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Thoughts of a vasectomy reversal couple…

This week I don’t have to go into work. We had Christmas Eve and Christmas Day with the munchkins and then they headed to their mom’s house for a week. We picked them up Monday morning and we have them until Wednesday morning when they get dropped off at school. Our break routines are always […]

via It’s Our Year — Not the Average Mama

What does the vasectomy site look like at the time of a reversal?

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There are several things about the picture above. First of all, the vas deferens has been isolated and is ready to begin the vasectomy reversal procedure proper. There are basically three parts to a vasectomy reversal.

  1. First you have to dissect out the  vas deferens and identify the vasectomy site. In the case above this was easy. You see in the middle of the picture a conglomeration of clips which were used to do the vasectomy. I like it when clips have been used. The area is much easier to find and there is less damage to the vas deferens.
  2. Secondly, the vasectomy site is excised and fresh vascularized vas deferens are delineated and prepared to reconnect.
  3. Finally the actual reversal. The microscope is brought into the operative field and after having approximated the two ends…the reversal is performed under the microscope using microscopic suture, usually 12-14 on each side.

Another interesting finding in the above picture is the sperm granuloma. On the right side of the clips you see a bulge before the vas narrows. This finding is a positive sign of success and that the fluid will be favorable. In this case the vasectomy had been done 5 years previously and the fluid noted upon transection showed a mildly cloudy fluid which with microscopic evaluation showed whole sperm.

So even before the reversal procedure with the microscope even started there where several positive findings the will contribute to a reversal success and pregnancy.

Considering a vasectomy reversal? We do them all the time and the consultation is free. Make an appointment 24/7 by just leaving your number and we’ll contact you. 

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How long to pregnancy after vasectomy reversal?

From Vasectomy.com

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Although vasectomies should be viewed as a permanent form of birth control, there may be certain circumstances in which a man desires to have his vasectomy reversed. If this is the case, questions might arise about how long it takes for a vasectomy reversal to result in pregnancy.

There are no definitive answers. Research indicates that, if a reversal is successful, it can take anywhere from three months to several years for couples to get pregnant. Up to 75 percent of all vasectomy reversals ultimately lead to natural pregnancies, with over half occurring in the first two years.

However, there are several factors that impact whether conception will occur and how quickly:

  • Type of vasectomy reversal procedure: The type of vasectomy reversal procedure a man has will impact reversal success and pregnancy outcomes. Men who have a vasovasostomy — the shorter and simpler of the two types of reversal procedures — tend to have higher success rates than those who have undergone a vasoepididymostomy. The vasoepididymostomy is a more complicated procedure, and is performed when a surgeon believes that the vas deferens tube is blocked closer to the testicle, in a coiled part of the vas deferens known as the epididymis. Because patients who have had a vasoepididymostomy tend to have longer periods of impaired sperm motility, it tends to take longer for their partner to conceive.
  • Time since the vasectomy procedure: The amount of time between the original vasectomy procedure and the vasectomy reversal also affects the length of time it will take to conceive. In general, higher success rates have been reported when the reversal is performed closer to the original vasectomy procedure, especially if less than five years. After 10 years of a vasectomy, pressure within the vas deferens can cause a rupture or blockage in the epididymis. This blockage requires the micro-surgeon to perform a more difficult vas-to-epididymis reconstruction, which causes the success rate to decrease.
  • Maternal and Paternal Age: If a woman is over 35, her hormone levels and ovulation cycles may be harder to predict; if a man is over 50, the quality or concentration of his sperm may slightly decrease. Both of these can increase the amount of time to conception. Talk to your urologist about which alternative methods for conception, such as in vitro fertilization, might be an option.

What It Boils Down To

There is no perfect way to predict when, or if, a couple will be able to get pregnant after a vasectomy reversal. But talking to a doctor can help couples understand their own personal chances of success, which obstacles may stand in the way of conception, and whether a reversal is the right choice.

Reviewed December 4, 2012, by Larry Lipshultz, MD – Urologist

References:

Busato, W.F. (2009). Vasectomy reversal: A seven year experience. Urologia Internationalis, 82(2), 170-174.

Graham, S.D., & Keane, T.E. (2009). Glenn’s urologic surgery. Philadelphia, PA: Lippincott Williams and Wilkins.

Labrecque, M., Durfresne, C., Baone, M.A., & St-Hilaire, K. (2004). Vasectomy surgical techniques: A systematic review. BMC Medicine, 2, 21-32.

