The Vasectomy Reversal Part 4: Patency Factors

The vas deferens is a relatively large pipe, but the its lumen--the actual tube that carries the sperm--is very small. The goal of a vas reversal is to re-connect that tiny tube and ensure that it remains open, or patent,as we say in medical jargon. Here are some factors that influence success.
1: Obstructive interval--this refers to how much time has passed, in years, since the vasectomy was performed. In general, the shorter the better, but success rates for vas reversals performed up to 9 years after the initial vasectomy still reach into the 90% range, for skilled surgeons. Patency rates tend to dip a bit after the 9 year mark, but remain high, ~70%. Vas reversals have successfully been performed on men with 20 years long obstructive intervals!
2: Vasal fluid inspection: During the vas reversal, after identifying the were the vasectomy was performed, the surgeon opens the vas deferens and examines the fluid that leaks from the open tube. The fluid is inspected for a number of factors, and whether or not the fluid contains sperm is the most important prognostic indicator that the vas reversal will be successful.
3: The location of the anastomosis--when the surgeons re-connect the 2 ends of the vas, that connection is called the anastomosis. Anastomoses performed at the level of the vas have higher patency rates than when the vas is connected to a site closer to the testicle, such as the epididymis, the tube that sits on top if the testicle.
4: Technique: The microsurgical approach using very fine suture material and adherence to strict surgical technique will give the best results. The anastomosis must be perfectly water tight and under no tension or the anastomosis is sure to eventually fail.

As always, any questions, please feel free to contact me.

The Lancet varicocele study.

Varicoceles cause male infertility and varicocele repair improves outcomes. I agree with the comments of Drs Ross and Benoff. The study is flawed.

The Vasectomy Reversal Part 3: Patient Selection

This is part 3 in my series on vas reversals and will deal with issues pertaining to patient selection. When I see a patient who requests a vas reversal, I want to know several things.
1: How old is his wife? This is actually the first question that I ask, since advanced maternal age is the most difficult of all conditions to overcome from a medical standpoint. Men whose wives are in their late 30’s or early 40’s may want to consider proceeding directly to IVF with a sperm aspiration, since time is of the essence in these cases. In other words, the clock is ticking.
2: The medical history. The obstructive interval--how long has it been since the vasectomy--and the man’s overall health are important factors for consideration prior to committing to a vas reversal. In addition, certain physical exam findings may have important implications for a successful outcome and may influence the vas reversal specialist one way or another.
3: Patient preference. Some patients are opposed for a variety of reasons, be they religious, cultural, or philosophical, to assisted reproduction and feel that reversing the vasectomy restores the couple to a “more natural state.” After providing the couple with a proper informed consent, ultimately, I let them decide.
4: Insurance issues: While no one may like to admit it, insurance coverage almost always plays an important role in a couple’s decision to proceed or not with a vas reversal, especially in Suffolk County, Long Island, where I practice urology. Despite the fact that a vas reversal is the most cost-effective approach, if insurance will cover 1 or 2 cycles of IVF, and nothing for a vas reversal, the couple in general will opt for IVF. Occasionally, insurance will only cover IVF after a failed vas reversal, so patients choose the reversal for this reason. When I counsel patients, I rarely know ahead of time the insurance factors, and I give the couples my best advice given the man’s medical history and the woman’s age, then the couples decide. Usually, insurance issues prevail in the ultimate decision.

Thanks for reading. If you have any questions, as always, just contact me.