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Georgia vasectomy reversal., No Needle No Scalpel Vasectomy

Myths about Vasectomy Reversal

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The following is from a vasectomy reversal doctor in England. The process is similar to but not exactly the same as at Georgia Vasectomy Reversal, however it is informative and adds to the data base of the couple contemplating a vasectomy reversal.

Vasectomy reversal myths debunked

If you decide to undergo a vasectomy reversal, having accurate information at your fingertips will ensure you are as informed as possible. Here are some of the most popular myths associated with reversing a vasectomy.

If you’re too old, you can’t have a vasectomy reversal

The reality is, a vasectomy reversal can be performed at any age, so long as an individual is healthy enough to undergo the treatment.

A vasectomy reversal rarely works after 10 years

This is a popular misconception and is based on outdated studies. Modern techniques used today have increased the vasectomy reversal success rate even if the original vasectomy was performed years ago. Even after about 20 years, you still stand an 84% chance of success following a vasectomy reversal.

Anti-sperm antibodies cause infertility even after a vasectomy reversal

It is widely believed that anti-sperm antibodies attack healthy sperm following a reversal and can cause infertility. In actual fact, antibodies are present in the blood and not in sperm following a vasectomy reversal, so are normally not responsible for any fertility problems that may arise following the procedure.

IVF is a better option than vasectomy reversal

You will need to weigh up the pros and cons of choosing IVF or vasectomy reversal, but there are many benefits to choosing reversing a vasectomy over IVF. For starters, a vasectomy reversal is a quick, single procedure that has good success rates, enabling you to conceive a baby naturally. In contrast, IVF is a gruelling process that often requires several attempts to increase the chance of success. The cost of a vasectomy reversal is also much lower compared to IVF procedures. Bear in mind also that there is a greater chance of multiple pregnancies when opting for IVF, so if you are only hoping for one baby, a vasectomy reversal is easily a better option.

Vasectomy reversal successes are the same whoever you choose

This is not the case at all. Doctors and standards vary, so if you want to achieve the best results possible choose a surgeon who is specialised in vasectomy reversal and has extensive experience. Mr Harriss has many years of experience and is available to answer any questions that you may have.

 

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FAQ-Vasectomy Reversal 101

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Articles addressing common questions regarding a vasectomy reversal.

A Microscopic Vasectomy Reversal Podcast by Dr. McHugh

If you prefer to read a PDF of Reversal 101

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Georgia vasectomy reversal., Microscopic Vasectomy Reversal, Reversing a vasectomy

Does prior sperm aspiration have a negative impact on vasectomy reversal?

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A lot of couples debate which of the two major methods of having a child after vasectomy they should pursue. Often times it is a decision based on cost. For that couple wanting to do IVF first, this study shows no significant scarring as a result of the aspiration and no significant negative effect to a successful vasectomy reversal.

Vasectomy Reversal Possible After PESA

Urology – July 30, 2008 – Vol. 24 – No. 07

Vasectomy reversal is possible after percutaneous sperm aspiration.

Article Reviewed: Results of Vasovasostomy or Vasoepididymostomy After Failed Percutaneous Epididymal Sperm Aspirations. Marmar JL, Sharlip I, Goldstein M: J Urol; 2008; 179 (April): 1506-1509.

Results of Vasovasostomy or Vasoepididymostomy After Failed Percutaneous Epididymal Sperm Aspirations.

Marmar JL, Sharlip I, Goldstein M:
J Urol; 2008; 179 (April): 1506-1509

Background: 4% to 6% of men consider having children after vasectomy. Choices are either vasectomy reversal or sperm aspiration for in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI). Percutaneous sperm aspiration (PESA) is one way for sperm retrieval, but the degree of epididymal damage is unknown. The request for microsurgical reconstruction after failed PESA is limited.

Objective: To investigate the ability to perform vasectomy reversal after failed PESA-IVF-ICSI. Design: Retrospective study involving a specialized subset of patients who requested and underwent a vasectomy reversal after PESA. Participants: 8 patients who failed 1 to 4 attempts at IVF-ICSI with sperm retrieved by PESA. Methods: Patients were identified from the records of 3 experienced infertility microsurgeons. The side of the PESA was determined. Vasovasostomy (VV) or vasoepididymostomy (VE) was performed based on standard of care–intraoperative fluid from the testicular end of the vas. Two-layer VV or end-to-side/2-stitch VE was performed. Postoperative semen analysis was performed at 3-month intervals. Results: All patients had bilateral PESAs performed. Of the 8 patients, 4 had no apparent abnormality to the caput of the epididymis, 2 had small blue cysts at the caput, and 2 had small areas (<0.5 cm) that appeared necrotic or ischemic. No specific puncture site for the PESA could be seen at the time of reconstruction. Ten of 16 vasal units had sperm in the testicular end of the vas at the time of vasectomy reversal. Six of 16 vasal units had pasty fluid and required VE, and 1 patient had a bilateral VE. The time from vasectomy was from 15 to 22 years. All patients postoperatively had sperm in the ejaculate from 1 to 200 million/cc, with 15% to 90% motility. Surgery resulted in 4 pregnancies leading to deliveries. Conclusions: PESA caused only limited trauma to the epididymis with 87.5% of patients able to have a vasovasostomy on at least one side. Vasoepididymostomy was more likely related to the duration from vasectomy than due to scarring from PESA. Reviewer’s Comments: This paper reports on an important question about a simple percutaneous procedure to retrieve sperm for IVF-ICSI. A select group of men will want to undergo vasectomy reversal after a failed IVF-ICSI cycle. This paper answers the concern about possible scarring from PESA–it does not appear to. The technique did not differ in outcome despite 3 different surgeons involved for both PESA and reversals. The study is, of course, limited by the small number, but this surgery is not performed very often. The ability to bypass/avoid scarring at the epididymis may be related to several ducts coming from the rete testes to become efferent ducts before becoming a single tubule. The caput is often the target for PESA; therefore, if any scarring occurs, then the other efferent ducts may provide sperm down the epididymis. (Reviewer–Ajay K. Nangia, MBBS).