Palkhivala, A. (2006). Vasectomy reversal: Data point to choice of technique. Urology Times, 43(2), 23, 41.

Vasectomy Reversal-What a Woman Wants to Know.

From Vasectomy.com

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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?”

All women lose the ability to conceive by late middle age. Women over the age of 40 may experience difficulty conceiving with assisted reproductive techniques (ART).

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.

In Summary:

  • 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.

What to expect after a vasectomy reversal…is it like having a vasectomy?

From Vasectomy.com

What You Can Expect After a Vasectomy Reversal

Vasectomy reversals are longer and more complicated than the original vasectomy procedure. Because of that, recovery takes more time, although it is still fairly quick. In general, side effects after a reversal tend to be mild and disappear within a short period of time.

The First Few Days

During the first couple of days after surgery, you may experience slight swelling or bruising in the scrotum. In addition, the surgery and anesthesia could cause a headache, general pain, and nausea, among other short-lived side effects.

To soothe the scrotal area and help minimize swelling during the first few days, you’ll need to elevate your legs, stay off your feet, and use ice packs. You’ll need to avoid submerging the incision in water fort he first 48 hours after the procedure–showers after a day or so are just fine but avoid baths and swimming, both of which increase the risk of infection. Your surgeon will also give you a course of antibiotics to prevent infection.

Contact your doctor immediately if you have sudden chills or fever, swelling or pain that gets worse, or drainage from the site of surgery. These are all potential signs of infection.

The First Few Weeks

After a vasectomy reversal, you will gradually be able to return to your previous physical activities, typically over the course of three to four weeks.

Within a week or so you should be able to return to work and handle most of your normal routine, but you’ll want to avoid major physical activity for two to three weeks. This includes heavy lifting, working out, and excessive walking or driving.

You should also be able to resume sexual activity within two to three weeks; the procedure should have no effect on your sex drive nor your ability to have an erection or orgasm.

Pregnancy after Reversal

Your doctor will begin checking for the presence of sperm in your semen after one or two months, and will continue testing periodically until sperm have reached acceptable levels. It’s normal for sperm to take several months to appear in ejaculate, and it can sometimes take up to 15 months for them to return.

One way in which the success of a vasectomy reversal is measured is sperm count and sperm motility. Both of these may not return to a normal range for three to six months. Overall, 92 percent of vasectomy reversals result in sperm returning to the semen.

The ultimate test for whether a reversal has been successful, however, is pregnancy, which can sometimes occur as quickly as a few months after the procedure or as long as several years later. Roughly 30 to 60 percent of vasectomy reversals ultimately lead to natural pregnancies, and over half result in pregnancy within two years.

Reviewed November 19, 2012 by Sarah K. Girardi, MD – Urologist

References

van Dongen J, Tekle FB, van Roijen JH. Pregnancy rate after vasectomy reversal in a contemporary series: influence of smoking, semen quality and post-surgical use of assisted reproductive techniques. BJU Int. 2012; 110(4):562-7.

Michielsen D, Beerthuizen R. State-of-the art of non-hormonal methods of contraception: VI. Male sterilisation. Eur J Contracept Reprod Health Care. 2010 Apr;15(2):136-49.

Vasectomy reversal more cost effective than IVF?

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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.

Objective: To investigate and compare the economic impact of IVF versus vasectomy reversal for obstructive azoospermia over time using population data and analytic models. Continue reading Vasectomy reversal more cost effective than IVF?

Age of the female is important to vasectomy reversal success.

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Female Age >=40 Years Affects Pregnancy Success Following Vasectomy Reversal

Urology – October 30, 2007 – Vol. 23 – No. 06

A female partner’s age >=40 years should be considered part of the counseling for vasectomy reversals.

Article Reviewed: Effect of Female Partner Age on Pregnancy Rates after Vasectomy Reversal. Gerrard ER Jr, Sandlow JI, et al: Fertil Steril; 2007; 87 (June): 1340-1344.

Effect of Female Partner Age on Pregnancy Rates after Vasectomy Reversal.

