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No-scalpel Microsurgical Vasovasostomy (Vasectomy Reversal)

General Information from Urologist Dr. Carlos Marois in Montreal


Vasectomy

Vasectomy is an operation that aims to block sperm from going into the vas deferens of each testicle (the tube leading to each testicle) which is the conduit through which sperm join the ejaculatory canals during ejaculation through the ureter. Each vas deferens tube is sectioned and ligated. The ejaculate therefore no longer contains sperm. The sperm that is not used degenerates and is progressively destroyed. The intervention is relatively simple, quick and has a low rate of complications.


If You Change Your Mind

Between 2 and 6% of vasectomised men have a change of heart later and would like to be fertile again, despite vasectomy being a permanent contraceptive method. For a long time, it was considered to be irreversible.


Two Possible Options

There are 2 options in the case that you should desire a pregnancy after vasectomy: vasovasostomy (vasectomy reversal) and testicular biopsy associated with intracytoplasmic sperm injection (ICSI).


Vasovasostomy (Vasectomy Reversal)

Vasovasostomy is the method of choice for being able to have children after vasectomy. It has a very high success rate. The other advantage is that the rate of complications is very low compared to other techniques such as in vitro fertilization.


Vasovasostomy (Vasectomy Reversal): Not Always Possible

During a vasectomy reversal, the continuity of each extremity of the sectioned vas deferens tubes is re-established. However, sometimes vasovasostomy is not possible. The vas deferens must then be directly connected to the epididymis (the palpable structure above the testicles where the sperm which is produced in the testicles is stored before being directed into the vas deferens. This procedure is termed vasoepididymostomy. This procedure is more technically complex.


What Are the Success Rates of a Vasectomy Reversal?

This is evaluated by the rate of permeability, which refers to the presence of sperm in the ejaculate. In the literature, the average rate of permeability after a reversal of vasectomy is between 75 and 85%. This differs from the rate of natural pregnancy by about 75%.


The success rate for vasectomy reversal depends on several factors, notably the partner’s fertility and the duration of the vasectomy.


Chances of Conceiving After Vasovasostomy (Vasectomy Reversal)

According to statistics from the American Society of Reproductive Medicine, the chances of conceiving after vasovasostomy are statistically favourable when the reversal is done within 3 years of the vasectomy. The permeability rate is 95% and the pregnancy rate is 75%. Over 15 years, the permeability rate is 70%, and the pregnancy rate is 30%. This is notably due to the fact that with time, the narrow tube surrounded by the epididymis runs a greater risk of being under pressure and being damaged. The increased pressure is mainly due to the flux and constant accumulation of fluids and sperm from the testicles. Though this may not cause any apparent damage, scar tissue can form on the rupture site of the epididymis and represent an extra obstacle on the sperm’s path.


Another statistic reported in the Canadian Urology Journal, CUAJ, in November 2007, volume 1; 4, page 388-393, on the factors that contribute to successful vasovasostomy, clearly showed that there was a progressive reduction in the permeability rate and in pregnancy that was directly related to the time since obstruction after vasectomy (see the following 2 curves).

Rate of pregnancy and the interval since obstruction

Rate of permeability and the interval since obstruction

Age and Conception after Vasovasostomy (Vasectomy Reversal)

The age of the patient generally has little influence on the success rate of vasectomy reversal. Pregnancy after vasectomy reversal however is influenced by the age and fertility of the partner. The rate of pregnancy is not as good (14%) among couples where the woman is over 40 years old; it is 56% for women in the age 25 to 39 range and rises to 67% in the age 20 to 24 range.


Complications

The presence of complications during vasectomy, which generates a considerable amount of scar tissue, can reduce the chances of success when a reversal is subsequently attempted. Trauma to or infection of the scrotum may have the same effect.


It is possible that the patient will not produce sperm after surgery or that he produces anti-sperm antibodies after vasectomy, which can inhibit the spermatozoa’s ability to travel through the woman’s mucus membrane.


The technique used also impacts the rate of success. Vasovasostomy has a better success rate than vasoepididymostomy. That procedure has a low success rate, around the 30 to 45% mark.


Aside from the technique used and the time since vasectomy, the skill of the surgeon is essential to the success of the procedure.


How Long Do You Have to Wait for a Pregnancy After Vasectomy Reversal?

Generally, you have to wait up to 12 months after the reversal to obtain a pregnancy. It can take up to 2 years in some cases for fertility to be re-established after the intervention.


Successful pregnancy after vasovasostomy can be more difficult than before vasectomy, because an extended fibrosis may have developed in the vas deferens or in the epididymis. The quality of the sperm can also change and anti-sperm antibodies can also explain this difficulty.


Preparation

We first discuss the intervention to determine whether vasovasostomy is the most appropriate procedure. We will ask you about your health and perform a physical exam.


It is also important to evaluate the odds of success of the procedure.


After getting clear on all these points, we ask you to sign a form to confirm that you have understood the intervention as well as the possible risks associated with it.


You will abstain from taking aspirin or anti-inflammatory medication for 5 days prior to the intervention and from alcohol on the day of the intervention. It is also recommended to shave the penis and the scrotum the day before the intervention.


Vasovasostomy illustration

The Procedure

Vasectomy reversal can take place in hospital, in short stay or in a private clinic. Hospitalisation is not usually necessary. The surgery is often performed under general anesthetic (you will be “asleep”), but can also be performed under local anesthetic. Sometimes an intravenous sedative is administered. We ask you to fast for a few hours before the surgery.


An anxiolytic is administered upon arrival. The vas deferens is isolated by a skin incision smaller than 1 cm. The scar tissue of the ligated tube is re-sectioned in order to get a clean section. After, we check the repermeability potential on the side of the epididymis, by examining the liquid that comes out of the sliced canal under the microscope.


Two incisions will be made in the scrotum. The incision is usually longer than the first that was made during vasectomy to expose the two sides of the vas deferens and join them adequately. During the operation, if the tube is in good enough condition to allow the flow of a sufficient amount of sperm, a vasovasostomy is performed. Surgery is conducted under a high resolution microscope. The 2 tubes are then sewn back together using very fine thread, almost invisible to the naked eye, using 10X to 40X visual magnification. The procedure can take up to 2 hours given its complexity and the use of magnification.


Occasionally, the vas deferens can be too scarred to allow for an adequate flow of sperm. In this case, we must perform a vaso-epididymostomy.


Possible Complications

The risk of complications is very low if the intervention is performed by a surgeon with training in vasovasostomy. Nevertheless, there can occasionally be wound infection, scarring problems, and, more rarely, hematoma.


Vasovasostomy rarely engenders serious complications. The most common complaint after the intervention is ecchymosis on the scrotum. An infection can occur, but you will receive a dose of antibiotics before the intervention. A secondary obstruction can also occur, causing azoospermia (zero sperm count).


Affordable Prices to Make Vasectomy Reversal More Accessible

You are outside of the province of Quebec and you have questions concerning your insurance coverage? Call us today. Numerous satisfied patients have come from Alberta and all across Canada to our offices in Montreal. Call Urologist Dr. Carlos Marois for more information and to discover our prices.

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