 

 

Georgia vasectomy reversal., Microscopic Vasectomy Reversal, Reversing a vasectomy, vas reversal cost

Vasectomy Reversal-Age of the female is important.

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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).

Georgia vasectomy reversal.

Does the type of vasectomy performed affect the microscopic vasectomy reversal?

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No Sireee Bob!

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.

Georgia vasectomy reversal.

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? →

Georgia vasectomy reversal.

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).

Georgia vasectomy reversal., sperm granuloma and vasectomy reversal, What does a sperm granuloma look like during a vasectomy reversal

What does the vasectomy site look like when removed at a microscopic vasectomy reversal?

Vasectomy reversal: What is the significance of a sperm granuloma after vasectomy!

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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.

A sperm granuloma improves Vasectomy Reversal Success.

The presence of a sperm granuloma at the time of a vasectomy reversal is a good sign and improves the success rate by 5-10%.

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 commonly 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.

Some of Dr. McHugh’s Success Stores and Pictures

McHugh Vasectomy Reversal Success Stories
Dr. McHugh is Georgia’s most experienced vasectomy and microscopic vasectomy reversal urologist.

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Vasectomy Reversal Better With Same Partner as Prior to Vasectomy-Georgia Vasectomy Reversal

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If nothing else…this article is interesting. Although the most common cause of desiring a vasectomy reversal is a male who has had children and a vasectomy has remarried someone with no children. This study showed that %17 of the time a reversal is desired by a couple who have had a vasectomy and now desire more children. Their success rate is higher than if the male remarries and has a reversal.

Vasectomy Reversal Better With Same Partner as Prior to Vasectomy 

Urology – July 30, 2015 – Vol. 32 – No. 12

Vasectomy reversal success in regard to clinical pregnancy is improved if the patient has the same partner before and after vasectomy.

Article Reviewed: Higher Outcomes of Vasectomy Reversal in Men With the Same Female Partner as Before Vasectomy. Ostrowski KA, Polackwich AS, et al: J Urol; 2015;193 (January): 245-247.

Background: Vasectomy reversal is requested by around 6% of men who previously had undergone a vasectomy and desire subsequent fertility. Frequently, this is due to a new relationship; however, some couples desire another child or may have lost a child. Two small prior studies have suggested improved pregnancy rates following vasectomy reversal with the same partner as before vasectomy.

Objective: To determine if clinical pregnancy and birth rates are higher for men undergoing vasectomy reversal with the same female partner.

Design: Retrospective review of a prospectively collected database.

Methods: All patients from a single surgeon were reviewed from 1978 to 2011. Obstructive interval, surgery type, vasal fluid character, and sperm character were recorded. Men either self-reported pregnancy and birth rates or completed a survey response. All patients had at least 12 months of follow-up data.

Results: Over the time frame, 3135 men underwent vasectomy reversal; 17% (524 men) undergoing vasectomy reversal had the same female partner. A total of 258 (49%) responded to the survey, and 89% (229) underwent bilateral vasectomy reversal. The average patient and partner age was significantly higher in the same partner group compared to the new partner group, although the same partner group had a significantly shorter obstructive interval at 5.65 years versus 9.23 years. Overall, the clinical pregnancy rate for men with the same partner was 83% compared with 60% in men with a new partner. After regression, this maintained an odds ratio of 2 and was significant.

Conclusions: Men undergoing vasectomy reversal with the same partner experience a higher pregnancy rate compared men with a new partner.

Reviewer’s Comments: This article supports prior articles by Kolettis et al and Goldstein et al. The larger number of patients provides an excellent dataset even though it is a single surgeon. The success rates are substantially higher and maintain significance, even after controlling for ages and obstructive interval. It is also useful to have typical data of a 60% pregnancy rate for those with a new partner. Many patients are interested in “success” following surgery, and this is not solely a desire to have sperm return to the ejaculate. There are limitations, however, because the survey results were returned by only 49% of patients, leaving the potential for reporting bias. Overall, this information is useful when counseling patients with the same partner as prior to vasectomy.(Reviewer–Gregory Lowe, MD).

 

Author: Ostrowski KA, Polackwich AS, et al
Author Email: hedgesja@ohsu.edu
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The most cost effective vasectomy reversal in Georgia.

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Cost-Effectiveness Analysis of Vasovasostomy Techniques

Urology – September 30, 2016 – Vol. 34 – No. 7

The authors found decreased costs without compromises to surgical outcomes with the modified 1-layer vasovasostomy technique.

Article Reviewed: Comparative Cost-Effectiveness Analysis of Modified 1-Layer Versus Formal 2-Layer Vasovasostomy Technique. Nyame YA, Babbar P, et al: J Urol; 2016;195 (February): 434-438.

Continue reading The most cost effective vasectomy reversal in Georgia. →

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