fbpx

Tag Archives: no scalpel vasectomy

No scalpel vasectomy overview.

Thank you for your interest in our practice regarding a no scalpel vasectomy.  Dr. McHugh is Georgia’s most experienced board certified urologist performing both vasectomies and microscopic vasectomy reversals.

Although vasectomies can be performed most any day of the week, our most common day is Friday. Scheduling a vasectomy is usually not a problem, as Friday is reserved all most exclusively for performing vasectomies.  Dr. McHugh performs  between 20-30 vasectomy a month and has done thousands during his career.

We accept most insurances and your cost is based on the allowable for your particular plan. We will assist in you estimating that amount before the procedure.

Our all-inclusive price for self pay patients is $950.00. (Consultation and the procedure.) For self pay  patients preferring conscious sedation in our on site accredited surgery center, the all inclusive fee is $1300.00. This is done with a board certified anesthesiologist.

For patients who prefer conscious sedation, this is available on Thursdays. We have a board certified anesthesiologist, an accredited surgery center and can assure you a safe, pain free and anxiety free experience.

Here are a few informative links to review:

Vasectomy eBook by Dr. McHugh

After the Vasectomy bullet points

A Vasectomy in pictures-YouTube  (Over 4000 views on YouTube!)

A Vasectomy in pictures-Website.

Website Vasectomy Page

A member of our team will be reaching out to you to answer any questions you may have and to schedule, if you like, a vasectomy consultation.

Thank you! We look forward to participating in your care.

John McHugh

Patrick Shelow
Patrick Shelow
30/07/2022
Really can’t speak highly enough about Dr. McHugh’s office. The procedure was very fast and Dr. McHugh explained everything he was doing which brought ease to the entire procedure. I typically have to tell doctors that I need more lidocaine and they brush me off until they can see the original shots did not work. Dr. McHugh took what I said seriously and even stopped to add more through the procedure. Was very nice to be listened to and taken seriously. Recovery has been easy with relatively no pain at all. Something that so many folks dread should take comfort in knowing you’re in good hands by having your procedure preformed in this office.
Zack Helm
Zack Helm
20/07/2022
I recently had a minor complication with a Vasectomy in Ohio and very little feedback from my doctor. I started googling my problem and found Dr. McHugh had graciously given feedback to folks who had the same problem I had across the county. I was so uncomfortable that I decided to give his office a call. His nurse Megan was extremely kind and offered me great advice. Dr. Mchugh even called personally and helped answer all my questions and looked at my test results. The Dr. gained no benefit from helping me at all and quite frankly could have ignored me. I'm so grateful I got to speak with him and would put my full confidence in him performing my vasectomy.
Erik B
Erik B
17/07/2022
Dr. McHugh and staff were Above and Beyond my expectations, Vasectomy was quick and painless and recovery with the provided “Instructions for after your Vasectomy” worked out well, only experienced some minor soreness that went away after the 2nd day. Thank you.
Pablo Mercado
Pablo Mercado
09/07/2022
Best experience! Would recommend it to any of my family or friends.
Austin Hicks
Austin Hicks
09/07/2022
Wonderful experience! Dr. McHugh is very professional and makes you feel at ease from beginning to end. I would recommend him and his team to anyone!
Nicholas Barnes
Nicholas Barnes
08/07/2022
My vasectomy reversal here was great. I'm only one day in but have had less swelling and pain than when I had the original vasectomy done. Thanks to Dr McHugh and all his amazing staff I have high hopes that even after almost 9 years, my reversal will be a success.
John Addington
John Addington
05/07/2022
Cody Batten
Cody Batten
04/06/2022
Autumn Febus
Autumn Febus
01/06/2022
Snip snip complete. My experience is one all should have (if you decide). Doctor and staff was very professional. Way easier than what I was expecting. I cannot express my thanks for how I was cared for the whole time. Highly recommend !
Kevin Wright
Kevin Wright
21/05/2022

Review - 1 - Social Post

Brightest Vasectomy in the sky?

Most casual observers will think of the North Star as the brightest star, in fact it is Sirius. (The North Star is known for its dependable location in the sky, not its brightness.)

