Is it really possible to reverse a vasectomy?
Vasectomy reversal is not only possible but is highly successful when performed by an experienced male infertility micro-surgeon. Unfortunately, other doctors without these special skills will often attempt to perform the surgery themselves, rather than referring the patient to a male infertility specialist. To have your best chance for success, you should see a specialist.
As a patient, you will need to make sure that your doctor performs the procedure regularly and successfully. A good idea is to ask to speak with some of his patients that have already undergone the procedure.
Studies have shown that the outcome of surgery is so dependent on the surgical technique and the surgeon who performs it that it is well worth making the extra effort in going to a specialized center. Although failed vasectomy reversals can be repaired, the first attempt at reversal is the easiest, most cost effective and affords the best opportunity for success.
What is the success rate for vasectomy reversals?
The results of vasectomy reversal are reported as two percentages. The first is patency rate, or the percentage of men who have sperm restored to the ejaculate after reversal. This means that the operation was technically successful, and is commonly known as the vasectomy reversal success rate.
The second statistic reported is the pregnancy rate. The pregnancy rate is always lower than the patency rate because many more factors play a role in getting pregnant beyond the return of sperm in the ejaculate.
The results of microsurgical vasovasostomy from the Vasovasostomy Study Group data are greater than 90% patency if sperm were present in the vasal fluid at the time of surgery, and pregnancy rates up to 76%.
This is the study quoted by most surgeons when asked about results of vasectomy reversal.
Dr. Werthman’s personal results to date are an over 98% patency rate (sperm restored to the ejaculate) if sperm were present in the vasal fluid at surgery. This data is from the last 1000 vasectomy reversals performed by Dr. Werthman.
Don’t you need to check to see if I am still making sperm after my vasectomy?
Men continue to make sperm regardless of how long it has been since the vasectomy unless other factors come into play. Some of those include injury to the testicles, exposure to chemicals or toxins, and certain serious medical problems. Barring any of these situations, no investigation need be undertaken prior to a reversal to assess sperm production.
Some older physicians are still performing testicular biopsies prior to vasectomy reversal. This is no longer recommended or necessary.
It has been a long time since my vasectomy; can I still get it reversed?
It is definitely true that the closer you are to the time of your vasectomy, the easier it will be for us to reverse it. However, in the hands of a skilled micro-surgical specialist who is experienced in vasectomy reversal, even men who have waited 15 years and longer since their vasectomy can enjoy a complete reversal and fatherhood.
The latest study to look at success rates of vasectomy reversal performed 15 years or more after vasectomy (published in Fertility and Sterility, March 2002) shows that the pregnancy rates for intervals 15-19 years, 20-25 years and greater than 25 years are 49%, 39%, and 25% respectively.
The Los Angeles Times Health Section recently ran an article on the increased success of vasectomy reversal for vasectomies more than 15 years old.
Dr. Werthman has helped a man father a child 57 years after his vasectomy, the oldest on record.
My urologist did a vasectomy reversal, but it hasn't worked. Can it be re-done successfully?
Because a vasectomy reversal has failed does not mean all hope is lost. Re-doing the surgery using meticulous and proper technique can produce success in more than 80% of cases.
At the Center for Male Reproductive Medicine, we specialize in re-do vasectomy reversals. 10% of the reversals we perform are re-operations on patients who had failed surgery elsewhere. Dr. Werthman currently performs two to four vasectomy reversals per week.
More than half of our patients travel from outside the Los Angeles area for treatment, so we are fully prepared to help with all the information you require, as well as with accommodations.
Typically, patients stay in Los Angeles for 2-3 days. Dr. Werthman will perform the initial evaluation a day prior to the procedure, and you will be ready to return home one day after the procedure.
We offer patients all the possible options to get pregnant, as well as combinations of treatments. That way, you can choose what is best for you, not what we might want you to do because of our own limitations.
Won’t sperm antibodies keep my wife from getting pregnant, even after a vasectomy reversal?
It is actually unlikely that this would be an issue for you. Most patients do not have antibodies present on their sperm after a vasectomy reversal, and most couples don’t have a problem getting pregnant after vasectomy reversal because of antibodies.
Antibodies are small molecules that the body produces to fight off infections and other substances that the body thinks don’t belong. The antibodies stick to the invader and help destroy it.
Sperm are made in the testicle and shielded from the immune system such that in the normal situation the body doesn’t even know they are there. When a man has a vasectomy, the vas is cut and the sperm may leak out. This could allow the body to “see” sperm for the first time. The body’s natural reaction is to produce antibodies to try and kill the sperm.
If we measured the blood of men who underwent vasectomy then we could detect antibodies to proteins located on sperm in the blood of 70% of these men. While this number seems very high, it is somewhat meaningless. The reason is that only antibodies measured on the sperm themselves, not in the blood may play a role in hindering pregnancy.
A recent study published in the medical journal Urology showed that it was actually a partial blockage of the vas after the reversal that was responsible for poor sperm quality, and not anti-sperm antibodies. When the reversal was fixed, the patients got pregnant in most cases. So, while antibodies can cause problems for some patients, they are clearly not responsible for most cases of post-vasectomy reversal infertility.
My wife is over 37, is there really any point in getting my vasectomy reversed?
Yes, there is. While a woman’s fertility does start to decline when she is in her thirties, many women can still conceive into their forties. The pregnancy rates for women ages 36-40 and greater than 40 years old whose husbands underwent vasectomy reversal are 32% and 28% respectively. (Fertility and Sterility, March 2002)
The pregnancy rates for any fertility enhancing procedure are related to the female partner’s age. While in-vitro fertilization does give the opportunity for the quickest way to conceive in a given cycle, the success rates per cycle for women over 37 decrease dramatically to less than ten percent for women over 41.
The oldest woman to conceive whose husband we treated with vasectomy reversal was 47 and the oldest woman to deliver a baby was 44 at the time when the reversal was performed.
With ICSI (IntraCytoplasmic sperm injection) only a handful of sperm are needed, why should I have a vasectomy reversal?
Both vasectomy reversal and ICSI/sperm aspiration are good alternatives to father a child after vasectomy. They each have advantages and drawbacks.
In most situations, vasectomy reversal offers the greatest chance for pregnancy. It requires one procedure to be performed only on the man and couples can then try to get pregnant every month the old fashioned way using “IBF” or what we call “in-bed fertilization.” ICSI on the other hand requires that both partners undergo a procedure. The woman is stimulated with fertility drugs to treat what is really a “male problem.”
The costs of establishing a pregnancy are three times greater with ICSI than with vasectomy reversal. It is even less expensive to have a vasectomy reversal and a repeat vasectomy (if desired) than to have ICSI. The advantage of ICSI is the possibility for some couples to establish a pregnancy quicker than with vasectomy reversal.
We recommend ICSI/sperm harvesting in those situations where vasectomy reversal would be difficult or impossible, the female partner is of advanced reproductive age, or when there is also a female factor contributing to the infertility. Each couple's circumstances are unique and need to be addressed on an individual basis. Our goal is to assist couples in having a child of their own, regardless of the path they choose.
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