Gerrard ER Jr, Sandlow JI, et al:
Fertil Steril; 2007; 87 (June): 1340-1344

Objective: To determine the effect of female age on pregnancy rates after vasectomy reversal. Design: Retrospective review of men undergoing vasectomy reversal performed by 3 urologic surgeons. Female partners were stratified by age. Participants: 294 men who underwent vasectomy reversal were included. Twenty-one of these men had a female partner aged 20 to 24 years, 80 had a partner aged 25 to 29 years, 117 had a partner 30 to 34 years, 62 had a partner 35 to 39 years old, and 14 of the men had a female partner >=40 years of age. Methods: Microscopic vasovasostomy or vasoepididymostomy was performed under general anesthesia. Pregnancy rates were stratified into the 5 female partner age groups and then collapsed into 2 groups consisting of female partners <40 years old and those >=40 years old. The two-group t test was then performed. The minimum follow-up was 12 months unless pregnancy occurred prior to that. Results: The obstructive interval, type of reversal, mean follow-up time, and patency rates (83% to 99%) were not significantly different when stratified by female age. Pregnancy rates were 14% to 67% and were not significantly different between the 5 female age groups. Stratification into 2 groups showed pregnancy rates with a female partner >=40 years of age were 14% versus 56% for partners <40 years old (P <0.04). Conclusions: A female partner >=40 years of age was a significant factor in pregnancy rates following vasectomy reversal. Reviewer’s Comments: This paper reiterates that it is important to counsel couples about the female partner’s age when discussing vasectomy reversals. This is particularly important in view of similar results in this age group with in vitro fertilization-intracytoplasmic sperm injection and sperm aspiration. One limitation of this study was the small group of cases (n=14) with a female partner >=40 years old. (Reviewer–Ajay K. Nangia, MBBS).

 

Having a microscopic vasectomy reversal will lower the chances of getting prostate cancer. True or false?

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Answer: False-The vasectomy did not increase the chance of prostate cancer in the first place.

Vasectomy Not Associated With Prostate Cancer

Urology – February 28, 2009 – Vol. 25 – No. 04

There is no association between prostate cancer and age at vasectomy or years since vasectomy.

Article Reviewed: Vasectomy and the Risk of Prostate Cancer. Holt SK, Salinas CA, Stanford JL: J Urol; 2008;180 (December): 2565-2568.

Background: The majority of the literature now has shown no association between vasectomy and prostate cancer. The effect of vasectomy on men with a family history of prostate cancer or on those who underwent a vasectomy at a young age or had an extended period of time since the procedure has been poorly studied due to small sample sizes and short study follow-up.

Objective: To assess the risk of prostate cancer in men by age and length of time to exposure from vasectomy to disease.

Design: Population-based, prostate cancer case-controlled study.

Participants: 1327 men aged 35 to 74 years residing in King County, Washington, with a diagnosis of prostate cancer.

Methods: Cases of prostate cancer were identified from the SEER database for this population. Structured in-person interviews were conducted. Eligible controls were identified by random digit telephone dialing. Analysis based on prostate cancer Gleason score and stage was performed. Analysis was also performed based on demographics, age, prostate cancer screening history (within the last 5 years), family history of prostate cancer, and vasectomy parameters.

Results: 1327 men were eligible for study from the SEER database; 1001 completed the personal questionnaire. In total, 1340 controls were identified, of which 942 were interviewed. The control population showed that men who had undergone vasectomy were older, white, married, non-smokers with higher income and education, and had undergone PSA screening. Of men with prostate cancer and controls, 36% had undergone a vasectomy. Mean number of years since vasectomy in cases and controls was 21.1 years. No significant association was seen between prostate cancer and vasectomy status, age at vasectomy, years since vasectomy, or year of vasectomy. There was no evidence of risk estimates across vasectomy parameters. Risk did not change if men with prostate cancer within 2 years of vasectomy and controls with no PSA screening within 5 years (n=136) were excluded.

Conclusions:

No association was found between prostate cancer and vasectomy, even in men who had a vasectomy performed at a young age or had an extended period of time since vasectomy.

Reviewer’s Comments: This paper is a well-conducted, large case-control study that answers the concern about possible limitations of previous work that reported the lack of association between prostate cancer and vasectomy. This criticism often indicated inadequate follow-up since vasectomy to make this claim. In this study, average time since vasectomy in cases of prostate cancer and controls was 21 years. Multiple variables were looked at including vasectomy in the face of prostate cancer family history and screening. This large study should end the criticism on previous work that did not answer the question of prostate cancer and time from vasectomy. (Reviewer–Ajay K. Nangia, MBBS).

$500.00 off vasectomy reversal-Schedule before 2017!

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Just call our vasectomy reversal coordinator and mention this post. She will schedule your reversal as soon as possible!  770-535-0001 ext 113 or kathy.burton@ngurology.com. 

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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 kathy.burton@ngurology.com is available to help with all things vasectomy reversal. CareCredit is an option for couples preferring to pay over time.