Tag Archives: vasectomy reversal

Did you know this about vasectomies?

About 500,000 vasectomies are performed each year in the U.S. Although the procedure is cheaper, faster, safer, and more reliable than female sterilization (1 pregnancy in 100), only 9% of sexually active men in the United States get vasectomies, while 27% of women get tubal ligations.

A good reason why you shouldn’t have a vasectomy.

“It can be reversed, right?”

Well, yes. However, just because you can reverse a vasectomy, doesn’t mean that you will achieve pregnancy.

I have done several thousand vasectomies and  several hundred microscopic vasectomy reversals, so…here are some things to consider “before” you decide to have a vasectomy.

  • We tell patients that they should consider a vasectomy permanent and it is…and it isn’t. It can be reversed but it doing so may or may not result in pregnancy.
  • A reversal is not covered by insurance and costs range between $3,000- $15,000.
  • It is a surgery, there will be an incision on the scrotal area that has to heal and there may or may not be time out of work or cessation of physical activities for a few weeks.
  • If it works, i.e. the opening is reconnected and sperm begins to flow again in the ejaculate, there may not be numbers or quality enough to achieve pregnancy.
  • It is a patient endeavor as it takes 3-6 months for the testicles to begin producing sperm again normally and if pregnancy occurs it usually does between 6-18 months.
  • The longer the period between the vasectomy and the reversal, the lower the chances of success.  Click here for success rates based on the vasectomy interval.
  • One must visualize how it would feel to have gone through the surgery, the recovery, and the expense only to be on the side of the percentages where pregnancy does not occur.

So…you don’t want to have a vasectomy unless you are pretty darn sure you don’t want to have any more children. An option is to bank sperm before the vasectomy. This costs about $200 a year.

Conclusion: If you think there is any possibility that you might want to have more children do not have vasectomy. Depending on a reversal, even in the best scenario of surgeon and time interval from the vasectomy, is a risky endeavor.

On the flip side: If you have had a vasectomy, the chances of achieving pregnancy is essentially zero.  In this setting having a reversal is very reasonable as any chance at pregnancy with a reversal is better than no chance. This is the reasoning most couples have when deciding to pursue a reversal.

Two interesting things about having a vasectomy.

 

First interesting thing: Getting an infection is uncommon. Most urologists do not place a suture in the small opening necessary for doing the procedure and this may be protective.

Second interesting thing: If there is a sperm granuloma or some swelling or tenderness under the scrotal skin, it usually resolves on its own and…is it almost always just on one side. In my experience it is rare to have an issue with both sides of the procedure. Each side is independent of the other. Go figure!

More questions? Go to the vasectomy page and read the eBook.

Common “myth” about having a vasectomy.

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Myth: There will be no ejaculation after a vasectomy.

Truth: 90% or more of the ejaculate comes from the prostate. Only a small percentage is sperm. So having a vasectomy will not result in any noticeable change in the volume of the ejaculate.

Vasectomy A-Z

Vasectomy Overview from Healthgrades

 

Healthgrades Reviews for Dr. McHugh 

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Vasectomy Quick Facts

Vasectomy Quick Facts

Here is a helpful collection of interesting facts and points of information about vasectomy:

  • Each year, between 500,000 and 600,000 men select vasectomy as the permanent birth control method of choice in their family.
  • Vasectomy is considered nearly 100 percent effective, safe, and does not interfere with sexual pleasure.
  • The No-Scalpel Vasectomy (NSV) procedure was developed in the early 1970s in China by Dr. Li Shunqiang.
  • During the past few decades, over 15 million vasectomies have been performed around the world using the NSV technique.
  • No-scalpel vasectomy can be completed in about 15 – 20 minutes.
  • A vasectomy does not reduce a manís sexual drive, virility or his ability to have or enjoy sex.
  • About 85 percent of health care insurance programs include coverage for the vasectomy procedure, so there may be little or no cost to you.
  • Most vasectomy procedures are performed by urologists; medical doctors who are specialists in the male and female urinary tract and the male reproductive organs.
  • Sterilization for a man (vasectomy) is significantly less expensive than for a woman (tubal ligation), which may be as much as five times more costly. Learn more about vasectomy costs.
  • Many vasectomy procedures are performed on Thursdays or Fridays to allow for a weekend vasectomy recovery time – before returning to work the following week.

Dr. McHugh is one of Georgia’s most experienced urologists performing vasectomies and vasectomy reversals.

A vasectomy…in colors!

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A vasectomy in five colors…Blue/ the normal path of sperm from the production in the testicle, out the epididymis and into the vas deferens…Black/ the “grain of rice” opening on the scrotal skin over the vas defernes…Red/ the area of the transected vas and the segment removed…Green/ the lumen of the vas which is fulgurated or cauterized on either side of the transected vas…Yellow/the absorbable suture used to both occlude the vas and to seal off small vessels that may cause a delayed hematoma. No wonder that the chances of “growing back together” is less than one in two thousand! And why the dreaded complication of a egg sized knot “hematoma” is seldom seen after a vasectomy performed by Dr. McHugh.

Vasectomy Reversal: A “preoperative” predictor of better than average results?

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This is the isolated vas deferens at the time of a reversal. You can see the clips and a mass effect of the body’s attempt at healing the vasectomy “trauma.” This is called a sperm granuloma. Note the vas tubes going into the mass of healing and clips. Both sides are normal in appearance and normal caliber.

What a granuloma does is act as a “pop off” valve and releases some degree of pressure on the testicles. This in turn makes for less damage to the testicles and allows them to rebound sooner from a reversal. In many cases it will also improve the character of the fluid at the time of the reversal (which is also a favorable finding for the percentages of success).

So, if you are considering a reversal and in the shower examine yourself and feel a knot along the course of the vas tube above the testicle, this is a favorable sign and that you may have a better than average success rate for both patency  and pregnancy.

Just a small and interesting caveat for the couple thinking about reversing a vasectomy.

Take away? Success of vasectomy reversal not always related to the age of the patient. This is a common concern.

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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).

 

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).

 

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

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