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).
The decision to reverse a vasectomy should be considered carefully by each couple. As a woman, you may have special concerns that are difficult to express.
Vasectomy reversal (and the microsurgery involved) raises questions for both men and women. Although men need to be forthcoming about any questions, concerns and fears they share with their physician, it is just as important for women to be informed and reassured about the procedure. You may be surprised to know that many women share the apprehensions about reversal surgery that you may have.
Candid questions, correct information, and the assurance of an experienced urologist are the keys to feeling more comfortable and sure about the decision you and your spouse have made to have a vasectomy reversal. Make a list of the questions that concern you most before meeting with your doctor.
Here are some of the questions women commonly ask:
“This is my first marriage– and his second. Will my spouse’s older age affect the health of his sperm or our babies born after his reversal?”
Generally speaking, a man who has healthy sperm can reasonably expect to father a healthy child. A man’s age does not affect fetal development the way a woman’s does. But time does have an impact on successful conception.
The longer the amount of time between a man’s vasectomy and his reversal, the less potent he may become. This is why: After a vasectomy, unreleased sperm collect in the testicles before being absorbed by the body. The body responds to the unspent sperm with a reaction that can affect, to some degree, sperm quality and health. Over time, this reaction can gradually reduce the mans sperm count, and impair sperm motility.
A successful reversal that results in pregnancy is proof that the man has a healthy, adequate sperm count. The course of pregnancy that follows a vasectomy reversal should be as normal as any other pregnancy. A vasectomy reversal merely restores sperm to the seminal fluid. It should not affect the health of an unborn baby in any way, no matter how old the man is at the time of his reversal.
“Will a vasectomy reversal affect a man’s ejaculation?”
Sperm is only a tiny portion of the seminal fluid that is released at ejaculation. Just as a vasectomy does not change the volume, color, or consistency of the ejaculate, neither does a vasectomy reversal. Sperm are impossible to detect in seminal fluid without the use of a microscope. The quality, intensity and duration of a mans orgasm and ejaculate will not change after a reversal.
“How long will it be until my spouse and I can resume sex?”
Physicians usually advise that it is best to wait three or four weeks following the reversal procedure before returning to sexual activity. It will take additional time before sperm returns to the ejaculate.
“Does the vasectomy reversal procedure leave scars?”
Despite the greater complexity and time involved in a vasectomy reversal procedure, there is usually no lasting or noticeable difference to the feel or appearance of the scrotum.
“How soon can I expect to get pregnant?”
If reversal is successful and healthy sperm rejoin the seminal fluid, it may take 12 months, on average, to achieve pregnancy. The range, from reversal to conception, is between one and 82 months. Most couples achieve pregnancy within a year.
“Can I and should I be examined and tested for fertility first, before we decide on a reversal?”
Since many couples consider reversal surgery a costly matter, women often do choose to consult with their own physicians or fertility specialists first, to determine whether there is any question or doubt about the woman’s ability to conceive and complete a healthy pregnancy.
“How long will my husband be in pain, and what can I do to help?”
You can expect your husband to experience some degree of discomfort and swelling in the first three to five days following reversal surgery. A gradually decreasing ache in the scrotal region will follow and may last for three to four weeks. His attention to doctors orders during the recovery process, lots of ice and rest, and your tender loving care will be the best medicine for your husband.
“Does a vasectomy reversal make you more, or less, susceptible to sexually transmitted diseases?”
Vasectomy and vasectomy reversal surgery do not protect couples from the risk of transmitting or contracting a sexually transmitted disease. These diseases are transferred in body fluids, such as saliva or semen. Both men and women should use condoms if any potential risk of sexually transmitted disease exists.
“How old is ‘too old’ for a couple considering vasectomy reversal?”
Men can remain potent and father children even after the age of 70. However, a man may not want or be able to parent a new child at a later stage of life. The older you are, the fewer the years that you have left in which to raise an infant to adulthood. And older couples often have more health problems as they age.
“My husband does not want more surgery-he says that sperm aspiration is easier and just as effective as vasectomy reversal. Is it?”
A vasectomy reversal, performed under general anesthesia, is virtually painless, more natural and more likely to result in pregnancy than an assisted reproductive technique (ART) that begin with sperm aspiration as the first step. Besides a lower rate of success, ARTs have much higher costs, involve a greater number of complex, uncomfortable procedures, and take considerably more time than that required to perform a comparatively simple and safe reversal.
