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Tallahassee FL | Why Don’t All Urologists Perform Microscopic Vasectomy Reversals

Georgia Vasectomy Reversal | Experience, Success and the Best All-Inclusive Price in the Southeast.

GA Vasectomy Reversal success baby with tongue out.

Microscopic Vasectomy Reversal Urologist | Surprisingly, few urologists perform vasectomy reversals and even fewer perform commonly.

In fact, it is rare for any urologist to perform vasectomy reversals on a weekly basis.

Why Is That?

  • There is a steep learning curve to master. A microscopic vasectomy reversal is difficult to perform.
  • The ability to provide the necessary components to perform microscopic vasectomies is expensive.
  • Very view of the patients who have a vasectomy want to reverse it (5%). Active reversal surgeons draw their patients from a large market area.
  • A reversal is not covered by insurance.
  • Success is not guaranteed.
  • Having to use a hospital increases the cost dramatically and performing in an office limits the type and level of anesthesia offered.
  • The procedure takes 2-4 hours to perform.
how-big-is-a-micron

Why is the skill in using an operating microscope and having an experienced surgeon reverse your vasectomy important?

Interestingly, the answer is complicated. Below detail several of the reasons. Notably, only 5% of the men who have had a vasectomy will desire to reverse it. As a result, this limits the number of patients who need a reversal. Furthermore, most urologists uncommonly see patients who need a reversal.

Additionally, insurance does not cover a vasectomy reversal. The surgeon offers a package plan for all of the costs involved. In other words, the surgeon coordinates, and pays the various entities necessay to perform a reversal.

Incidentally, Dr. McHugh utilizes an operating microscope and uses microscopic suture to join the very small openings. Additionally, he places 14-16 sutures in each vas deferens.

For example, the thickness of a strand of hair is 100 microns.

Moreover, the surgeon operates with suture measuring 70 – 100 microns. Therefore, the suture is about the diameter of the human hair.

Of note, the outside thickness of the vas deferens is about 2 mm. The lumen of the vas (the inner channel) averages about 5.6mm in diameter.

In addition, 500 microns is about the size of the opening in the vas deferens (.5mm).

As a matter of fact, the lumen of the vas deferens is approximately the size of the “O” in God on a penny.

Interestingly, Dr. McHugh places 14-16 microscopic sutures the size of hair to join a tube that is less than a millimeter in diameter.

Microscopic Vasectomy Reversal Urologist

Notably, surgeons use suture to close an incision of any common non-microscopic surgical procedure that is bigger than the tube in which sperm travels in the vas deferens. Hence, the necessity of microscopic suture.

In summary, reversal surgeons use very small sutures to connect very small openings. In other words, there has to be enough room after connecting the tubes for sperm to travel in their quest to achieve pregnancy.

drawing of sperm in the vas deferens

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Few Urologists Perform Microscopic Vasectomy Reversals | In short, the necessary components of a successful vasectomy reversal practice:

✅ Experienced and skilled microscopic surgeon. Dr. McHugh has performed hundreds of microscopic vasectomy reversals.

✅ Practice owned and nationally accredited surgery center. This assures safety, oversight and the ability to offer general anesthesia.

✅ Success. See some of our success stories.

✅ Acceptable all-inclusive price with no hidden fees. See breakdown of cost package.

✅ Board Certified: American Board of Urology.

✅ Experienced staff (R.N.s), operative microscope, microscopic instruments and sutures.

✅ Awarded “Best in Georgia.” Dr. McHugh is one of the southeast’s most experienced microscopic vasectomy reversal specialists.

✅ Performs vasectomy reversals on a regular basis. Dr. McHugh does two reversals each week.

Informative website with content written by Dr.McHugh based on personal experience and national studies. See In link bio|Dr. McHugh

✅ Free and convenient vasectomy reversal phone consultation.

Common Vasectomy Reversal Questions:

  • What is the success rate? This depends on the experience of the surgeon, the interval of time between the vasectomy and the reversal and the findings at the time of the surgery. The shorter the interval the better the chances of success.  Success rates-Click here.
  • How many microscopic vasectomy reversals has Dr. McHugh done? Thousand of procedures and hundreds of vasectomy reversals have been successfully performed in our accredited Urological Surgery Center.
  • What is the cost? Our fee is all-inclusive and “no hidden fees.” (Surgeon fee, Accredited Facility Expense, Anesthesia, R.N. nursing, Operative microscope, microscopic suture and… an experienced, skilled and pleasant staff.)
Dr. McHugh performing a microscopic vasectomy reversal in an operationg room.

In fact, Dr. McHugh performs two reversals every week in our practice owned and accredited surgery center.

