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After two unsuccessful non-microsurgical vasectomy reversals elsewhere...
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.
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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 ?
How Long Will A Vasectomy Reversal Remain 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.
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.
We hope our miscellaneous questions section will help you with answers regarding a vasectomy reversal.