A common question for the couple having had a microscopic vasectomy reversal is, “When should we check for the presence of sperm?” (As discussed elsewhere this will tell you two things: one that the testicles are now producing sperm and that the vas deferens is open i.e. the repair was successful.)
Although is a patient who had a vasectomy a relatively short time before the reversal may have sperm on the first ejaculate, the most fruitful time to check for sperm is in the three to four month range. In some it may take longer than that. The time frame depends on the time between the vasectomy and the reversal with the longer time interval resulting in a longer time for sperm to return.
Because most of our patients are from out of town, we often get calls as to how they check for the presence of sperm without having to come back to Gainesville. The two options would be to submit a specimen to the local hospital lab to be examined under a microscope which can quickly and easily be done but at some expense or a couple could use the kit provided by spermcheck.com. This kit has become a nice alternative to the post vasectomy patient who wants to assure sterility but would prefer not to have to give a specimen and then take it to the doctors office to be examined.
Even though the kit is to check for successful vasectomy, the presence of sperm for the post reversal patient would indicate things are on the right path to pregnancy. It would not indicate a specific number just presence or absence of sperm. A formal semen analysis would be required for the sperm parameters of count and motility. The minimum number of sperm to achieve pregnancy is usually 20 million with at least 40% having good forward motility.
This video is actually a nice primer to microscopic vasectomy reversal giving the patient an idea of what things look like during the procedure. Reminds me of listening to a Beatle interview back in the day.
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.
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!
Marly and Robert Kapish
I have done over a thousand vasectomies and to my knowledge have not seen this syndrome in my practice.
Having said that, I do believe this malady does exist. But here is the thing, when a patient has a vasectomy reversal to alleviate the pain, it may not be the reversal per se that makes the pain go away.
I recently did a vasectomy reversal on a patient that wanted the procedure to have another child. He did, however, mention that he was told that clips were used for his vasectomy and that he had had pain in the right testicle since the procedure. At the time of the reversal on the right side I found a sperm granuloma (an inflammatory mass in the area of the vasectomy as a result of the body’s attempt to correct the trauma of the surgery and response to sperm which the body views as a foreign body) and marked surrounding inflammatory changes. There were clips noted and dissecting the granuloma out, cleaning the two ends of the vas and removing the “inflammatory glob” was more difficult than the usual dissection. So at the end of the reversal on the right side the patient had the granuloma removed and pristine ends of the vas reconnected with microscopic suture.
It is too early to say if the reversal in terms of pregnancy and patency was successful. But what if his right testicular pain goes away? Maybe it is the removal of the sperm granuloma and not reconstituting the vas. In other words a vasectomy reversal done of post vasectomy pain syndrome that is successful, might have been because of removing the scar tissue and not the reversal.
I had a reversal patient several months ago tell me as he was leaving our surgery center that the primary reason for having the reversal was for pain and not children. He failed to tell me that preoperatively and if he had I would have discouraged having a reversal for that purpose alone. (Surgeon’s rule number one: Don’t operate on folks for pain.) As it turned out, he wrote me a note complimenting my staff at our surgery center and that he was very pleased with the results, i.e. no more pain not that there was a pregnancy.
In summary, there may be something to having a reversal to alleviate chronic post vasectomy pain but it may have more to do with removing the sperm granuloma and inflammatory tissue than restoring the flow of sperm.
As most of our microscopic reversal patients are from out of town, we offer free accommodations at Gainesville’s Holiday Inn-Lanier Centre. This hotel is less than two miles from our surgery center and depending on the travel needs of the patient, we can reserve a room the night before or after the procedure.
Considering the time, expense and emotions involved with having any surgical procedure, we are happy to offer this small convenience to our out of town patients. At scheduling, Kathy (ext. 113) will happily arrange for you.
If you are considering a vasectomy reversal, even if you are unsure who you will choose to perform it, it is a good idea to have a preoperative consultation. You can ask the pressing questions that concern you, you can get a concept of the procedure, the time it will take, the cost, and as a result of the exam of the previous vasectomy site-you will know if there are any contraindications for the procedure pertinent to you. It is also an opportunity to get to know the physician that may be doing the procedure.
The reason it is not unusual for a consultation to be free for reversals is that the visit and the subsequent procedure is usually not covered by insurance. The free consultation is beneficial to both parties and by being at no cost encourages the couple to take that”first step” to the journey of having another baby.
Gainesville Urologist Provides Unique Niche for Microscopic Vasectomy Reversal Surgery in Northeast Georgia.
Northeast Georgia Urologist John McHugh M.D. is one of a small number of urologists in Georgia who performs the Microscopic Vasectomy Reversal routinely.
“Naomi Aria Polk was born 12 months after having my surgery, & we couldn’t be happier with our newest addition!” Reginald Polk
Only a small percentage of urologists both perform this procedure at an acceptable cost and have the experience to assure optimal results.
Gainesville, Georgia (PRWEB)
Community urologist John McHugh routinely performs a procedure that most urologists don’t do at all. Although the concept of a vasectomy reversal (removing the vasectomy site scar and reattaching the vas tubes) is simple, the actual performance of the procedure is not. Two issues make a vasectomy reversal unique compared to other procedures that the urologist performs: one the number of couples who desire a reversal is only six percent of those who have had a vasectomy and as a result the number of potential reversals for the average practicing urologist is small, two the procedure involves microscopic suture and use of the operating microscope and as a result there is a steep learning curve. These two factors contribute to the fact that very few urologists perform vasectomy reversals and fewer yet perform it frequently to do it well. Although pregnancy after a reversal is multifactorial it all begins with the quality of the joining of the two ends of the vas deferens in a tension free and watertight fashion and this in turn highlights the importance of an experienced surgeon.
“Although I have done reversals for over twenty-five years, the opening our Urological Ambulatory Surgery Center in 2009 has added the dimension of making the procedure more cost effective and efficient for the patient. We have the same suture, operating microscope, microscopic instrumentation and staff without the expense of the hospital,” says Dr. McHugh.
Dr. McHugh performs the procedure using a modified two layer anastomosis using microscopic suture, a Zeiss operating microscope with anesthesia provided by a Board Certified Anesthesiologist. His surgery center is accredited adding safety of the patient to the benefits the reversal he performs.
“Few urologists perform microscopic vasectomy reversals routinely because the number of patients who desire it is small. If you add to this the cost of having it performed in a hospital and the fact that the procedure is not covered by insurance, you can see how the patients become very selective. In addition, the patient must undergo the expense and inconvenience of this procedure and rightfully wants the best chance of pregnancy. Few urologists meet the criteria of providing both acceptable cost and the experience to assure optimal results,” adds Dr. McHugh.
Dr. McHugh uses a technique in which the tube inside each vas deferens is joined by using six 9-0 microscopic sutures, which are smaller than a hair in diameter, making the use of a microscope a necessity. The outer layer is then joined with additional sutures assuring a watertight connection.
The procedure involves two small upper scrotal incisions and takes between two and half and three hours to perform. Success of the procedure is affected by the length of time between the procedure and when the vasectomy was done. Historical data regarding success rates depending on when the vasectomy was performed is on the reversal page of his practice website-ngurology.com.
Dr. McHugh offers a free consultation to couples considering having a vasectomy reversal and complimentary hotel accommodations for out of town patients who desire it.
“The microscopic vasectomy reversal has become for me the most enjoyable and rewarding procedure I perform as a urologist.” – Dr. John McHugh
Dr. McHugh has written several books available on Amazon and has practiced urology in Gainesville, Georgia for twenty nine years. His interests include history, writing, dogs, water and fishing.