REVERSAL VASECTOMY (MICROSURGICAL VASOVASOSTOMY)
Our aim is to help a couple achieve a live birth. Successful outcome depends on the quality of surgery performed but also the overall assessment of the male having the surgery and his partner`s fertility status. As certified fertility specialists with extensive artificial reproductive treatment experience we will provide you with an unbiased opinion on the likely success rates for conception following reversal surgery or IVF.
Sperm collection and freezing services can be provided at the same time as reversal surgery.
We perform microsurgical rejoining of the vas using a superior minimally invasive technique. In contrast to conventional reversal procedure through a large scrotal incision and exteriorising the testicle, we rejoin the vas with a two layer watertight microsurgical anastomosis via a one centimetre incision. The tied off ends are identified and reopened. The vas opening which is less then ½ millimetre diameter is rejoined with sutures that are hardly visible to the naked eye. The technique requires use of an operating microscope to view the vas ends, magnified up to 20 time’s normal vision. The procedure to rejoin both vasa takes one to two hours to perform by a surgeon and assistant and is usually performed under general anaesthesia.
The advantages of this technique over conventional methods include:
- Minimally invasive approach
- Meticulous double layer rejoin using very fine sutures
- Small incision and no need for a drain
- Day surgery with same day discharge
- Rapid recovery and return to work
- Reduced pain and post operative complications
- Reduced costs
A personal series of 120 men followed up for up to 3 years has demonstrated the presence of sperm in the ejaculate following surgery in 90 % (the success rate is therefore 90%).
50 % of these men had a child following the procedure (with varying intervals between having had a vasectomy and a reversal) .
FACTORS WHICH INFLUENCE SUCCESSFUL OUTCOME
INTERVAL BETWEEN VASECTOMY AND REVERSAL
The increase in pressure which results from tying off the vas is transmitted to the much finer and thin walled duct which attaches to the vas called the epididymis. After variable periods of time but more commonly 10 years following vasectomy this duct may dilate causing a “blowout” or rupture . Because it is a single duct, sperm will no longer reach the site where vasectomy was performed. Rejoining the vas under these circumstances will not be successful as ruptures are usually bilateral. Ruptures rarely cause symptoms and are not easily diagnosed by examination or imaging. Finding spontaneous flow of fluid when the vas is open at reversal is a good but not absolute prognostic sign for successful outcome. The presence of live sperm in the fluid of the opened vas is the best finding for success.
Particularly in the first two years after vasectomy it is not unusual to find the presence of “antibodies” to sperm in blood tests. When persistent in high levels in later years they may interfere with sperm function by causing sperm to clump or stick together following ejaculation thus interfering with their ability to fertilise oocytes (the females eggs). Tests on ejaculated sperm give the best indication of the significance of sperm antibodies and overall their presence is not a contraindication to surgery. The majority of reversal surgeons are not currently carrying out antibody tests.
As demonstrated by the use of post vasectomy collected sperm for IVF purposes, the quality and normal fertilising capacity of sperm following vasectomy declines proportionally to the length of time following vasectomy. This again is a variable phenomenon as we have personal experience of males easily achieving pregnancies following reversal procedure 17 years after original vasectomy.
OFTEN ASKED QUESTIONS
“How do I know if the operation has been successful?”
If pregnancy has not occurred within 3 months semen analysis is performed to demonstrate that viable sperm are present in the ejaculate.
“How long does it usually take to be successful?”
Most pregnancies occur in the first year following surgery. In situations when sperm counts do not return to normal a longer interval of time may be required.
“What complications can occur?”
Complications are the same as for the original vasectomy procedure. These will be discussed prior to the procedure. Instructions that will guide you postoperatively will be given to you on discharge.