In a straight comparison, reversal surgery is preferable to ART and should be considered first, unless conception and pregnancy cannot be achieved any other way.
“What if we just want one child. Would not sperm retrieval and in vitro fertility be more efficient?”
Not necessarily. The rate of multiple order births–twins or triplets–is several times higher with in vitro fertility than with natural conception following a vasectomy reversal. The risk of having twins with IVF is 20 to 50 percent depending on which IVF center one is treated at.
A vasectomy should be considered permanent, so have reasonable expectations about the success of reversal surgery. Be informed and discuss all your options with your spouse and your physician.
Some men or couples may not be well suited or economically prepared for a vasectomy reversal or second family, particularly if either partner is over the age of 40 or in poor health. Vasectomy reversal microsurgery is often evaluated as a first course option; generally preferable to assisted reproductive techniques for many couples.
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 firstname.lastname@example.org is available to help with all things vasectomy reversal. CareCredit is an option for couples preferring to pay over time.
If you look at the top right picture you’ll notice that the method used for this vasectomy was a clip. You’ll also notice that the vas to the left of the clip is larger in diameter than the vas extending below the clip. This is because the larger diameter vas is coming from the testicle and is always larger to the pressure of the sperm produced. This is the area of the vas at the time of the reversal where fluid is checked for its character and the presence or absence of sperm or sperm parts. When the testicular end is cut you almost always see fluid emanate promptly.
This back pressure is what is felt to be responsible for post vasectomy pain syndrome. I have postulated in a previous post that the inflammatory changes around the spot of the vasectomy could also contribute to this syndrome and the pain.
Although not all urological microscopic surgeon remove the entire vasectomy site, I always do. I feel it is cleaner and may help with any pre-reversal symptom issues related to this area of healing/inflammation associated with the vasectomy.
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).
Objective: To determine vasovasostomy outcomes in instances in which only sperm parts are present intraoperatively in the vasal fluid, rather than in full sperm. Design: Retrospective review of outcomes from 3 institutions with experienced male reproductive microsurgeons for men undergoing vasovasostomy in cases where only sperm parts were noted in fluid from the transected vas.Participants: 34 men who underwent bilateral (n=31) or unilateral (n=3) vasovasostomy. Methods: Men who were identified with sperm parts (sperm heads or sperm with partial tails) in the vasal fluid bilaterally or sperm parts on 1 side with intravasal azoospermia on the contralateral side when the vas was transected during vasovasostomy were included in the study. Microsurgical vasovasostomy was performed using either a modified 1-layer technique or a formal 2-layer technique. Results: The overall patency rate was 76% (26 of 34 men), and the pregnancy rate was 35% (7 of 20). Analyzing 8 procedures that did not result in sperm in the ejaculate, 2 had only an occasional sperm head bilaterally from the transected vasa, and 1 had observed an occasional sperm head on 1 side and contralateral intravasal azoospermia. Excluding these 2 cases, the patency rate was 84% (26 of 31). Conclusions: These results are similar to or better than those of epididymovasostomy outcomes, and argue that vasovasostomy should be performed in cases where only sperm parts are noted intraoperatively in the transected vas.Reviewer’s Comments: Mounting evidence supports that vasovasostomy can and should be performed when only sperm parts or even clear fluid is noted intraoperatively in the transected vas. (Reviewer–Craig S. Niederberger, MD).
Over the years men have told me they were having a vasectomy because their wife told them that, “I’ll want to have sex more if I don’t have to worry about getting pregnant.” One such patient, a neighbor, stopped me in my drive way three months after his vasectomy to tell me, “She lied!”
Vasectomy May Lead to Increased Sexual Intercourse Frequency
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.
Methods: Data were extracted from 2 cycles of the NSFG (2002 and 2006-2008) and analyzed. Men were included if they were previously sexually active and were aged >25 years. Female partners were also surveyed in the NSFG and were included if they were between 25 and 45 years of age. Sexual frequency was compared between men (or male partners of female respondents) who had a vasectomy and those who did not. The database captured sexual intercourse frequency over the preceding 4 weeks.
