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.
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.
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).
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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 become an issue for the couple desiring a reversal in the male with one testicle. 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. Of note we often times give a price discount because we only have to one side.
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).
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
Under 3 years
Greater than 15 years
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).
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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 […]