Vasectomy Reversal Surgery India
High rate of successful vasectomy reversals is a reality, but only in the hands of a highly skilled and experienced microsurgeon. Study after study confirms that the absolute best predictor of the success of a vasectomy reversal is the skill and expertise of the microsurgeon performing the reversal.
Vasectomy Reversals have become a fairly common procedure over the past twenty years due to dramatically improved success with microscopic techniques. Only two conditions must be satisfied for sperm to be returned to a patient's semen with vasectomy reversal. The patient must have sperm available to pass through the reconnection and also the reconnection must be essentially watertight. The surgeon's goal is to achieve a very precise circumferential reconnection of the sperm canal edges by using meticulously placed microsurgical sutures.
What is Vasectomy Reversal?
Vasectomy Reversal is a microsurgical procedure to restore the flow of sperm through the vas deferens. In a vasectomy procedure, the vas deferens is cut and clamped. A vasectomy reversal involves removing the clamps and stitching the vas deferens together again.
Vasectomy Reversal pricing varies by country and region. Vasectomy reversal cost anything between $4000 and $20000 but can be lowered by $1-2k if it can be done as outpatient surgery (not possible in all types of Vasectomy Reversals).
Vasectomy reversal is the most cost-effective way to achieve pregnancy for most couples when the male partner had a prior vasectomy. Regardless of how many years have passed since the vasectomy, as long as there is no female factor impairing fertility such as endometriosis, polycystic ovaries and age over 40, micro-surgical vasectomy reversal in experienced micro-surgeons hands is proven to be the most cost effective way to achieve a pregnancy.
Vasectomy Reversal success rates depend on how long ago the original vasectomy was performed. The longer the time the greater the chance of blockage or damage to the vas deferens. About 97% vasectomy reversals result in return to normal sperm counts and 50% of cases resulted in pregnancy. However, if the vasectomy occurred 15 or more years then the figures drop significantly.
Vasectomy Reversal and Pregnancy - It takes at least 12 months after Vasectomy Reversal before your partner has a chance of becoming pregnant and most pregnancies occur 2 years after the vasectomy reversal.
How is Vasectomy Reversal Performed?
With the patient under local or general anesthesia, a 1-2 inch incision is made in the scrotal skin over the old vasectomy site. The two ends of the vas deferens are found and freed from the surrounding scar tissue. A drop of fluid from the testicular end of the vas is placed on a glass slide and examined using a light microscope. Since the testicle continues to produce sperm after a vasectomy, the fluid in the vas should contain sperm. There are 3 possible scenarios that may be encountered when examining the vasal fluid. The first, most common, and best scenario is that the vasal fluid will contain whole sperm. The second possible finding is that the fluid is thin and contains only sperm parts or no sperm. The third is that the fluid is thick, pasty and contains no sperm. The consistency is something like toothpaste. This last scenario usually means that a "blow out" or rupture has occurred in the epididymis. Sperm leak out if the pressure in the tubule becomes greater than the resistance in the wall of the tubule; similar to the way a pipe breaks in the basement when the water pressure gets too high. The body tries to heal this tubule and a scar forms. This causes a second blockage in the epididymis, which will need to be bypassed to allow the sperm to get out into the vas. If this second blockage is present and is not recognized, then the operation is usually not going to be successful.
Vasectomy Reversal - Common Myths & Misconceptions:
Myth #1: Men stop making sperm after a vasectomy
Fact: Men continue to make sperm regardless of how long it has been since the vasectomy unless other factors are involved. Some of those include injury to the testicles, exposure to chemicals or toxins, and certain serious medical problems. Aside from these situations, no investigation need be undertaken prior to a reversal to assess sperm production. Some physicians recommend and perform testicular biopsies prior to vasectomy reversal, but this is no longer considered to be necessary under most circumstances.
Myth #2: Vasectomy reversals don't work after 10 years.
Fact: This is a common misconception that I have heard by both gynecologists and urologists who don’t perform many vasectomy reversals. This misconception is based on older studies of vasectomy reversal prior to the refinement of vasoepididymostomy surgery. Back then; all patients who had a vasectomy reversal underwent a vasovasostomy even if they had a second blockage in the epididymis. Obviously a vasovasostomy will generally fail if the blockage is not addressed. Success rates for older vasectomies have increased dramatically with the advent of the refined vasoepididymostomy and new microsurgical techniques. A 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.
Myth #3: Even if sperm are present after a vasectomy reversal, your wife won't get pregnant because of anti-sperm antibodies.
Fact: Antibodies are small molecules that the body produces to fight off infections and other substances that the body believes do not belong. The antibodies stick to the invader and help destroy it. What does this have to do with sperm, you might ask? Sperm are made in the testicle and shielded from the immune system so in the normal situation the body doesn’t know they are there. When a man has a vasectomy, the vasa are cut and the sperm may leak out if the ends of the vas are not properly closed. The body’s natural reaction is to produce antibodies to try and remove the sperm. If we analyzed the blood of men who underwent vasectomy then we potentially would detect antibodies to proteins located on sperm in the blood. Only antibodies measured on the sperm themselves, however, not in the blood play a role in hindering pregnancy. 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. A partial blockage of the vas after the reversal usually appears to be responsible for poor sperm quality and not anti-sperm antibodies. While antibodies can cause problems for some patients, they are clearly not responsible for most cases of post-vasectomy reversal infertility.
Myth #4: You shouldn't have a vasectomy reversal if your wife is over 37.
