There
may be any number of reasons why you have decided to
consider a vasectomy reversal.
At the Center for Reproductive Health, we have a
friendly, experienced and highly professional team
to help you arrive at the right decision, whether it
is a vas reversal or the non-surgical approach
called percutaneous epididymal sperm aspiration. At
this appointment the counseling doctor will explain
the nature and details of the operation and answer
any questions you may have. In particular the
doctor will try to ensure that you are making the
correct decision, bearing in mind your personal
circumstances. It is very difficult to provide
accurate information about the success rate of a
vasectomy reversal.
The counseling doctor and or the surgeon will of
course be happy to expand on this information as it
applies to you. If you decide to go ahead an
appointment for the operation can be arranged
without delay. There will be some post-operative
swelling and bruising, but healing is rapid and you
should feel much better after two or three days.
Nonetheless, it should be stressed that you must at
all costs avoid any strenuous activity for at least
ten days after the operation and it is also
advisable to allow one or two weeks off work. Semen
tests are arranged at 12 and 16 weeks after the
operation when we will make an appointment for you
to see the counseling doctor to discuss the results.
Post-operative care is very important and if at any
time you are concerned about the progress of your
recovery, or you have any questions, expert advice
and help is always available.
There are several ways of
assessing men who are candidates for vasectomy
reversal prior to surgery. These include the history
and physical examination and determination of serum
gonadotropin and
antisperm antibody (ASA)
levels. In general, the prior fertility history and
the length of time since the vasectomy, along with a
careful examination establishing the testicular size
and consistency, the length of vasal defect, the
presence or absence of a granuloma at the vas site,
and the condition of each epididymis, provide
adequate information to counsel the patient on the
likelihood of a successful outcome.
When there is an uncorrectable blockage to sperm,
which can occur naturally or in some cases of
vasectomy, sperm can be collected from behind the
blockage by a minor surgical procedure. Sperm can
usually also be collected from a small tissue sample
taken directly from the testis in cases of severe
lack of sperm production. Either way, the sperm are
relatively few and immature but usually sufficient
to achieve fertilization by ICSI.
A large multicenter study by the Vasovasostomy Study
Group showed reduced patency rates and reduced
pregnancy rates with increasing length of time from
the vasectomy to its reversal. This resulted from a
higher percentage of men developing proximal
obstruction due to rupture of the epididymal tubule
over time. Scarring and induration in the epididymis
may evidence this condition. A sperm granuloma,
which results from leakage of sperm at the vasectomy
site, may protect against this process by releasing
pressure on the proximal structures.
An association between the presence of ASAs and
infertility has been well established. With the
disruption of the blood-testicular barrier that
occurs following ductal obstruction, ASAs can
develop, and an elevated level may be seen in up to
60% of men following vasectomy. But from 2% to 30%
of fertile men have elevated levels of agglutinating
ASA levels in the serum, and this elevation does not
always correlate with elevated levels in the semen.
We therefore do not routinely use serum ASA levels
in decision-making when considering vas reversal.
The highest success rates for vasectomy reversal are
achieved through a microsurgical procedure that
allows for an accurate mucosa-to-mucosa leak-proof
anastomosis that is free of tension and that
preserves the blood supply. Competence in
microsurgery is a result of special training in
microsurgical technique, laboratory practice, and
experience. In the hands of a skilled surgeon, men
who had their vasectomies from 3 to 8 years
previously can expect post-vas reversal patency, as
demonstrated by finding viable sperm in the semen
90% of the time and pregnancy rates of 50% in their
partners.
