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Can a Failed Vasectomy Reversal Be Successfully Re-operated ?
This depends on the cause of the failure. If sperm were seen in one or both vas contents at the time of surgery, or sperm reached the patient’s semen only transiently after the reversal, microsurgical repeat vasovasostomy (VV) will very likely be successful. Unfortunately, surgeons performing only an occasional vasectomy reversal often neglect examining the vas contents for presence or absence of sperm. A surgeon absolutely cannot determine sperm presence or absence by the naked eye. The most common cause for failed vasectomy reversals is the inappropriate non-microsurgical technique using sutures that are too large to achieve watertight reconnections.
The failure of a competently performed microsurgical “vasovasostomy” (VV) following the absence of any sperm in the contents of each vas usually is due to “blowouts” in each epididymis. Under these circumstances a re-operation should be performed only by a micro-surgeon with proven “vasoepididymostomy” (VE) expertise, bypassing the blowouts.
...What more needs to be said?
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After two unsuccessful non-microsurgical vasectomy reversals elsewhere... |
Which Is Better, Vasectomy Reversal or In Vitro Fertilization (IVF) ?
Although many OB/GYN specialists tout IVF as a superior procedure, it is significantly less successful than microsurgical vasectomy reversal and much more expensive.
IVF generally requires surgical harvesting of sperm from the husband and high tech sperm injection (ICSI) to fertilize the wife’s eggs, which were also obtained surgically, but only after multi-thousands of dollars were spent on fertility drugs to enhance her ovulation.
Add the risk of multiple birth pregnancies and finally compare “test tube conception” to “ bedroom conception” aesthetically.
There really isn’t much of a comparison.
How Long After Vasectomy Can A Reversal Still Be Successful ?
First, it’s reasonable to assume that the testicles will continue making more than adequate sperm in most patients into their sixties and seventies.
We have already explained the gradual decline in successful vasectomy reversal with longer intervals between vasectomy and reversal, but this is not due to decreased sperm production.
The more years since the vasectomy, the more opportunity for a “blow out” of the epididymis to occur, unless a protective sperm granuloma developed at one of the vasectomy sites.
My oldest vasectomy reversal was a patient 38 years since vasectomy.
He would have had a #5 prognosis with a MBG of only $1,750, if sperm never appeared in his semen.
However, he had a fingernail sized sperm granuloma at each vasectomy site.
These raised his prognosis to #1, “Excellent”, and he had a pre-op written MBG for 100% of the surgical fee, $5,000.
At surgery, he had sperm swarming in the vas contents bilaterally and his six week post-op sperm concentration was 15 million/ ml. and expected to improve for another 3-4 months. Truly a “slam dunk”! Prognosis is not determined solely by the interval since vasectomy.
Each patient’s prognosis must be individualized.
One of my long interval reversal patients was so excited with his new daughter that he gave his story to the NATIONAL ENQUIRER.
It was on the front page in the July 4, 1995 edition.
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Click the image on the left to read the article. |
Will I Need Just Vasovasostomy (VV), or Will I Need Vasoepididymostomy (VE) ?
Only a few of the many surgeons performing vasectomy reversals can perform the very difficult VE with even decent results.
Many of the few truly expert VE reversal surgeons obtained their expertise 15-25 years ago when performing VE’s on all patients without live sperm in their vas was considered appropriate.
Consequently, they obtained their expertise at the expense of hundreds of patients who we now know may have been better off with simple VV’s.
I was prevented from following their path by my unique accountability with a Money Back Guarantee that I initiated in 1990.
I did a few VE’s (1-2 each month) for three years but only on patients with no sperm at all in their vas, and I had a 20% success rate.
Only 1-2 VE’s per month is not enough to become an expert.
Many VE experts, or aspiring to be VE experts, do VE’s on over half their patients.
They could not afford to do this with a MBG in effect.
I have reviewed my entire VV practice and found that 82% of my patients have their MBG guarantee satisfied by sperm in their post-op semen.
That means only 18% of all my patients truly needed a “vasoepididymostomy” (VE), instead of a vasovasostomy (VV).
To complicate matters further, we often cannot determine at surgery which patients do and which patients don’t need VE’s.
You can’t be certain a VE is needed even in patients with no sperm at all during the reversal surgery.
8% of my patients with no sperm in either vas at surgery subsequently had sperm in their semen after my VV's.
Many more patients have only old, decomposing sperm in various (mild to severe) stages of decomposition.
These will obtain sperm in their semen at progressively higher frequencies depending on less and less visible decomposition of their sperm.
I don’t like guessing, and that’s what it usually boils down to, about a patient’s need for a VE at the original reversal operation.
If my VV’s are unsuccessful, I’m satisfied the patient had “blowouts” in each epididymis and I refer them to one of the proven competent VE surgeons available.
How Long Will A Vasectomy Reversal Remain Successful ?
What About Anti-Sperm Antibodies ?
It is estimated that between 50% to 75% of patients having had a vasectomy have positive blood testing for anti-sperm antibodies.
In the 1980's this was thought to be a significant problem.
As medical management of these antibodies has greatly improved, it also has become apparent that only antibodies attached to the sperm have a deleterious effect, and the frequency of this as a problem has been much less than suspected 20-25 years ago.
Although anti-sperm antibody problems are no longer a major concern, many surgeons without vasectomy reversal skills and most OB/GYN specialists touting IVF, ICSI, etc. repeatedly exaggerate the importance of anti-sperm anti-bodies.
Testing the blood for anti-sperm anti-bodies is meaningless and don't let anybody waste your money on this test. An immuno-assay of sperm is needed to diagnosis an anti-sperm antibody problem and there are not any sperm available for testing pre-op.
Hopefully, forever.
However, a reported 3% (Journal of Urology, 1985), and perhaps now estimated more accurately at 5-6% of patients experience the tragedy of “transient fertility”, which I personally call “delayed scarring”.
This is the spontaneous disappearance of sperm that have been successfully restored to a patient’s semen.
This can occur a few weeks, a few months, and even a few years after the successful vasectomy reversal.
I have not read an acceptable explanation of the cause, but I personally think it occurs when the blood supply at one of the vas ends is diminished at the time of reversal and a subsequent stressful event (intercourse? ) results in over-stressing this weakened vas end and the muscle dies from infarction, very similar to the heart muscle (myocardium) death during a “heart attack”.
All vasectomy reversal surgeons routinely try to preserve the blood supply to all four vas ends, but sometimes our best efforts fail without us having any warning.
The good news is that re-operation can almost always restore the sperm to the patient’s semen and re-occurrence of delayed scarring and sperm disappearance has been less than 1% after re-operations in my experience.
I think this is due to many new blood vessels that develop after the first reversal, called “neovascularization” and they provide additional protection.
Because of possible sperm disappearance following vasectomy reversal, family planning by birth control is felt to be contraindicated at least until the first baby has arrived.
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