In addition, the frequency of multiple gestations has been dramatically decreased by single embryo transfer and other contemporary enhancements in IVF. These changes dramatically improve the cost-effectiveness of sperm retrieval and IVF. Both treatment with both vasectomy reversal as well as sperm retrieval and IVF mandates that the male partner will undergo a procedure, the extent of the procedure with vasectomy reversal is far more extensive, requiring hours of anesthesia, typically general anesthesia, with its associated risks.
The question at hand is not whether vasectomy reversal is a procedure that should be offered to couples. The question is whether it should be the first step for these couples. Every advantage that a vasectomy reversal provides couples relies on the female partner having normal fertility potential; therefore, a vasectomy reversal should only be performed after female reproductive capacity is confirmed.
There are, however, additional factors that must be considered prior to vasectomy reversal. The availability of a trained microsurgeon must certainly be taken into consideration. Without a microsurgeon skilled in both vasovasostomy as well as vasoepididymostomy available to perform the procedure, vasectomy reversal should not be undertaken and couples may be better served with sperm retrieval and IVF.
Furthermore, men who have any evidence of a decline in fertility and spermatogenesis may be poor candidates for vasectomy reversal. For example, men with small, soft testes or an elevated FSH may have compromised sperm production, and additional evaluation including endocrine work-up is needed 6. The sperm production may be so impaired that the couple would require ART even if sperm returned to the ejaculate, causing a delay in achieving a pregnancy — but still requiring ART.
Progressive decline in sperm production becomes more common as men age — and the population of men requiring vasectomy reversal tend to be older. Vasectomy reversal is unnecessarily invasive in subfertile males because sperm can be acquired through testicular or epididymal aspiration for the ART procedure which would have been required anyway. Furthermore, these same subfertile couples will appreciate not requiring additional contraception if the vasectomy can be maintained during and after ART. Men who had pelvic, inguinal, or prostate surgery after their vasectomy may also not be candidates for reversal because of the possibility of additional damage to the ejaculatory system which would make repair at the site of the vasectomy fruitless.
The desire for multiple children is an oft-cited reason for vasectomy reversal as a primary treatment for obstructive azoospermia. Again, however, the female partner's fertility will dictate whether this is a realistic possibility or not. Because it can take up to two years for sperm to return to the ejaculate after vasectomy reversal, at least this much time must be factored into the equation that determines a couple's likelihood of pregnancy through natural conception 7. The not inconsequential number of couples who fail their initial attempt at vasectomy reversal and require a reoperation will also have more years of waiting added to their reproductive timelines, as will the couples who have secondary stricture of the anastomosis who then require revision.
Not all female partners will have the reproductive staying power to tolerate this multi-year delay, and thus a thorough understanding of her fertility potential is warranted prior to undertaking the vasectomy reversal process. The definition of success after vasectomy reversal must be carefully evaluated when counseling patients regarding outcomes. Closer examination of the published literature and actual definition of success, however, is warranted. Couples do not request vasectomy reversal because they simply desire a return of sperm to the ejaculate; the ultimate goal is actually to have a healthy child.
Information regarding pregnancy and live birth rates from natural conception is often lacking in vasectomy outcomes papers, posing a challenge to adequately inform and counsel the couple. While many factors unrelated to the technical success of a vasectomy reversal will clearly inform this particular outcome, the drastic difference between patency rate and natural conception rate should prompt thoughtful consideration of what defines success after a vasectomy reversal.
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One must realistically consider and compare these data. With this frank comparison of outocome data, why even consider surgical vasectomy reversal? For the male fertility expert counseling a couple interested in fertility after vasectomy, sperm retrieval with IVF is the preferred option. Even if vasectomy reversal is initially attempted, the vast majority of couples will require IVF. Vasectomy reversal. Fertil Steril. Female age-related fertility decline. Committee Opinion No. Obstet Gynecol. A vasectomy is a safe and effective procedure that prevents sperm from exiting the penis during ejaculation.
This happens by cutting the vas deferens the long, thin tubes carrying semen that run from the scrotum to the urethra. Simply put, a vasectomy makes a man intentionally sterile, or unable to have children. A vasectomy is a minimally invasive procedure. It is one of the best birth control options out there, and one of the cheapest in comparison to procedures like female sterilization.
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A vasectomy should always be considered permanent. Men who are considering a vasectomy should be sure in their decision to not want more biological children. While there is a procedure that can reverse a vasectomy, called a vasovasostomy, you should avoid receiving a vasectomy with a potential reversal in mind. Sometimes unexpected life events result in the decision to reverse a vasectomy , and if you find yourself in that situation, we can help.
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However, sperm banking can be expensive, so talk with your partner before making a decision. Once the area is completely numb, the surgeon will make two small cuts into the scrotum, and find the vas deferens. After the vas deferens are identified, they will be lifted through the incision site.
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Then, the doctor will simply cut and remove part of the tubes. Finally, the tubes are cauterized and clipped off. Not so bad, right? The small incisions will heal on their own, usually not requiring any additional stitches. Not at all! You will be the same man you were before the procedure—just with no sperm.
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Some men worry that a vasectomy will make them weak, gain weight, lose hair or decrease their sexual drive. Some men even enjoy sex more after a vasectomy, since there is no longer a need to worry about unintentional pregnancies or birth control. To prepare for a vasectomy, refrain from taking medicines like aspirin, or any prescribed blood-thinning medications, for at least one week prior to the procedure.
On the day of the procedure, make sure to shower and thoroughly clean the scrotum. The scrotum will need to be shaved before the procedure, and sometimes immediately after.source
Vasectomy Specialist in Tyler, TX
We also recommend patients eat a full, normal breakfast prior to the vasectomy. You will be sore after your vasectomy, so we recommend taking a few days to rest and recover. Most men prefer to have the procedure later in the week, so that they can use the weekend to rest and not miss work. After two or three days, you should be back to normal. Interestingly enough, a majority of men decide to have a vasectomy before March Madness. Usually around a week after the procedure, you will be able to return to your normal, protected sexual activity.
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