Tag Archives: vasectomy reversal cost

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.

Age of the female is important to vasectomy reversal success.

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Female Age >=40 Years Affects Pregnancy Success Following Vasectomy Reversal

Urology – October 30, 2007 – Vol. 23 – No. 06

A female partner’s age >=40 years should be considered part of the counseling for vasectomy reversals.

Article Reviewed: Effect of Female Partner Age on Pregnancy Rates after Vasectomy Reversal. Gerrard ER Jr, Sandlow JI, et al: Fertil Steril; 2007; 87 (June): 1340-1344.

Effect of Female Partner Age on Pregnancy Rates after Vasectomy Reversal.

Gerrard ER Jr, Sandlow JI, et al:
Fertil Steril; 2007; 87 (June): 1340-1344

Objective: To determine the effect of female age on pregnancy rates after vasectomy reversal. Design: Retrospective review of men undergoing vasectomy reversal performed by 3 urologic surgeons. Female partners were stratified by age. Participants: 294 men who underwent vasectomy reversal were included. Twenty-one of these men had a female partner aged 20 to 24 years, 80 had a partner aged 25 to 29 years, 117 had a partner 30 to 34 years, 62 had a partner 35 to 39 years old, and 14 of the men had a female partner >=40 years of age. Methods: Microscopic vasovasostomy or vasoepididymostomy was performed under general anesthesia. Pregnancy rates were stratified into the 5 female partner age groups and then collapsed into 2 groups consisting of female partners <40 years old and those >=40 years old. The two-group t test was then performed. The minimum follow-up was 12 months unless pregnancy occurred prior to that. Results: The obstructive interval, type of reversal, mean follow-up time, and patency rates (83% to 99%) were not significantly different when stratified by female age. Pregnancy rates were 14% to 67% and were not significantly different between the 5 female age groups. Stratification into 2 groups showed pregnancy rates with a female partner >=40 years of age were 14% versus 56% for partners <40 years old (P <0.04). Conclusions: A female partner >=40 years of age was a significant factor in pregnancy rates following vasectomy reversal. Reviewer’s Comments: This paper reiterates that it is important to counsel couples about the female partner’s age when discussing vasectomy reversals. This is particularly important in view of similar results in this age group with in vitro fertilization-intracytoplasmic sperm injection and sperm aspiration. One limitation of this study was the small group of cases (n=14) with a female partner >=40 years old. (Reviewer–Ajay K. Nangia, MBBS).

 

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).

$500.00 off vasectomy reversal-Schedule before 2017!

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Just call our vasectomy reversal coordinator and mention this post. She will schedule your reversal as soon as possible!  770-535-0001 ext 113 or kathy.burton@ngurology.com. 

Our contact page.

Because a vasectomy reversal is usually not covered by insurance, the patient usually pays an all inclusive fee to the surgeon. This fee covers all of the components of having a surgical procedure such as:

  • The fee of the surgeon to perform the reversal.
  • The facility fee which includes the cost of the nurses and staffing, the facility (operating room), suture materials and the operating microscope, the anesthesiologist and the anesthesia supplies necessary to put a patient to sleep.
  • The cost of overnight accommodations (if necessary).

At Northeast Georgia Urological Associates our facility is accredited and owned by our practice which in turn allows our all inclusive fee to be much less than if a hospital were used. Our anesthesiologists are board certified as well as Dr. McHugh.

The all inclusive cost for a  microscopic vasectomy reversal at the Northeast Georgia Ambulatory Surgery Center is $6,500.00. After promotion- $6,000.00.

Kathy Burton 770.535.0001 ext 113 or kathy.burton@ngurology.com is available to help with all things vasectomy reversal. CareCredit is an option for couples preferring to pay over time.

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

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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.

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 always 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.

Post Vasectomy Pain Syndrome. Real? Will a vasectomy reversal help?

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Can There Be Complete Resolution of Pain for Men With PVPS?

One of the most complimentary letters I have ever received was from a patient on whom I performed a vasectomy reversal for relief of  chronic testicular pain which started after his vasectomy years previously. Go figure!

Urology – June 15, 2016 – Vol. 34 – No. 3

A subset of men have complete resolution of postvasectomy pain with vasectomy reversal. Most men have some improvement in pain scores with vasectomy reversal.