According to Greek mythology, Sirius was the dog of the hunter Orion, and the ancient Romans placed the star in the constellation Canis Major (Latin for “Greater Dog”). The Romans thus referred to the sweltering period when the rising of the sun and Sirius converged as the “dies caniculares” or “days of the dog star.”

By the 1500s, the English world began to call the same summertime point on the astronomical calendar as the “dog days.”

Check out our free eBook on: Everything you’d want to know about “the brightest” no scalpel vasectomy in Georgia.

Dr. McHugh is Georgia’s most experienced no scalpel and microscopic vasectomy reversal urologist. 

Will the Vasectomy Reversal procedure be like my Vasectomy?

A vasectomy takes about 15 minutes and I do them through a single “size of a grain of rice” opening.

A reversal, in my hands, takes about two hours and more commonly uses two incisions (3/4 inch on each side of the upper scrotum over the course of the vas deferens) and requires an operating microscope and microscopic suture.

I tell patients that it is a minor procedure, minimal blood loss or other complications, but it does take two hours to do. Bruising and some scrotal swelling is more common and there is a longer recovery period.

So…to the question…same structure (the vas deferens) different procedure.

Is it worth driving from Atlanta to Gainesville for a vasectomy? You bet!

best of hall logo

No Pain – More Gain!!! 

  • Fair Self Pay Pricing.
  • Pre-Vasectomy medication for pain and anxiety.
  • Dr. McHugh is one of Georgia’s most experienced urologists performing vasectomies and microscopic vasectomy reversals.
  • Conscious sedation in our Ambulatory Surgery Center with an anesthesiologist- i.e No Pain.
  • In most cases (whether you have insurance or not) the cost is the same as if you had a vasectomy in an office setting. 
  • How is it the same price? We waive the facility fees for vasectomies.
  • This means-No Pain – To you or…your pocketbook.
  • Oh yea…Dr. McHugh’s free Ebook on Vasectomy-Click here.

a healthgrade image

Anesthesia in an accredited surgery center, no pain vasectomy, essentially the same price as in an office, and 30 years of experience makes the decision to drive 45 minutes to Gainesville for a vasectomy…a no brainer.

Contact us or use the form below to make an appointment 24/7. A pre-vasectomy consultation is preferred, however to make the Atlanta to Gainesville vasectomy even easier, ask about the same day consult/vasectomy option with our vasectomy coordinator.

Reversal: Does it matter which type of vasectomy was done?

img_0427

In the big scheme of things nope! However the picture shown above the vasectomy was done with clips. For the reversal surgeon this type of vasectomy is the easiest to find and usually is associated with a smaller segment to remove.

When the vasectomy has been done with fulguration alone (burning the inside of the severed vas) it be hard to find the actual site of the vasectomy. The defect is sometimes so small that the entire vas tube appears as if nothing has been done.

If a sperm granuloma has formed this is very easy to find and is a positive thing as the fluid is much better in this case.

Finally, a vasectomy should only be done if the couple is wanting “permanent” birth control. So a urologist doing a vasectomy in a way to make a reversal easier in my opinion is not the right attitude for either the patient or the doctor.

Vasectomy Reversal Success Depends on Three Big Things…Read On!

IMG_3116

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).

 

If it was easy to get pregnant before the vasectomy…will it be easy to get pregnant after the reversal? Well…it depends.

img_0421

So…I hike a trail most every evening after work and on the weekends that takes about an hour. My vasectomy reversal coordinator Kathy get several calls a day about scheduling either a reversal or a free consultation about arranging for a reversal. Many of our patient live a long way away and ask, “Can I speak to the doctor by phone?”

Kathy routinely says, “Can he call you between 5 and 6 tonight?”

The interested couple most commonly says, “Yes. Perfect.”

So last night Kathy gives me two people to call who have an interest in reversing their vasectomy. The second patient I call asked the question, “My wife and I got pregnant very quickly. I mean one the first try. Does this mean that we’ll get pregnant just as quickly after the reversal?”

Good question and very similar to this common question, “Will the reversal surgery be like the vasectomy?”

