For the past thirty years, vasectomy has been one of the most popular, effective and safest methods of contraception or sterilization because of its success rate. In 1982 more than 15% of all couples using contraception relied on sterilization of the male partner. Vasectomy causes sterility by blocking the flow of sperm from the testicles. This method of contraception involves a minor surgical procedure usually done in doctors' offices. Because of the simplicity of this method and its effectiveness, about a million men have this procedure done yearly.
It is important to note that a vasectomy does not significantly alter a person's ability to produce sperm. Therefore almost all men who fathered children in the past will have sperm present within the testis and epididymis following a vasectomy. A vasectomy is reversible, but the reversal is not always successful.
Often men who have vasectomies request a vasectomy reversal. As a result vasectomy reversal has become an integral part of the urology practice during the same years. Many men still at a young age find that their personal situation has changed and start researching options to begin or extend their family. They may have divorced, lost their spouse, or simply decided that the vasectomy was a mistake. A typical person requesting a reversal is a man in his late 30's, divorced, and married to a woman who has not had any children.
It is important to physicians that each couple has a thorough understanding of all of the available options before deciding how to proceed. The first option should be surgical exploration and reconstruction of the male reproductive system to restore the flow of sperm to the prostate. The second option is to harvest sperm from the husband and then use those sperm to fertilize the wife's egg in the laboratory (IVF). Urology Team physician, Dr. Loren Jones, has a special interest in vasectomy reversal..
What is Vasectomy Reversal?
A vasectomy reversal is the reconnection of the vas deferens. The correct medical term for vasectomy reversal is vasovasostomy. An incision is made in the scrotum and the two previously cut ends of the vas deferens are located. The urologist cuts a small portion of the ends of the vas deferens to make sure they are open. Then using microsurgical techniques, the physician reconnects the vasa. This is called anastomosis of the vasa. A rejoined vas deferens can become a passageway for semen to be ejaculated at orgasm. The surgeon's clinical experience and attention to general principles enhance successful outcome.
Chances for Success with Vasectomy Reversal
Any vasovasotomy procedure has a greater chance of success if the vasectomy was performed within the last ten years.
Disconnecting the vas deferens is certainly much easier than stitching it back together. Microsurgical techniques achieve the best results. There are a variety of techniques for reconnecting the two ends of the vas deferens, with no one type of procedure being significantly better. Vasectomy reversal is more time-intensive and complex than a regular vasectomy. The vasovasostomy procedure usually takes about two to three hours. The procedure is done under general anesthesia in a hospital.
Before having surgery The Urology Team physician will obtain a complete history and physical if necessary. The surgery will then be scheduled at a mutually agreeable time. During surgery the physician will assess the condition of the tissue to help predict the chance of success. The surgeon will evaluate the quality of the fluid coming from the vas end at the vasectomy site to see if there is sperm within the fluid. Finding the sperm within the fluid is terrific. If the vasectomy was performed within three years of the reversal, the statistical likelihood of reopening a vas channel and finding sperm is about 80-90% with a subsequent pregnancy rate of 50-75%.
There are occasions where the distal end of the vas deferens must be connected to the epididymis. This situation generally occurs when a very large portion of the vas deferens has been removed. This is a more complicated procedure called a vasoepididymostomy. It requires more time to perform and pregnancy rates are greatly reduced. Every case is unique. There are no guarantees about the success of a reversal.
Risks and Complications
There are risks and potential complications with any medical procedure and you should go over these with your physician very carefully. The microsurgical technique used in a vasectomy reversal is very complex and it is a delicate procedure. It is important to know that it is generally considered to be a low-risk and complication-free procedure, but as with any surgical procedure, it does carry some risk. Some pain and discomfort may be expected and this normally decreases and disappears within a couple of days after routine postoperative care. You may develop an infection, which can include fever, chills, drainage and pain from the incision site. You may experience internal bleeding of the scrotum thereby experiencing increased pain, excessive swelling, a black and blue area or a growing lump. The most disappointing result is failure of the procedure to restore fertility. If you have any problems, it is important to call your physician.
Preparations for your Procedure
The best preparation for your vasectomy reversal is to have all of your questions answered by your physician before surgery. You will be given numerous instructions including.