Article Reviewed: Vasectomy Reversal for Postvasectomy Pain Syndrome: A Study and Literature Review. Polackwich AS, Tadros NN, et al: Urology; 2015;86 (August): 269-272.

Background: Vasectomy is a common and effective procedure for sterility. Although complications are infrequent, postvasectomy pain syndrome (PVPS) does occur in some subset of patients. Most previous studies report that men who have PVPS do not generally seek additional medical treatment and have minimal affect on quality of life. However, a small subset has pain significant enough to require additional care and procedures.

Objective: To determine outcomes of vasectomy reversal (VR) for PVPS.

Design: Retrospective chart review.

Methods: A single surgeon series was reviewed for men who underwent VR for PVPS. Although there was not an algorithmic approach to preoperative pain management, patients were only considered for VR if they had worsening of pain with ejaculation or arousal. The location of vasectomy site along the vas deferens was recorded at time of the procedure in the operative note. Pain scores were evaluated with a non-validated questionnaire by recall.

Results: 31 patients from a pool of 123 potential patients were included. There was a 59% improvement in pain scores, with 34% of patients reporting a complete resolution of pain. Two patients required additional procedures for pain (epididymectomy and orchiectomy), and 84% of patients would recommend VR to a man with PVPS. There was no relationship between location of vasectomy and possibility of PVPS.

Conclusions: VR for PVPS demonstrated significant improvements in pain scores in this study.

Reviewer’s Comments: Although the questionnaire is non-validated and the pain scores are by recall, the fact that men generally reported an improvement in pain scores with VR is reassuring. As roughly one-third of men had total resolution of pain, there is likely an etiology of vasal obstruction leading to pain among these men. I have always wondered if some of the cases captured in studies looking at PVPS are really just the background of orchalgia in the population that we now attribute to the previous vasectomy. Considering how few men seek medical attention and undergo procedures for PVPS, I have always believed there is likely a group of men who have intermittent scrotal pain and a group who clearly have pain from vasectomy-induced obstruction. In their comments, the authors observe how patients seemed to group into complete (or almost complete) resolution of pain or minimal change in pain. As the authors were thoughtful by only considering men for reversal if they had pain with ejaculation or sexual stimulation, one would hope that this would only select men who truly have an obstruction-induced pain syndrome. This is a nice addition to the literature and does point out that there are some men who fully respond to reversal for PVPS. These men, however, may be difficult to identify preoperatively.(Reviewer–Charles Welliver, MD).

 

Tubal ligation vs. Vasectomy-which is more common?

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The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy.

Urology – April 30, 2016 – Vol. 34 – No. 1
Vasectomy is not associated with decreased frequency of sexual intercourse.
Article Reviewed: Relationship Between Vasectomy and Sexual Frequency. Guo DP, Lamberts RW, Eisenberg ML: J Sex Med; 2015;12 (September): 1905-1910.
Background: Men often report the concern that having a vasectomy will impair their future sexual function.

Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.

Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.

Continue reading Tubal ligation vs. Vasectomy-which is more common?

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

The Semen Analysis after a Vasectomy Reversal-Meaning.

Sperm-egg

I saw a patient recently on whom I performed a reversal around a year ago. He and his wife have not achieved pregnancy. He showed me the report of a semen analysis which showed around 50 million sperm with a motility of over 50%.  Although 60-150 million sperm is considered normal, most urologists feel that any count above 20 million is suitable to achieve pregnancy. Motility should be over 45% (i.e. 45% of the sperm under the microscope are observed to be moving forward).  Other parameters such as morphology (how the sperm look) are less important.

From the perspective of the surgeon who performed the procedure, any sperm in the ejaculate indicates that the reversal was successful and now it is up the the male to begin to produce the quality of sperm necessary to achieve pregnancy. As well, there is the added dynamics of the female ability to have a child. As a rule, when there is no pregnancy between a couple without the history of a vasectomy, the problem is about 50/50 male to female. The point is that even if the post reversal male has adequate sperm, pregnancy still requires other factors to be in place as well.

In the above scenario, the good sperm count and motility is a very good start and indicates a good reversal. And it makes the point about couples understanding the difference between patency (presence of sperm after a reversal) and pregnancy. There is usually a 10-15% differential between the two.

Pregnancy is a many splendored thing-Pregnancy after a reversal is a multi-factorial thing.