VASECTOMY REVERSAL

Vasovasostomy (VV)

The vas deferens is the tube (duct) that carries sperm from the testicle to the prostate and urethra. Vasectomy is a leading cause of obstruction of the male reproductive ducts, but many men may be born with or acquire such obstructions later in life from trauma or infection.

The ultimate success of a reconstructive procedure is pregnancy and is dependent on several factors: the age and fertility of the female partner, the age and previous fertility of the male, the method of vasectomy, the surgeon's experience, the technique of vasectomy reversal (the use of optimal magnification/microscope), the quality of the fluid seen coming from the vas at the time of the operations, and most importantly, the length of time since the vasectomy was performed. In a large study of 1500 patients from multiple institutions, the success rate correlated with the length of time since vasectomy. The shorter the interval from vasectomy to reversal, the higher the success rate. In men whose obstructed interval was less than 3 years, the likelihood of sperm present in the semen after reversal is approximately 80-85% and pregnancy was observed in 70% of the wives. On the contrary, when the obstructed interval was greater than 15 years, only 50% of men will have sperm in their semen following reversal and the pregnancy rate was significantly lower at 30%. In most men, i.e. those with obstructed intervals between 4-14 years, the likelihood of having sperm in the semen is about 80% with a pregnancy rate of 45-60%. In interpreting this data, one should keep in mind that the age of the wives plays an important role in the overall pregnancy rate. Men who are older, i.e. those who have had long obstructed intervals, may have older partners. This difference may account for some of the pregnancy rate difference as outlined above.

Vasovasostomy is done on and outpatient basis. Anesthesia will be either general or spinal/epidural. Oral pain medication will be prescribed and is generally required for 24-48 hours. Tylenol or Motrin may then be used. An ice pack should be placed on the scrotum for the first 24 hours. No heavy lifting, sports, or sexual activity should be engaged for 4 weeks. You may return to work in 7 days unless your job is physically demanding; then you may return in 10-14 days. A semen analysis will be obtained 8-12 weeks after surgery. Some men may not have sperm for 6 months to a year.
 

Vasovasostomy
 

The average length of time to achieve pregnancy is about six to nine months. Up to 10% of patients will develop a recurrent obstruction after sperm were initially present. You may consider sperm banking once the sperm count has peaked to safeguard against this occurrence. Bleeding and infection are uncommon complications. Scarring and persistent pain at the operative site occurs very rarely.



SPERM ASPIRATION/EXTRACTION

Recent breakthrough in IVF enables us to achieve pregnancy with a very small number of sperm. In men with production problems or obstruction not amenable to surgical reconstruction, directly obtaining sperm from the testicle or epididymis for IVF is the only option for biological parenthood.

Testicular and epididymal sperm are functionally immature. They are not very motile and most do not have the ability to home in on the eggs, even if they are placed together in a test tube. They must be directly injected into the eggs to achieve fertilization through a procedure called IVF/ICSI.

Testicular and epididymal sperm cannot be used for intrauterine insemination due to their functional immaturity and the low number of such sperm retrievable. Their use requires IVF/ICSI (Intracytoplasmic Insertion).

The sperm may be sucked out with a small needle (apiration) or processed out from a small piece of testis tissue (extraction). Aspiration can only be used in men with normal sperm production; it is less traumatic but removes only a very small number of sperm, too few for sperm banking, but sufficient for immediate use. Sperm aspiration/extraction with IVF/ICSI is and alternative to surgical reconstruction. There are pros and cons for each approach; in my opinion, vasectomy reversal is more appropriate for most men, if one considers the likelihood of success and overall costs.

We strongly recommend that you become well-informed of all aspects of these options before reaching a decision. We are here to help you, and we look forward to the opportunity to discuss with you the various options available and answer any questions you may have.

This monograph was supplied in part by Jerry Yuan, MD Assistant Professor of Surgery (Urology) Emory University School of Medicine