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 The most common reason to perform sperm duct microsurgery is to reverse a vasectomy. Dr. Buch has performed numerous successful vasectomy reversals since 1985 using the most up-to-date microsurgical techniques. He has reported his success rates in medical journal articles and seminars, and he has been a pioneer in the use of frozen sperm from the site of the vasectomy reversal. The frozen sperm provides a "back-up plan" for future attempts at pregnancy should sperm fail to return to the ejaculate in spite of a technically excellent microsurgical vasectomy reversal.
Currently, 98% of our clients who have a straight-forward vasectomy reversal (vasovasostomy) will have successful return of sperm to the ejaculate, and 65% will achieve pregnancy by natural means. This compares favorably with the 85% pregnancy rates of couples trying to get pregnant naturally (those who are not associated with a vasectomy reversal). These numbers are why so many people come to Dr. Buch for vasectomy reversals from other major cities. When sperm returns after a successful vasectomy reversal, the natural pregnancy rates can be enhanced by use of medication for persistent sperm antibodies, and through the use of sperm processing (washing) in combination with insemination of the female partner.
In cases where the time from the vasectomy to the attempt at vasectomy reversal has been more than 10 years, there is an increased chance of a secondary blockage in the ducts closer to the testicle, which are called the epididymis. Even in these technically more demanding cases called epididymovasostomy (EV or VE), our success rate for return of sperm is 85%
and our natural pregnancy rate is 50%. Currently, our patient with
the longest duration from vasectomy to successful vasectomy reversal
with return of sperm in the ejaculate is 30 years!
Microscopic Vasovasostomy and Epididymovasostomy
Increasingly more men are presenting to the urologist for vasectomy reversals or to correct acquired blockages of the sperm duct system. Fortunately, microsurgery has advanced significantly in the past several years so that reversing a once thought of as permanent sterilization (vasectomy) is now highly possible. My career has been dedicated to men's fertility issues since 1985, and I specialize in microsurgery, having previously directed the men's infertility program at two universities.
It should be remembered that much of the success of a vasectomy reversal depends on two factors: (1) the skill of the surgeon and (2) the findings at the time of the surgery. Although a microscopic vasovasostomy is not always necessary to produce an effective outcome, it does result in higher success rates. I perform a two layer repair using microscopic sutures and the latest microsurgical equipment including the operating microscope. I prefer to have my patients operated on as an outpatient. This affords them the opportunity of returning to their home or a nearby motel, saving them considerable expense and making the overall experience much more pleasant. I perform procedures at the Legacy Surgery Center of Frisco. It is a superb outpatient surgical facility fully staffed by anesthesiologists and nurses trained in the care of patients who are having outpatient procedures.
Operating time for a vasovasostomy or epididymovasostomy is approximately 4 hours. A local anesthetic is usually used in conjunction with a light general anesthetic, so that our patients wake up quickly and have no immediate discomfort. Postoperative care should include an evaluation of wound healing at 1-2 weeks, and a first semen analysis at 4 weeks. Semen analyses are then obtained at 2 month intervals until the semen analysis stabilizes or pregnancy is achieved. Routine follow up semen testing and visits will provide the best success rates.
Below you will find a short description of the operative technique. As mentioned previously, a second important factor in determining a successful outcome is the surgical findings. When the vas is opened, fluid will flow from the testicular side of the vasectomy site. If sperm are present, then a vasovasostomy (VV) is performed, and 98% of such patients will demonstrate a return of sperm with an associated 65 % or greater pregnancy rate. If fluid is not found, or the fluid that is found is not acceptable quality (for example, if no sperm are present), then a more technically demanding connection of the vas to the epididymis (the gland that collects the sperm from the testis) will be performed. This operation is called an epididymovasostomy (EV or VE), and sperm return to the ejaculate in 80% of such cases. In many cases, moving sperm from the site of the reconnection can be retrieved and frozen for storage and later use as “fertility insurance” should sperm fail to return to the ejaculate. Unfortunately, as opposed to ejaculated (mature) sperm, the immature but moving sperm from behind the blockage can only achieve reliable pregnancy rates from IVF-ICSI and cannot be used for artificial insemination. Please ask us for further details on sperm freezing at the time of your initial office visit.
The current all-inclusive cash price for vasectomy reversal (without sperm freeze) is $8,300. My package pricing compares favorably with similarly trained specialists outside of Texas whose costs are between $9,000 and $10,000 or more.
Beginning January 1, 2008 all redo vasectomy reversal cases will be charged an additional $400 to cover the increased costs of anesthesia and facility required for these lengthier cases. We appreciate your understanding.
Anesthesia and Facility
The quality of the reconnection of the vas ends is maximized when there is no patient movement during the procedure. Light general anesthesia is very safe and routinely accomplishes this. Sedation and local anesthesia often do not achieve perfect stillness of the patient and the quality of the vas end reconnections promptly decreases with patient movement. Legacy
Surgery Center of Frisco, is an accredited surgical facility. Accredited surgical facilities are the only sites you should consider for vasectomy reversal or other male infertility type surgery. Hospitals, ambulatory surgical centers, and only a few surgeon's offices provide truly accredited facilities for the patient's safety.
Sutures: Size Matters when it comes to reconnecting the two vas ends!
Dr. Jeffrey Buch uses the strict 2-layer microsurgical vasovasostomy
technique. True microsurgeons, like Dr. Buch use 10-0 size sutures most commonly and never larger than 9-0. “Naked eye” surgeons and surgeons using the minimally magnifying loupes rarely use smaller than 6-0 sutures. These 6-0 sutures resemble anchor rope when viewed through the operating microscope. Post-operative leakage of vas fluid and sperm out of the vas between these relatively huge 6-0 sutures into the outside tissues usually results in localized scarring, blockage, and reversal failure. These unfortunate patients comprise a significant percentage of the cases for the true vasectomy reversal surgeons with their re-operations.
The Operating Microscope is used to place every suture reconnecting the tiny sperm canals inside each vas end. Placing these sutures is one of the most important aspects of the operation. If it is not done with the powerful magnification of an operating microscope, this is not microsurgical technique and leakage with scarring and failure is very likely.
Please feel free to call me or my staff at (972) 612-7131 or fax (972) 612-7161. I look forward to helping you!
Contact Legacy Male Health Institute, P.A to find more information on vasectomy reversal success & cost.
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