Tag Archives: vasoepididymostomy

Intimacy after vasectomy same as after a vasectomy reversal?

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From Vasectomy.com

Click here for article.

I usually tell patients wait one week after a vasectomy and three weeks after a vasectomy reversal before resuming sexual activity. Other than the fact that the reversal is a more  substantial procedure to recover from in time there is little difference in this particular regard. JM

If it was easy to get pregnant before the vasectomy…will it be easy to get pregnant after the reversal? Well…it depends.

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So…I hike a trail most every evening after work and on the weekends that takes about an hour. My vasectomy reversal coordinator Kathy get several calls a day about scheduling either a reversal or a free consultation about arranging for a reversal. Many of our patient live a long way away and ask, “Can I speak to the doctor by phone?”

Kathy routinely says, “Can he call you between 5 and 6 tonight?”

The interested couple most commonly says, “Yes. Perfect.”

So last night Kathy gives me two people to call who have an interest in reversing their vasectomy. The second patient I call asked the question, “My wife and I got pregnant very quickly. I mean one the first try. Does this mean that we’ll get pregnant just as quickly after the reversal?”

Good question and very similar to this common question, “Will the reversal surgery be like the vasectomy?”

Regarding the latter, the reversal takes approximately two and half hours, a vasectomy less than 15 minutes. So no a vasectomy is not like a reversal.

Regarding the former question: the issue is not that you and your partner are very fertile, the success of the reversal depends on the experience of the surgeon and the time interval since the vasectomy.

The perfect scenario? A short time since the vasectomy and a urologist who does reversals microscopically often. It does not hurt that the wife was fertile, that is good. For the male however the production of good sperm suitable for pregnancy decrease as time elapses since the vasectomy.

It was a good question and I hope this helps you understand the nuances of a microscopic vasectomy reversal. You might check out this internal site link.

Success rates.

Reversal consults are free. Leave a number or email and we’ll schedule an in office consultation or Dr. McHugh will call you while on his walk!

What does the vasectomy site look like at the time of a reversal?

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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.

  1. 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.
  2. Secondly, the vasectomy site is excised and fresh vascularized vas deferens are delineated and prepared to reconnect.
  3. 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.

Considering a vasectomy reversal? We do them all the time and the consultation is free. Make an appointment 24/7 by just leaving your number and we’ll contact you. 

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Vasovasostomy vs. Vasoepididymostomy-Nuance #1

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Many institutions recommend a vasoepdidymostomy if no sperm are seen in the fluid of the transected vas deferens at the time of the reversal. The article below begs to differ.

Vasovasostomy Recommended When Only Sperm Parts Noted

Urology – November 30, 2006 – Vol. 22 – No. 04

Vasovasostomy can and should be performed when only sperm parts are noted intraoperatively in the transected vas.

Article Reviewed: Outcomes for Vasovasostomy Performed When Only Sperm Parts Are Present in the Vasal Fluid. Kolettis PN, Burns JR, et al: J Androl; 2006; 27 (July/August): 565-567.

Outcomes for Vasovasostomy Performed When Only Sperm Parts Are Present in the Vasal Fluid.

Kolettis PN, Burns JR, et al:
J Androl; 2006; 27 (July/August): 565-567

Objective: To determine vasovasostomy outcomes in instances in which only sperm parts are present intraoperatively in the vasal fluid, rather than in full sperm. Design: Retrospective review of outcomes from 3 institutions with experienced male reproductive microsurgeons for men undergoing vasovasostomy in cases where only sperm parts were noted in fluid from the transected vas.Participants: 34 men who underwent bilateral (n=31) or unilateral (n=3) vasovasostomy. Methods: Men who were identified with sperm parts (sperm heads or sperm with partial tails) in the vasal fluid bilaterally or sperm parts on 1 side with intravasal azoospermia on the contralateral side when the vas was transected during vasovasostomy were included in the study. Microsurgical vasovasostomy was performed using either a modified 1-layer technique or a formal 2-layer technique. Results: The overall patency rate was 76% (26 of 34 men), and the pregnancy rate was 35% (7 of 20). Analyzing 8 procedures that did not result in sperm in the ejaculate, 2 had only an occasional sperm head bilaterally from the transected vasa, and 1 had observed an occasional sperm head on 1 side and contralateral intravasal azoospermia. Excluding these 2 cases, the patency rate was 84% (26 of 31). Conclusions: These results are similar to or better than those of epididymovasostomy outcomes, and argue that vasovasostomy should be performed in cases where only sperm parts are noted intraoperatively in the transected vas. Reviewer’s Comments: Mounting evidence supports that vasovasostomy can and should be performed when only sperm parts or even clear fluid is noted intraoperatively in the transected vas. (Reviewer–Craig S. Niederberger, MD).