Nothing to eat or drink after midnight the night before your surgery.
Eliminating the use of aspirin or anti-inflammatory medication for several days before the surgery. These medications can increase the risk of bleeding. Please ask your physician about any other medications you are taking.
Shaving the front portion of your scrotum.
Any showering procedures that you need to follow.
Bringing clothing or athletic support that you may need to the hospital with you, so that you can prepare yourself to go home. It is always a good idea to wear loose fitting outer clothing.
Driving preparations and safety after the procedure - Even though this is an outpatient procedure, you will be given general anesthesia or spinal anesthesia. You will need to stay in the hospital for several hours. Because you receive anesthesia, you will be groggy and will require the assistance of somebody to help you get home.
You can expect a recovery from the reversal to be a little bit different from your original vasectomy. This is due to the fact that you have just had general anesthesia for the procedure and also the fact that the procedure usually takes two to three hours.
You should keep all of your activities to a minimum for probably four to five days.
You should not lift anything heavy or do any physical exertion for the first three to four weeks.
An ice pack or frozen bag of peas placed on the scrotum for short periods can soothe the scrotal area during the first couple of days. This ice pack will help minimize any swelling that you may have.
Wear snug cotton briefs or an athletic supporter for extra support.
You may experience some discomfort from surgery and this usually can include a slight swelling, bruising, or discoloration in the scrotal area.
Please keep in mind that sometimes when you receive anesthesia for surgery, you will be left with some headache, body ache, nausea, or some other minor symptoms that will usually diminish in the first couple of days.
You may resume sexual activity when you are comfortable, usually after 2 weeks. Ask your doctor what he recommends. You may notice blood in your semen and this is normal.
Your doctor will advise you of appropriate use of painkillers and/or antibiotics if necessary.
For a couple of days after surgery, you should take showers and not baths.
Postoperative scars are really nothing to worry about. The scrotum generally heals very well.
Probably the most important thing to remember is to contact your physician immediately if you are experiencing any fever, chills, increased pain or swelling at the surgical site, or any drainage.
Follow Up Care After Your Reversal
Postoperative follow-up includes an evaluation of wound healing at least 10 days to 2 weeks after the surgery. You will also have a semen analysis in about 6-8 weeks. Most semen analyses are then obtained for approximately 4-6 months or until the semen analysis stabilizes.
Post Reversal Sexual Activity
It is important to know that sperm may not appear for several months after you have had your procedure. Your doctor will schedule a semen analysis in one to two months and periodically thereafter to check your sperm count. An effective vasectomy reversal simply allows the sperm to rejoin the seminal stream during ejaculation and really should not affect your sex drive. It will also not affect your ability to have an erection or orgasm, or most importantly your ability to have and enjoy sex. Your sperm is really only a very small part of the total liquid in your semen. The amount of fluid, intensity, color and texture really should not appear to change at all once your seminal fluid again contains sperm. If you have any anxiety after the vasectomy reversal regarding sexual problems, or just any postoperative anxiety, please call the office and talk to your physician about your concerns.
Expense Related to Reversal Procedure
Please remember that this is an ELECTIVE procedure, and it is usually not covered under most insurance plans. Unlike a vasectomy, most insurance plans do not cover the cost of the vasectomy reversal. The range of vasectomy reversals physicians fee alone can be anywhere from $5,000 to $10,000. Any additional office visit and semen analysis will be charged accordingly. The monetary issues as well as payment requirements will be discussed with you during your first visit with the surgery scheduling coordinator including the cost of the procedure as well as other costs outside of the physician's services, for you to consider. This often includes labs, hospital costs, x-rays, and general anesthesia. Occasionally there will be a pathology charge for tissue evaluation.
Options if the Reversal Does Not Work
Patients who are likely candidates for a second vasectomy reversal surgery are those who evidence healthy sperm in the seminal fluid somewhere in the vas or epididymis during the first reversal surgery. We think that the physician's role here is very important in identifying the problems that possibly were identified during the first vasectomy reversal and use that information as an evaluation for a second procedure. The alternative to vasectomy reversal is sperm harvesting and IVF.
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