Results: A total of 5838 men met inclusion criteria, with 353 of these having a previous vasectomy. Men who had a vasectomy engaged in intercourse at a mean rate of 5.9 times per month compared to 4.9 times in men who had not had a vasectomy (P =0.0004). Additionally, men who had a vasectomy were less likely to have not engaged in any sexual intercourse in the preceding month. In the survey of female partners, 5211 women responded regarding their male partners, and 670 partners had a previous vasectomy. Again, men with a previous vasectomy had a higher frequency of sexual intercourse during the previous month (6.3 vs 6.0), although this difference was not statistically different (P =0.1341).
Conclusions:Vasectomy does not appear to negatively influence sexual frequency.
Reviewer’s Comments: 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. Previous reports have investigated if vasectomy has any effect on sexual function and satisfaction, with most finding minimal to no effect on sexual function. In fact, some reports have demonstrated improved sexual function with improved sexual satisfaction, likely due to the loss of anxiety about unwanted pregnancy. The authors of this article demonstrate through objective survey results that sexual frequency does not decrease and may increase with vasectomy. While no explanation can be extracted from these data, the results are encouraging and can certainly be mentioned while counseling men before vasectomy.(Reviewer–Charles Welliver, MD).
Heart-Healthy Foods With Lower Saturated Fat Equals Sperm Health
Urology – May 30, 2013 – Vol. 30 – No. 5
Ongoing indirect evidence suggests that heart-healthy diets are associated with the potential to improve sperm parameters.
Article Reviewed: High Dietary Intake of Saturated Fat Is Associated With Reduced Semen Quality Among 701 Young Danish Men From the General Population. Jensen TK, Heitmann BL, et al: Am J Clin Nutr; 2013;97 (February): 411-418.
Background: Saturated fat consumption has been correlated with some cancers and cardiovascular disease. Yet, whether saturated fat is correlated with abnormal sperm parameters needs more research.
Objective: To determine the impact of dietary fat on semen parameters among 701 young Danish men without azoospermia.
Design/Methods: This was a cross-sectional study of men recruited from their military fitness exam (2008 to 2010). Three-month recall-validated 136-item food frequency questionnaire, single semen sample, and physical examination were conducted for each participant. Median age was 19 years and median body mass index (BMI) was 22.5.
Results:Men with a high intake of saturated fat had lower total sperm counts. Men in the highest quartile of saturated fat intake had a 38% significantly lower concentration and a 41% significantly lower total sperm count compared to men in the lowest quartile. There were no other significant correlations found between semen parameters and other forms of dietary fat intake.
Conclusions: Diet may be a partial explanation for the reported greater abnormalities observed in sperm counts from other studies of the general population. Reducing the intake of saturated fat may improve reproductive and overall health parameters.
Reviewer’s Comments: This is part of a continuing series of studies that suggest you are what you consume in your diet regarding certain areas of health and – to some extent – fertility. Second, this is a cross-sectional study, whether it is a semen sample or dietary questionnaire is not level 1 evidence. In fact, the correlation between food frequency questionnaires and reality is still far apart. I do not remember what I ate yesterday, let alone months ago. Yet, the beauty of a large questionnaire and this study is that these snapshots might reveal a hidden general pattern or overall behavior that can provide some answers. I found it interesting that a higher percentage of men with a very low BMI were more likely to consume more saturated fat (seems counterintuitive, right?). Yet, men consuming more saturated fat were slightly more likely to smoke, drink more alcohol, report a sexually transmitted disease, consume more overall calories, eat more omega-6 fatty acids, and probably had less muscle mass. And, although the authors did adjust for most of these parameters in their study – which they believe makes the theory of saturated fat being a marker of unhealthy overall behavior less likely – I disagree (>30% of the saturated fat was coming from cheese and dairy products). There is a pattern of behavior to suggest a less healthy lifestyle in those who consume more saturated fat, which is similar to what has been found in many prostate cancer studies and cardiovascular reviews.(Reviewer–Mark Moyad, MD, MPH).
Although vasectomy reversal complications are rare, any surgery carries some degree of risk. Because vasectomy reversal is a longer and more complicated procedure than an original vasectomy, it has a greater chance of side effects.
In spite of the low risk factor, it is important to be aware of the potential complications associated with a vasectomy reversal. Before undergoing the surgery, ask a physician to go over these. Read More…