources. The change in cost of male factor infertility over time with the evolution of new techniques like ICSI has not been studied.
Because a vasectomy reversal is usually not covered by insurance, the patient usually pays an all inclusive fee to the surgeon. This fee covers all of the components of having a surgical procedure such as:
The fee of the surgeon to perform the reversal.
The facility fee which includes the cost of the nurses and staffing, the facility (operating room), suture materials and the operating microscope, the anesthesiologist and the anesthesia supplies necessary to put a patient to sleep.
The cost of overnight accommodations (if necessary).
At Northeast Georgia Urological Associates our facility is accredited and owned by our practice which in turn allows our all inclusive fee to be much less than if a hospital were used. Our anesthesiologists are board certified as well as Dr. McHugh.
The all inclusive cost for a microscopic vasectomy reversal at the Northeast Georgia Ambulatory Surgery Center is $6,500.00. After promotion- $6,000.00.
Kathy Burton 770.535.0001 ext 113 or email@example.com is available to help with all things vasectomy reversal. CareCredit is an option for couples preferring to pay over time.
Can There Be Complete Resolution of Pain for Men With PVPS?
One of the most complimentary letters I have ever received was from a patient on whom I performed a vasectomy reversal for relief of chronic testicular pain which started after his vasectomy years previously. Go figure!
Urology – June 15, 2016 – Vol. 34 – No. 3
A subset of men have complete resolution of postvasectomy pain with vasectomy reversal. Most men have some improvement in pain scores with vasectomy reversal.
Article Reviewed: Vasectomy Reversal for Postvasectomy Pain Syndrome: A Study and Literature Review. Polackwich AS, Tadros NN, et al: Urology; 2015;86 (August): 269-272.
Background: Vasectomy is a common and effective procedure for sterility. Although complications are infrequent, postvasectomy pain syndrome (PVPS) does occur in some subset of patients. Most previous studies report that men who have PVPS do not generally seek additional medical treatment and have minimal affect on quality of life. However, a small subset has pain significant enough to require additional care and procedures.
Objective: To determine outcomes of vasectomy reversal (VR) for PVPS.
Design: Retrospective chart review.
Methods: A single surgeon series was reviewed for men who underwent VR for PVPS. Although there was not an algorithmic approach to preoperative pain management, patients were only considered for VR if they had worsening of pain with ejaculation or arousal. The location of vasectomy site along the vas deferens was recorded at time of the procedure in the operative note. Pain scores were evaluated with a non-validated questionnaire by recall.
Results: 31 patients from a pool of 123 potential patients were included. There was a 59% improvement in pain scores, with 34% of patients reporting a complete resolution of pain. Two patients required additional procedures for pain (epididymectomy and orchiectomy), and 84% of patients would recommend VR to a man with PVPS. There was no relationship between location of vasectomy and possibility of PVPS.
Conclusions: VR for PVPS demonstrated significant improvements in pain scores in this study.
Reviewer’s Comments: Although the questionnaire is non-validated and the pain scores are by recall, the fact that men generally reported an improvement in pain scores with VR is reassuring. As roughly one-third of men had total resolution of pain, there is likely an etiology of vasal obstruction leading to pain among these men. I have always wondered if some of the cases captured in studies looking at PVPS are really just the background of orchalgia in the population that we now attribute to the previous vasectomy. Considering how few men seek medical attention and undergo procedures for PVPS, I have always believed there is likely a group of men who have intermittent scrotal pain and a group who clearly have pain from vasectomy-induced obstruction. In their comments, the authors observe how patients seemed to group into complete (or almost complete) resolution of pain or minimal change in pain. As the authors were thoughtful by only considering men for reversal if they had pain with ejaculation or sexual stimulation, one would hope that this would only select men who truly have an obstruction-induced pain syndrome. This is a nice addition to the literature and does point out that there are some men who fully respond to reversal for PVPS. These men, however, may be difficult to identify preoperatively.(Reviewer–Charles Welliver, MD).
The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy.
Urology – April 30, 2016 – Vol. 34 – No. 1
Vasectomy is not associated with decreased frequency of sexual intercourse.
Article Reviewed: Relationship Between Vasectomy and Sexual Frequency. Guo DP, Lamberts RW, Eisenberg ML: J Sex Med; 2015;12 (September): 1905-1910.
Background: Men often report the concern that having a vasectomy will impair their future sexual function.
Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.
Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.