Fact: While female fertility does start to decline when a women is in her thirties, many women can still conceive into there forties. The pregnancy rates for women ages 36-40 and greater then 40 years old whose husbands underwent vasectomy reversal are 32% and 28% respectively.
Myth #5: In-vitro fertilization is a much better alternative to vasectomy reversal.
Fact: One problem that a patient is faced with when there are two reasonably good treatments for the same condition is which one to choose? Both vasectomy reversal and in-vitro fertilization with sperm harvesting and intracytoplasmic sperm injection yield good results. In fact, the overall pregnancy rates for IVF and reversal (taking in to account all patients and female ages) are almost identical, but the overall cost of IVF is substantially greater per pregnancy. Of course, there is that thing of having to go and get the sperm for this process, a procedure no man would voluntarily embrace.
We believe in giving couples all their options and having them choose what is best for their own situation. IVF may make more sense than freezing and storing sperm. We frequently hear from patients who see female fertility specialists that vasectomy reversals do not work. This is plain and simply not true. They are then convinced to undergo an IVF cycle based on false or inadequate information. While there is nothing wrong with choosing IVF, it should be because you had the opportunity to evaluate accurate information and make an informed decision.
Myth #6: If you only want one more child then In-vitro is a better option than vasectomy reversal and than having a vasectomy again.
Fact: Vasectomy reversal is usually a better option for couples wanting only one more child. Actually, this probably describes the desire of most people who elect vasectomy reversal in the first place. Couples are often told to have IVF rather than a reversal and another vasectomy. This is usually very appealing to the husband but not so for the wife who has to go through the injections and egg harvesting procedure. The truth is that it is still way less expensive to have a reversal. If a repeat vasectomy is desired, this is usually a quick 10 -minute office procedure. Remember that it will take time to conceive and carry the pregnancy to term so most men won’t need another vasectomy by the time it is all over, even if it is something they think they will.
Myth #7: I should have my vasectomy reversal performed by someone who only performs this procedure.
Fact: This question is a little misleading. Specializing in vasectomy reversal as opposed to doing nothing else is probably a better question. I feel it is important that a surgeon have and maintain full staff privileges with a hospital. Most Urologists feel the same way although no one really likes to take call. In order to maintain full staff privileges, a physician is required to take one’s share of the emergency call for his or her specialty. There are not many emergency vasectomy reversals being performed that I am aware of and it is important to be competent taking care of all urological emergencies if that is what you are on call to do. If you should need to be hospitalized for any reason, it is also important that your urologist be able to do this for you rather than having to send you to someone else you do not know. A physician can loose his or her staff privileges for many reasons, and this may be a greater reason for you to have further concerns
The pros and cons of vasectomy reversal:
If a vasectomy reversal is successful then it can lead to natural conception which for most couples is more desirable, cost effective and certainly a lot more fun! It requires only one procedure be done and then most people are on their way. Reversal is usually much less expensive than a single cycle of IVF when all expenses are added up. Total costs are at least three times higher to deliver a child with IVF versus the average cost for a vasectomy reversal. The cons of reversal are that it doesn’t always work, some men don’t want to have a reversal and that it may take some time to conceive after a reversal. The mean time to pregnancy is about 12 months following a reversal but this is distributed on a bell shaped curve so some people will get pregnant sooner and others later than 12 months. This wait can be frustrating for many couples and it is easy to become discouraged. I have also had one patient go to another urologist who was closer to his home for a semen analysis and be told that he was sterile and needed to have the procedure repeated. I elected to refer him to a reference laboratory for a neutral reading, as his wife was most upset. The analysis returned with a count of 80 million sperm, but coincident with this report, he informed me that his wife was already pregnant. Fortunately, this was one of my earliest pregnancies, which further helped to improve his wife’s disposition.
Vasectomy Reversal - Success Rates
The results of vasectomy reversal are reported as two percentages. The first is patency rate; that means the percentage of men who have the return of sperm in the ejaculate after reversal. This means that the operation was technically successful. 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 other that the return of sperm in the ejaculate. The results of microsurgical vasovasostomy from the Vasovasostomy Study Group data are >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.
For microsurgical vasoepididymostomy the patency rate is over 60% and the pregnancy rate is 40%. Data collected by the Vasovasostomy Study Group (the largest multicenter study of vasectomy reversals, published in 1991) showed a distinct increase in success rates when the surgery was performed using an operating microscope by a skilled micro surgeon as opposed to utilizing loop magnification.
Cost of Vasectomy Reversal
Vasovasostomy costs vary greatly from location to location and from physician to physician. As with most services, the higher the volume, the lower one can afford to charge for the individual service. This is not to say that the costs are not substantial, but this procedure can be performed effectively and expertly for a reasonable out of pocket cost, including the travel cost associated with coming here for this procedure. The suture material alone that we use for this procedure can cost several hundred dollars. This as with other sterilization and disposable costs, are included in our fee. Many surgeons also utilize an add on code for the use of a surgical microscope. This may hide some of the obvious cost of the procedure initially. Then there is also the cost of the initial consultation and any follow-up visits. All are included.
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How success is the vasectomy reversal surgery?
Vasectomy reversal surgery is more successful if it's done fairly soon after the original vasectomy. About eight out of ten men are able to father children when their vasectomy is reversed within five years. The success rate falls as time goes on. Even if the operation is technically successful, the presence of sperm in your semen doesn't guarantee that your partner will get pregnant. Other factors that can affect your result include:
The time since your vasectomy
The type of vasectomy being reversed
The type of technique used to do the reversal
A problem with another part of the reproductive system
The presence of sperm antibodies
Your partner's age and her fertility