  • Importantly, we perform microscopic vasectomy reversals on a weekly basis in our practice owned, accredited for general anesthesia and dedicated reversal facility.
  • Do you have a payment program? Yes, we are in network with CareCredit.com for this option.
  • Will I have any pain during the procedure? No, we provide anesthesia by a board certified anesthesiologist. Our safety record has been impeccable. The pain after the procedure is slightly more than you may have experienced during the vasectomy.
  • Is it like having a vasectomy? No, a vasectomy takes 15 minutes and done through a “size of rice” opening. A vasectomy reversal takes our team approximately 2 hours. As a result, one can expect a bit more swelling and bruising. “The procedure  involves the same tube… but it’s a different operation!”
  • Is the age of my wife important? Yes. Success rates begin to decline as the female’s age goes above 39. The male is less age dependent.
Ga Vasectomy reversal success baby sleeping on pillow.

What’s more, we include hotel accommodations in our all-inclusive cost.

  • What if I have to travel a long distance to go home? Most couples will arrive the day of the procedure and then spend the night afterwards in a local hotel.  Hotel accommodations if necessary is complimentary for one night. (As a rule, couples within a few hours drive from our facility prefer to go home after the procedure and this is acceptable.)
  • How long before I can drive?  Usually within a week.  If the surgery is on a Thursday, for instance, the longer you can be off your feet with the scrotum elevated the less swelling you will experience.  The complete healing doesn’t occur until around a month, but patients can be active but careful during that time. Tight compression exercise underwear is better than the traditional “jock support.”
Dr. McHugh holding sleeping and peaceful vasectomy reversal baby newborn

After the Vasectomy Reversal Common Questions

  • When can I resume sexual activity? In three weeks.
  • When can I return to work? Desk work, with caution and being careful, in one week. If one has a strenuous job usually three weeks, however a lot of patients go back in one week but they have made arrangements to gradually get back to their normal work routine. (With the help of their co-workers.)

Importantly, Patience is a virtue.

  • How long does it take for the testicles to produce sperm again? Usually 4-6 months depending on when the vasectomy was done. (The shorter the interval between the reversal and vasectomy, the sooner the vesicles begin to produce sperm.)
  • If pregnancy occurs, what is the most common time frame? 6-18 months. This is important to remember this as achieving pregnancy after a vasectomy reversal is a patient process.
Dr. McHugh Ga Vasectomy Reversal Success Baby Sleeping peacefully

Moreover, opportunities for earlier booking is often available for patients choosing to be added to our active waiting list.

  • Are birth defects more common after a vasectomy reversal?  No.
  • Which is better in vitro methods or a vasectomy reversal? This is a decision which the couple should research and based on what is best for them. Proponents of a reversal state cost, the ability to have more than one pregnancy, less requirements by the female, and a more streamlined process from the decision to having the procedure.
  • How soon can I schedule the procedure? It is unusual not to  be able to schedule within a 6-8 weeks of inquiring. Our practice owns our surgery center, so it is not uncommon to open another operative day and perform two reversals on the same day to accommodate demand. (We also have an active “Waiting list” for couples who want to have the procedure sooner and are zable to be available on short notice.)
Dr. McHugh Ga Vasectomy Reversal Success baby standing near bed

Importantly, in the vast majority of cases the pre-operative medical evaluation and consultation can be done over the phone.

  • Is it necessary to have an in person consultation visit? In most cases no. The anesthesia doctors do not require new blood work or EKG if the patient is less than 50 and not on certain medications. The only thing that can’t be done ahead of the procedure is the exam of the testicles.
  • Is there a safety risk of the procedure or of the anesthesia? It is rare to have any injury to the testicles. Infections are uncommon, bruising is  common. There is no change in the male sexuality. The anesthesia is very safe and to date we have had no issues/complication related to this. Our anesthesiologists are all certified. Our safety record has been impeccable since opening our facility in 2008.

In summary, the vasectomy reversal requires many components to come together for the desired outcome. The precious addition to your family.

Ga Vasectomy Reversal Success baby playing in in bathtub with toys.

Vasectomy Reversal-Does the type of vasectomy done matter?

A common question asked is whether the reversal will be harder if clips were used or if the patient was told by the urologist “I took out a section and burned it.”

In the vast majority of cases this has no influence on the microscopic vasectomy procedure.

The procedure is harder if both sides of the vasectomy were done in the vas deferens closest to the testicle-the convoluted vas. This area is smaller in diameter and not straight (convoluted) and this makes the repair a little harder.

Whether clips or burned, there is not difference in how difficult the reversal will be. Having had clips makes the area of the vasectomy easier to locate.

The amount of vas tube removed is usually not an issue unless there is a very large segment removed and this is customarily not done.

Of note, if you have had two vasectomies done, this could be an issue. If you had a complication after the vasectomy, say a large hematoma or infection that had to resolve or be operated on, these may affect the repair. On all unusual issues, be sure to make the reversal doctor aware.

