Several times a month a patient, who has had a reversal, will drop off a specimen to see if there are any sperm present. This evaluation takes just a minute to do. If sperm is present it means that the reversal mechanically is open and has been successful. This evaluation however doesn’t count the sperm, that would require a full semen analysis which is done through the hospital lab and quantitates the actual number of sperm present.
For the purposes of seeing if the reversal “worked or not” the in office check for sperm is sufficient. If there are no sperm and it has been three months post reversal this may either means that reversal is not open but probably more likely that the testicles have not “picked up the ball” and started producing sperm yet. It can take four to twelve months for the sperm to be produced in numbers sufficient for conception. The time to producing sperm by the testicles post vasectomy is large part dependent on the interval between the vasectomy and the reversal.
It is always a “drum roll” moment when the specimen is dropped off for me to evaluate and always rewarding to see sperm moving about so excited to be set free and get to work.
The following is not a post reversal sample but it shows what you want to see in the ejaculate after a reversal. It is also interesting how the maker of the video created the project.
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There are several things about the picture above. First of all, the vas deferens has been isolated and is ready to begin the vasectomy reversal procedure proper. There are basically three parts to a vasectomy reversal.
First you have to dissect out the vas deferens and identify the vasectomy site. In the case above this was easy. You see in the middle of the picture a conglomeration of clips which were used to do the vasectomy. I like it when clips have been used. The area is much easier to find and there is less damage to the vas deferens.
Secondly, the vasectomy site is excised and fresh vascularized vas deferens are delineated and prepared to reconnect.
Finally the actual reversal. The microscope is brought into the operative field and after having approximated the two ends…the reversal is performed under the microscope using microscopic suture, usually 12-14 on each side.
Another interesting finding in the above picture is the sperm granuloma. On the right side of the clips you see a bulge before the vas narrows. This finding is a positive sign of success and that the fluid will be favorable. In this case the vasectomy had been done 5 years previously and the fluid noted upon transection showed a mildly cloudy fluid which with microscopic evaluation showed whole sperm.
So even before the reversal procedure with the microscope even started there where several positive findings the will contribute to a reversal success and pregnancy.
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The time from the vasectomy to the reversal is one of the most important factors in the reversal’s success.
The longer the interval the more effect of the vasectomy obstructing the natural course of things in the testicle has on sperm quality.
Determining how much negative effect has occurred as result of the vasectomy on the quality and quantity is variable and usually based on the time interval.
Assuming that because a vasectomy can potentially “shut down” production of normal sperm, the testicles, after a reversal, have to readjust and begin to produce sperm again.
The chart above shows the maturation of sperm in the testicle.
This process usually takes about three months.
So, if the testicles have stopped producing sperm and the obstruction of the vasectomy is corrected by the reversal, then it would take about three months for normal sperm to complete the maturation process and be seen in the ejaculate.
So this is why many reversal doctors tell their patients not to consider submitting a specimen for the presence of sperm after a reversal for at least 3-4 months.
It you submit a specimen at three months and there are no sperm, that is disappointing, but in many patients it may take up to a year for the testicles to resume their normal activity.
I have had patients with no sperm in the ejaculate at six months and achieved pregnancy at one year.