Regarding the latter, the reversal takes approximately two and half hours, a vasectomy less than 15 minutes. So no a vasectomy is not like a reversal.

Regarding the former question: the issue is not that you and your partner are very fertile, the success of the reversal depends on the experience of the surgeon and the time interval since the vasectomy.

The perfect scenario? A short time since the vasectomy and a urologist who does reversals microscopically often. It does not hurt that the wife was fertile, that is good. For the male however the production of good sperm suitable for pregnancy decrease as time elapses since the vasectomy.

It was a good question and I hope this helps you understand the nuances of a microscopic vasectomy reversal. You might check out this internal site link.

Success rates.

Reversal consults are free. Leave a number or email and we’ll schedule an in office consultation or Dr. McHugh will call you while on his walk!

ICSI vs. Vasectomy Reversal in men with prolonged interval since vasectomy?

Even after prolonged obstructive intervals of 15 to 20 years, vasectomy reversal offers better or comparable success rates to intracytoplasmic sperm injection.

Article Reviewed: Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years. Kolettis PN, Sabanegh ES, et al: Urology 2002; 60 (November): 885-888.

Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years.

Kolettis PN, Sabanegh ES, et al:
Urology 2002; 60 (November): 885-888Objective: To determine the outcomes for vasectomy reversal performed after at least 10 years of obstruction. Methods: 74 vasectomy reversal procedures were performed in 70 patients after obstructive intervals of 10 to 24 years (mean, 14.5 years). These patients were retrospectively reviewed for patency and pregnancy rates. Results: The overall pregnancy rate was 37%. Patency rates for an obstructive interval of 10 to 15 years, 16 to 19 years, and >=20 years were 74%, 87%, and 75%, respectively. Pregnancy rates for these same periods were 40%, 36%, and 27%, respectively. Assuming a live delivery rate per cycle of 25% for intracytoplasmic sperm injection (ICSI), the delivery rate for vasectomy reversal would not be exceeded until an obstructive interval of at least 20 years.

Conclusions: The authors believe that even after prolonged obstructed intervals, vasectomy reversal offers better or comparable success rates to ICSI. Depending on their success rates at various medical centers, a threshold obstructive interval probably exists at which ICSI surpasses vasectomy reversal.

Reviewer’s Comments: This is, in my opinion, a clinically worthwhile paper. It clearly shows the pregnancy and delivery rates in patients who have undergone vasectomy reversal surpass the historical success rates of ICSI even after prolonged obstructive intervals. In addition, vasectomy reversal avoids the complication associated with multiple births, which is commonly seen after ICSI and is cheaper. In summary, even in patients with prolonged obstructive intervals after vasectomy, vasectomy reversal is probably more effective, cheaper, and less complicated than is ICSI. (Reviewer-George S. Benson, MD).

Additional Keywords: 10 infertility interval reversal vasectomy

Reprints: Division of Urology; University of Alabama at Birmingham; 1530 3rd Ave S, MEB 606; Birmingham, AL 35294-3296 (Peter N. Kolettis, MD).

 

What is the effect of a vasectomy on the male? All you’d ever want to know.

135449-004-F2AB0A3F

From: Spermatogenesis. 2012 Oct 1; 2(4): 273–278.

Effects of Vasectomy and Vasectomy Reversal in Humans

Vasectomy is performed by transection of the vas deferens with suture, clips, cautery or a combination of these in the scrotal portion of the vas. This transection disrupts the mucosal, muscular, and adventitial components of the vas deferens, including the autonomic nerves that mediate vasal secretory function and peristalsis. Vasal obstruction results in increased intraluminal pressures within the testicular remnant of the vas deferens. The increased pressure may have physiologic effects on epithelial cell morphology, cellular ultrastructure, and gene expression in the vas deferens and epididymis. Moreover, sperm cannot traverse the intentionally obstructed vasal lumen, and as such they accumulate and die within the testicular remnant of the vas deferens and the epididymis. A resultant local inflammatory response occurs in reaction to dying sperm, which has significant downstream sequelae, including a systemic cellular and humoral immunologic response that may impair testicular and sperm function.The clinical importance of this response is not clear in humans. Vasal transection and occlusion cause significant, independent pathophysiologic sequelae that may or may not be reversible by microsurgical bypass of vasal and/or epididymal obstruction during vasectomy reversal in humans.

