vasectomy-reversal

Vasectomy Recanalization means either a Vasovasostomy or a Vasoepididymostomy. It denotes the process of reconnecting vas-to-vas or vas-to-epididymis so that sperm can once again inhabit the seminal fluid, which once ejaculated into the vagina, would impregnate the woman and make her conceive.

This canal/channel is what was cut and blocked by the earlier vasectomy.

Vasectomy Recanalization is carried out in an outpatient setting, under conscious sedation and is a short procedure with a quick recovery span.

In Vasectomy Recanalization, with both the procedures mentioned above, the highest success rates have been observed using the formal multi-layer technique, even though is also more challenging and time consuming.

Microsurgery results in the return of sperm to semen in 75 – 97 percent of patients and pregnancy occurs in 30 percent to 75 percent of female partners, subject to the time lapse from the earlier vasectomy.

Vasectomy Reversal and microsurgery have become increasingly popular and available. The skill and experience of the microsurgeon becomes the most important deciding factor.

The most commonly performed procedure is Vasovasostomy in which the two ends of the tube that carries sperm are re-connected after the vasectomy scar is cut away. This is not always the right procedure. In many cases, the pressure that builds up behind the vasectomy blockage causes the delicate beginning portion of the tube, called the epididymis, to rupture, much like a flimsy garden hose might if the nozzle is kept closed while the water is turned on. When this happens, a new level of blockage forms at that level, and a successful vasectomy reversal requires reconnecting all the way back to that level. This is called a epididymo-vasostostomy.  Many urologists who perform microsurgery stop short of performing epididymo-vasostomies because it is too technically challenging for them.  I  perform this procedure routinely and successfully.

Many  who perform vasectomy reversal use only high powered eyeglasses, known as “loupes” to aid them in seeing the tubes when they are attempting to reconnect them. The opening that must be perfectly aligned is only one third of a millimeter across (300 microns). It is below standard of care to perform this connection with anything less than a high powered operating microscope. I use a state of the art, fully automated, high powered operating microscope for all his vasectomy reversal surgeries. Surgery is usually carried out in a surgical suite under a general anesthetic.   General anesthesia ensures absolutely no discomfort for the patient during his procedure. Furthermore, there is no pressure on the patient and surgeon of having to ensure that the patient continues to lie absolutely still so he will not disrupt the surgery at a key moment during a critical stitch.

Microsurgery ensures return of sperm to semen in 75 percent to 97 percent of cases and pregnancy in 30 percent to 75 percent of female partners. Success is also conditional upon the length of time from the vasectomy until the vasectomy reversal, as well as other known and idiopathic variables. In some circumstances it is wise to consider setting aside some sperm to freeze at the time of the vasectomy reversal surgery so that in the event the reversal did not successfully restore sperm to the semen, that sperm could be used at a later time for the alternative treatment of in-vitro fertility with intra-ctyoplasmic sperm injection (IVF-ICSI). Such freezing of sperm at the time of the vasectomy reversal minimizes the risk of having to undergo a secondary surgery to retrieve sperm for IVF-ICSI.