Vasectomy Reversal Home Page
Vasectomy Reversal (Vasovasosotmy/Vasoepididymostomy )
While approximately half a million men per year elect to undergo a vasectomy, a segment of this population will later return with the desire to regain their fertility and explore the option of a vasectomy reversal. Fortunately, in the last 20 years, breakthrough improvements have been achieved for reconstruction of the vas deferens; specifically utilizing microsurgical techniques. At present, in experienced hands, a vasectomy reversal can be performed as an outpatient procedure and achieve excellent results.
Success following a vasectomy reversal depends on many crucial factors. These include the training and experience of the operating surgeon, the elapsed time since the vasectomy was performed as well as the fertility status of the female partner. While the interval between the vasectomy and the reversal is correlated with success rate, there is no “cut-off” date for a reversal. Men with intervals greater than 20 years have undergone the procedure with success.
Alternatives to vasectomy reversal do exist, however, for many couples vasectomy reversal offers the most natural and cost effective option for achieving a desired pregnancy. These alternatives include insemination using donor sperm or surgical testicular sperm retrieval (TESE) using the male partner’s sperm which must be accompanied by an in vitro fertilization (IVF) cycle for the female partner and use of intracytoplasmic sperm injection (ICSI).
Dr. Natan Bar-Chama, an experienced male reproductive microsurgeon
Dr. Bar-Chama is the Director of the Center for Male Reproductive Medicine at the renowned RMA of NY. He is one of a select group of fellowship trained and accomplished male reproductive microsurgeons practicing in Manhattan. Since 1994, Dr Bar-Chama has been the Director of Male Reproductive Medicine and Surgery at The Mount Sinai Hospital and The Mount Sinai School of Medicine. He is on the board of directors of the Society for Male Reproduction and Urology of the American Urological Association (AUA) as well as the American Fertility Association (AFA). Annually since 1995, Dr. Bar-Chama has been highlighted as one of the Best Doctors in New York Magazine as well as Castle Connolly’s Best MDs in America. His clinical practice is exclusively dedicated to male reproductive and sexual medicine and microsurgical reconstruction for the treatment of male fertility, including vasectomy reversal.
Vasectomy Reversal Surgical Technique:
A vasovasostomy is the procedure most commonly referred to as a “vasectomy reversal.” Under anesthesia, and through a 1-3 inch incision in the scrotum, an operating microsope and extremely fine microsutures are utilized to re-connect the severed ends of the vas deferens. Extreme precision and advanced surgical skills are required to re-attach the lumen of the vas deferens which has the diameter the size of a pen-dot (0.2-0.3mm). Under certain conditions whereby poor fluid quality and/or no sperm are found at the end of vas deferens, the more complex vasoepididymostomy procedure is performed. In this modification, the vas deferens is re-attached directly to an epididymal tubule observed intraopertively to contain sperm. A vasectomy reversal procedure usually lasts approximately 1.5 -4 hours.
Recovery & Post-operative Care
A vasectomy reversal can be performed at either a hospital or an outpatient surgical center. An outpatient surgical center will offer a more affordable vasectomy reversal as hospital facility fees will not apply. It is important to use an accredited outpatient surgical center that can demonstrate it provides quality and safe patient care. After a vasectomy reversal, the patient will return home the same day and should allow 2-4 days for recovery. Strenuous activity can be resumed after 4 weeks and normal sexual activity may be resumed after approximately 8 weeks from recovery.
After the vasectomy reversal procedure, slight swelling, discoloration, and discomfort in the scrotal area are to be expected. Some patients may also experience aching and nausea immediately after the vasectomy reversal due to the anesthesia. Pain medication will be prescribed for the first 2 – 7 days following the vasectomy reversal, after which ibuprofen or acetaminophen and scrotal support should be sufficient. A post-operative appointment will be scheduled 10-14 days after the microsurgical procedure to ensure healing is proceeding as expected. For those patients traveling from out of town, post operative monitoring will be arranged.
The average time from vasectomy reversal surgery to conception is approximately 12 months. Two to three months after the vasectomy reversal surgery, a semen analysis is obtained to test for the presence of sperm. Semen analyses are then repeated at 2-3 month intervals to further monitor outcome. Sperm is often observed by 6 months but occasionally may take longer and should be present at 18 months post surgery.
It is also possible that after a successful reversal the quality of the semen analysis declines over time due to the development of scar tissue. This occurs in approximately 10% of vasovasostomy and 20% of vasoepididymostomy patients. After a successful vasectomy reversal, patients can consider cryopreservation in order to insure sperm availability for future interventions.
With remarkable advances in microsurgical techniques, instruments and suture materials, success rates of vasectomy reversals have increased dramatically. Following microsurgical vasectomy reversal, sperm appears in the semen in approximately 70 to 95% of men and pregnancy without assisted reproductive technology occurs in 30-75% of couples.
Assisted Reproductive Technology
Vasectomy reversal is often more cost effective than sperm retrieval with an in vitro fertilization cycle (IVF) where intracytoplasmic sperm injection (ICSI) must be used. Vasectomy reversal allows couples to have subsequent children without additional medical treatment. However, there may be situations in which testicular sperm retrieval (TESE) with IVF and ICSI is preferred. Specifically, couples with both male and female factor infertility are often better treated with sperm retrieval and ICSI. For some couples, where time is an important factor, it is important to appreciate that after a successful vasectomy reversal, the average interval until pregnancy is about one year, while a successful IVF with ICSIcycle pregnancy occurs within one to two months of the female starting hormonal therapy. The choice of either sperm retrieval with IVF and ICSI or microsurgical vasectomy reversal should also be influenced by the pregnancy rates achieved with ICSI by the IVF laboratory with which you are working.
Ready to schedule a consultation for vasectomy reversal?
Call 212-756-5777 or fill out an online appointment request.
New patients can complete consultation paperwork prior to their appointment.
Out of town patients can take advantage of hotel discounts through RMA of New York and can anticipate being able to travel 2 days after the procedure.
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