Perhaps the most relevant study on the effects of vasal transection during vasectomy on vasal innervation was conducted by Dixon et al. in 1987.8 This group utilized immunohistochemical staining and electron microscopy to evaluate the intramural autonomic innervation of the human vas deferens after vasectomy. Vasal segments were harvested during vasectomy reversal and compared with nonobstructed vasal segments acquired at the time of initial vasectomy. They found that there were marked decreases in the noradrenergic innervation of the testicular vasal remnants in previously vasectomized men. These findings imply that vasal peristalsis, which is mediated by sympathetic autonomic activity, may be irreversibly impaired after vasectomy unless significant regeneration of autonomic nerve fibers occurs in the months and years following vasectomy reversal. Unfortunately, no studies have adequately assessed the regenerative capacity of vasal intramural nerves in humans after vasovasostomy or vasoepididymostomy.

Despite the paucity of anatomic and histologic data in the literature concerning vasal nerve recovery after vasectomy reversal, a study by Shafik et al. did provide further insight regarding vasal autonomic nerve function after vasectomy and vasectomy reversal.9 Shafik utilized transcutaneous electrovasography (EVG) to record the velocity, frequency and amplitude of nerve conduction in the vas deferens in 22 healthy men, 20 vasectomized men, and 18 men after vasectomy reversal. In normal, fertile men there was minimal temporal or individual variability in vasal conduction frequency, amplitude and velocity. In contrast, vasectomized patients exhibited lower conduction frequency and amplitude in the testicular vasal remnant and irregular, described as aberrant “vasoarrhythmic” conduction patterns. One to seven years after vasectomy reversal 7 of 22 patients had successfully conceived. Interestingly, 4 of these 7 patients had a normal electrovasographic evaluation during follow-up while 3 had decreased conduction frequencies and amplitudes but did not exhibit any vasoarrhythmia. This is in contrast to the 11 patients who failed to conceive, all of whom demonstrated electrovasographic evidence of vasoarrhythmia. Notably, the likelihood of abnormal vasal conduction studies was correlated with the interval of vasal obstruction prior to vasectomy reversal. This study suggests that nerve conduction recovery may be variable after vasectomy reversal, and seems to depend upon the interval of vasal obstruction.

Significant changes also occur in epithelial cell ultra-structure within the vas deferens after vasectomy, most of which are thought to result from changes in the intraluminal pressure after vasal ligation (increased pressure in the testicular vasal remnant and decreased pressure in the abdominal vasal remnant). Andonian et al. documented this phenomenon by comparing the ultra-structural features of the abdominal and testicular vasal remnants after vasectomy (harvested at the time of vasectomy reversal) to vasal segments harvested from fertile men undergoing vasectomy.10 Transmission electron microscopic analysis of vasal segments from healthy fertile men revealed the presence of many apical cytoplasmic protrusions from epithelial principle cells into the vasal lumen. Some of these protrusions remained attached to the principle cells by a stalk, whereas others were self-contained within the lumen of the vas deferens, suggesting a secretory process. The cytoplasmic protrusions, termed “apical blebs,” contain ribosomes and endoplasmic reticulum. Interestingly, these investigators observed a marked reduction in the number of apical blebs within the testicular remnants of the vas deferens in vasectomized patients undergoing vasectomy reversal. In addition, they observed dramatic luminal narrowing, epithelial cell flattening, reduction in organelle density, and absence of apical blebs on the abdominal vasal remnant. These findings are suggestive of de-differentiation of vasal epithelium within the abdominal vasal remnant in the absence of contact with seminal plasma. Whether or not these ultra-structural changes are clinically relevant and reversible with vasovasostomy or vasoepididymostomy remains to be determined.

