Vasectomy Reversal Success

The new data:

All comers 50% success rate. 

All patients 7 years or less since their vasectomy 76.9% success rate.  

All procedures done in office under local for less that $5000 total cost.   

Peri and post procedure sperm banking now available as well.  

Contact me now for more information.  

Practice makes better if not perfect.

I am definitely unusual.  Definitely unique. I have a microsurgical practice and training facility in my office.  I use it to hone my own skills and to train others in the technique of microsurgical vasectomy  reversal.  Does it cost me a lot of money?  You bet.  Why do I do it?   Because I don't want to practice on you.  For you, I want to be at my best.  Practice is how I get there.

Want to know more about a vas reversal?

Want to know more about a vas reversal?

Richard A Schoor MD 

Doing the anastomosis

Anybody can suture point A to point B, and doing just that is usually sufficient for the majority of surgical procedures. But vasectomy reversals require precision matched only by coronary bypass surgery to be effective. Please forgive me as I don't mean to belittle the life saving work that CT surgeons do by comparing them to me, namely a guy that performs vasectomy reversals, but good technique is good technique. Here are some key elements:

• High Power Microscopic Surgery: if you can't see the mucosa, you can't line it up properly
• Mucosa to Mucosa Apposition: the mucosa of one end of the vas, which is the lining of the tube, must be sutured to the mucosa of the other end of the vas. Suturing the mucosa to the muscular layer, which surrounds the mucosa, will look good to the nursing staff in the OR, but won't result in a patent anastomosis.
• Water Tight: the anastomosis must be water tight, or free of any leakage at all. This is distinct from a vascular anastomosis since the vascular system has platelets and other compounds that will "tighten the seal" automatically. The vas deferens relies on the surgeon to do all the work.
• Tension free: this is a basic tenet of surgery and certainly applies to vasectomy reversals as well. Any tension at all will cause a failed anastomosis.
• Perpendicular Cuts: prior to performing the anastomosis, the microsurgeon needs to "prepare" the 2 ends of the vas deferens by cutting them to create perfect ovals. I use a nerve clamp that enables me to cut the vas with a perfect perpendicular cut.
• Fine Suture: Anything larger than 9-0 for the mucosa is too big. As a general rule, if you can see the suture with your naked eye, it is too large for a vas deferens.
• Atraumatic: the vas deferens must be grasped, sutures must be placed, and the anastomosis must be stabilized in an atraumatic way. To facilitate this, I use special vasal approximators and jewelers forceps and I "line-up" the mucosa so my first throw--suture placement attempt--is my only suture placement attempt. Repeated attempts will cause edema and likely lead to ultimate failure.

Thanks for listening and I hope you enjoyed the post.

The IU.

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 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.

Vas reversal, part 2

This is part 2 of a series on vas reversals. In part 1, we discussed a little bit about the procedure and about how to select a vas reversal specialist. In this post, I’d like to discuss why you may want to consider a vas reversal over other forms of assisted reproduction aimed at your wife. Here is why.

First, you had the vasectomy. Your wife did not. By asking her to undergo in-vitro, you are essentially asking her to assume the risks of IVF related complications for what amounts to your condition. While most, if not all wives, are willing to do this, many husbands feel uncomfortable asking them to make this sacrifice.

Second, it costs less money to have a vas reversal. Plain and simple. The typical cost of a vas reversal is between $7000 to $10,000 dollars, which includes the surgeon’s fee, the anesthesiologist’s fee and the hospital/facility fee. It is a one time fee, and when successful--90% chance--can result in multiple pregnancies. Now consider IVF--in-vitro fertilization. One round of IVF costs anywhere from $12,000 to $20,000. And this is per attempt. Each attempt has a 25% to 30% chance of resulting in the birth of a bay 9 months later. Even the in the best of the best groups, 25% to 30%. Therefore, in all likelihood, you will need to pay $25000 to $50,000 to have a baby. There is no comparison. In skilled hands, the vas reversal is the cheapest, most cost-effective, way to go.

It is that simple. Contact me for any questions. And if you choose me for the vas reversal, I’ll pick up the tab for the first $100 dollars worth of baby clothes at Baby’s R Us.

The vasectomy reversal, part 1

Ten percent of men who have had vasectomies will, at some point in the future, decide to have a vasectomy reversal. If you are considering whether you want to have a vas reversal, you may wish to read the following.

1: All vas reversal doctors are not created equal. The vas reversal is a very challenging procedure that requires a high degree of technical expertise in order to maximize success rates. When choosing a reversal specialist, you may want to choose someone who has done many vas reversals and has specific advanced training in microsurgical technique.
2: “With the right tools, any job is easy.” This is something that my father-in-law likes to say. When it comes to vas reversals, it is certainly true. Experienced vas reversal specialists have their own special tools and instruments. The instruments are extremely delicate and fragile, so we keep them in protective cases and do not let other surgeons borrow them. Ask your surgeon to show you his instruments.
3: Success rates vary depending upon several factors. Perhaps the most important factor is obstructive interval--how many years have passed since the vasectomy was performed.
4: The vas reversal essentially involves “re-routing” the pipes. Re-connecting the vas to itself is known as a V-V, and has a > 90% success rate. Occasionally, due to a variety of factors, the surgeon will need to connect the vas to the epididymis--a procedure known as an E-V. The E-V has a ~70% success rate.
5: Success is defined a sperm returning to the ejaculated semen within 1 year after the vas reversal. Ideally, natural pregnancy follows. In cases where natural pregnancy does not ensue, couples still have the option to proceed with assisted reproduction, often in the form of a low cost artificial insemination.

If you any questions, please feel free to contact me.