 

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.

Predictive factors in sperm appearance after vasectomy reversal.

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Patient’s often ask, “What is your success rate?” The successful reversal is heavily influenced by the quality of the fluid at the testicular end at the time of the reversal and the time interval since the vasectomy. JM

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).

 

Can you achieve pregnancy after Vasectomy reversal and only one testicle?

Pregnancy with Vasectomy Reversal With One Testicle?

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Vasectomy Reversal Pregnancy with one testicle: The above logo is a microbrewery  company in our city and I thought the name lends itself to introduce this blog’s message. I should have been asked to be an investor!

Vasectomy Reversal Baby

Vasectomy Reversal Pregnancy with one testicle? Actually this question comes up often to the urologist. Patients lose a testicle for several reasons to include: chronic epididymitis, orchitis, undescended testicle, testicular cancer, trauma, and chronic pain. In the majority of cases having only one testicle does not affect fertility or male hormone production.

The reason we mention this here is that it does occasionally become an issue for the couple desiring a reversal. Can you reverse the vasectomy on one testicle and have success? Yes. Do you have a better chance of success after a reversal if you have two testicles? Yes.

Although the one testicle can produce the quality and quantity of sperm for pregnancy after a reversal, having two testicles results in a higher likelihood of success because there are two chances that the anastomosis (the repair of the vas deferens) remain open, two chances of having good fluid in the proximal (testicle side of the vas), and the benefit of two testicles contributing to the semen quality.

It is not unusual at the time of a reversal to have very good quality fluid on one side because of a sperm granuloma on that side, and on the other side the fluid is of poor quality i.e. cloudy with sperm parts and no whole sperm.

So…if we had our druthers, we’d want to begin with two testicles to work with, however it is reasonable to have a reversal if the patient only has one testicle.

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

See some of Dr. McHugh Vasectomy Reversal Success Stories!

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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).

 

Vasectomy Reversal success rates depend on several factors…and yes a little luck!

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From VasectomyMedical.com

Vasectomy Reversal Failure Rates and Success Rates Vary With:

  • The vasectomy reversal technique used.
  • The years between the vasectomy and the reversal attempt.
  • The experience and skill of the vasectomy reversal doctor.

Some of the best vasectomy reversal success rates reported in the literature for vasovasotomy are a patency rate of 99% with a pregnancy rate of 64%, not including couples where the woman was infertile. This means that in the hands of the surgeon who quoted these rates, he was able to restore sperm flow in the vas tube 99% of the time, and this allowed a pregnancy rate of 64%.

Not every time that sperm flow returns to the vas is pregnancy guaranteed. The expected vasectomy reversal success rates results for vasoepididymostomy in the hands of the same surgeon are lower, reportedly at 65% patency rate and a 41% pregnancy rate.

Factors influencing the success rate of reversal surgery include the following:

  • Time interval since vasectomy-The length of time passed since the vasectomy greatly impacts vasectomy reversal failure, as seen on this chart:
Years Between Vasectomy Sperm Return Pregnancy Rate
Under 3 years 97% 76%
3-8 years 88% 53%
9-14 years 79% 44%
Greater than 15 years 71% 30%

As previously noted, with longer intervals between vasectomy and reversal, there is an increased vasectomy reversal failure rate due to epididymal blockage as well as rupture and obstruction of the epididymal tubules.

  • Sperm granuloma-Sperm granulomas at the vasectomy site are a favorable prognostic sign and increase the likelihood of vasectomy reversal success.
  • Anti-sperm antibodies-Post-operative, sperm-bound antibodies result in a lower pregnancy rate or higher likelihood of vasectomy reversal failure.
  • Quality of vasal fluid-The vasal fluid quality is checked before a decision is made whether to proceed with a vasovasostomy versus vasoepididymostomy when reversing the vasectomy. If no sperm are present in the vasal fluid the gross appearance of the vasal fluid can help in determining between a vasovasostomy versus vasoepididymostomy. Cloudy, water soluble fluid indicates the best case for eventual return of sperm to the semen (higher vasectomy reversal success rate). Thick white greasy toothpaste-like material indicates the worst prognosis (a higher vasectomy reversal failure rate).
  • Microsurgical Vasectomy Reversal Technique-The vasectomy reversal technique and the doctor`s judgment and experience are important factors for success. Given that choosing the vasectomy reversal doctor is one of the few choices controlled by the patient, it may become an important factor in determining the vasectomy reversal success rate.
  • Associated conditions-Any condition that impairs sperm production for example a varicocele may lower postoperative pregnancy rates (increase vasectomy reversal failure rate).

A vasectomy reversal consult is free and easy to schedule 24/7. Leave your number below and we’ll call with an appointment.

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