Morphological changes are also apparent in the human epididymides after vasectomy. Older studies of cellular morphology and ultra-structure in the epididymides of vasectomized animals have demonstrated vacuolization and increases in the number and size of lysosomes within epididymal epithelial cells11,12 as well as segmental thinning of the epithelial lining of the vas deferens and epididymis near sites of luminal distension.13 In humans, dilatation of the entire epididymal tubule has been documented, with the most pronounced increase in luminal diameter noted in the cauda. Moreover, the height of the epididymal epithelium is altered by vasectomy. In normal men, maximal epididymal height occurs in the corpus of the epididymis. After vasectomy, however, the maximal height of the epididymal epithelium occurs in the caput.14 Alternations in the height of the epithelial cell layer in the epididymis after vasectomy suggest the presence of complex molecular biological effects of vasectomy on gene expression, as epithelial cellular volume and height are thought to be indicative of underlying RNA translational and protein secretory activities.

Indeed, recent analyses of the human epididymal transcriptome using microarrays have confirmed that vasectomy causes significant alterations in epididymal gene expression. Sullivan et al. characterized the epididymal transcriptomes within each region of the epididymis in both normal and vasectomized men.15Cluster analysis of nearly 3000 genes demonstrated that expression of 1363 genes did not differ based on vasectomy status, whereas 911 genes were expressed only in normal epididymides, and 660 genes were only expressed after vasectomy. Interestingly, three of the differentially expressed genes have well-established roles in sperm maturation during epididymal transit (NPC2, CRISP1, and DCXL).

Unfortunately, no studies have directly examined the impact of vasectomy reversal on gene expression in epididymal fluid or tissue, as the only candidates for such a study would be the rare patients who desire a vasectomy subsequent to successful vasectomy reversal. However, RNA and protein detection studies in semen after vasectomy reversals have suggested that some of the alterations in epididymal gene expression that result from vasectomy may not be reversible.15 The clinical significance of such studies remains to be determined.

Vasectomy with subsequent vasectomy reversal may also be associated with detectable alterations in sperm DNA integrity. Sperm DNA integrity testing has emerged as a valuable measure of sperm quality that is predictive of natural conception, pregnancy outcomes after intrauterine insemination, and pregnancy loss after in vitro fertilization cycles.16,17 The most commonly utilized assay is the sperm chromatin structure assay (SCSA), which is a flow cytometric method that sorts sperm according to their susceptibility to DNA strand breaks upon exposure to a denaturant.

A study by Smit et al. sperm looked at DNA fragmentation with the SCSA in ejaculated semen after vasectomy reversal in 70 men. They demonstrated that sperm DNA fragmentation was increased in the vasectomy reversal patients when compared with proven fertile controls (30% vs. 15%, p < 0.001). The increase in sperm DNA fragmentation was correlated with lower sperm concentrations, lower sperm motility, and a lower percentage of morphologically normal sperm.18 Interestingly, however, there was no relationship between sperm DNA fragmentation and the likelihood of pregnancy after vasectomy reversal. Though the clinical significance of sperm DNA integrity testing after vasectomy reversal remains unclear, this supports the notion that vasectomy likely causes a myriad of molecular biological sequelae, including sperm DNA damage, which may be irreversible in some cases.

Other factors have been isolated and suggested to be associated with infertility after vasectomy reversal, including antisperm antibodies,19,20 granuloma formation21and persistent mechanical partial obstruction,22which may occur despite partial patency and sperm in the ejaculate. Epididymal function, as discussed above, has been widely studied, as has epididymal dysfunction, which is believed by many to be one of the major factors contributing to infertility after vasectomy reversal when post-surgical patency has been established by demonstrating sperm in the ejaculate. Proteins isolated in epididymal fluid harvested at the time of vasectomy reversal, such as GTPase proteins in the Ras/RAB family and Syntenins, likely play a critical in sperm maturation23 and irreversible changes in protein synthesis despite microsurgical vasovasostomy or vasoepididymostomy may play a large role in infertility despite patency after vasectomy reversal.24,25

Myths about Vasectomy Reversal

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.

 

Helping couples achieve the new addition to their lives with microscopic vasectomy reversal.

Call Now Button
%d bloggers like this: