Overview

Approximately 500,000 men choose vasectomy each year as a permanent form of contraception. Between 2-5% of these men will desire to have their fertility restored through vasectomy reversal. Fortunately, success rates of vasectomy reversal are very high when performed by a fellowship trained urologist using a surgical microscope.

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Why is Fellowship Training Important?

A fellowship is additional training in a very specific area that a physician chooses to pursue after completion of residency. For example, most male fertility specialists have completed a 5 to 6-year urology residency and then a 1 to 2-year andrology fellowship (male fertility fellowship). Fellowship trained male fertility specialists are very rare, making up approximately 1% of U.S. urologists.

During this fellowship, the urologist becomes proficient at microsurgery. This is important when discussing vasectomy reversal because success rates depend on the training and precision of the urologist. During a microsurgical vasectomy reversal, numerous tiny stitches finer than a human hair are used to create the reconstruction. This is very time consuming and tedious, but helps to create a very secure reconstruction with minimal trauma to the surrounding tissues.

There are several advantages of using an operating microscope to perform a vasectomy reversal. For instance, the microscope allows for significant magnification which permits the surgeon to use stitches that are difficult to see with the naked eye. Not only does it allow the surgeon to work with tiny stitches, but it also helps the surgeon make sure the stitches are placed correctly to avoid kinks and gaps in the reconstruction. Lastly, and probably most importantly, the microscope allows for the more complex reconstruction when needed.

(Dr. Jared Moss completed a 5-year urology residency at University of Tennessee-Knoxville followed by a 1-year Andrology (male fertility) fellowship at Northwestern Memorial Hospital in Chicago, IL).

What Type of Reconstructions Are Possible?

There are two types of reconstruction: Vasovasostomy (V-V) and Vasoepididymostomy (V-E). Unfortunately, it is NOT possible to know prior to the surgery which type of reconstruction will be required.

To determine which reconstruction will be required, the physician will sample fluid from the end of the vas deferens that is closest to the testicle during the surgery to examine the quality of the fluid. If the fluid is favorable, meaning the fluid is clear or contains sperm/sperm parts, then the traditional V-V reconstruction is performed.

During a V-V, the surgeon bypasses the prior vasectomy site and connects healthy vas deferens above the prior vasectomy site with healthy vas deferens below the prior vasectomy site.

If the physician samples the fluid from the vas deferens and it is unfavorable (pasty or has no sperm/sperm parts), then the patient will need the more complex V-E reconstruction. In this scenario, the patient has likely developed a secondary obstruction upstream from the prior vasectomy site near the testicle. This is thought to be related to increased pressure overtime. Men who are greater than 10 years out from vasectomy are at higher risk for secondary obstuction and needing a V-E reconstruction.

During V-E reconstruction, the vas deferens above the prior vasectomy site is brought down to the epididymis (area off to the side of testicle where the sperm mature). The vas deferens is then very carefully connected to a single tiny epididymal tubule. This reconstruction is NOT possible without a microscope.

It is very important for patients to know in advance whether their physician is microsurgically trained and capable of performing the more complicated V-E when needed. If a patient needs a V-E and only receives a V-V, the operation will not be successful.

Surgery

Pros for vasectomy reversal: typically restores natural fertility, high success rates in appropriately selected couples when performed microsurgically, allows for multiple children over time, lower risk for multiples (twins), typically less expensive than IVF, and natural pregnancy is possible.

Cons for this approach include: requires general anesthesia, couples may need to proceed with insemination (IUI) or IVF if reconstruction is unsuccessful, average time to pregnancy after reversal is approximately 1 year, and requires contraception or repeat vasectomy after finished having children.

Success Rates

Regarding vasectomy reversal success, couples must understand the difference between patency (sperm returning to the ejaculate) and pregnancy.

Patency rates for vasectomy reversals are approximately 90% when performed with an operating microscope and when the preferred vas to vas (V-V) reconstruction is possible on at least ONE side. Pregnancy rates with this approach range from 40-70% dependent on multiple factors including female reproductive issues and age.

Sometimes the complicated reconstruction, the vasoepididymostomy (V-E) is required. Patency rates for this approach (when a V-E is needed on BOTH sides) are approximately 66% and pregnancy rates typically range from 30-50%, depending on female factors.

Unfortunately, there is no way to know prior to surgery which approach will be needed.

Other Options

In Vitro Fertilization (IVF)

It is important that couples understand that vasectomy reversal is NOT the only option to father children after having a vasectomy. Other options include testicular sperm extraction (TESE) and in vitro fertilization (IVF).

IVF is a procedure that is performed by a Reproductive Endocrinologist. Briefly, sperm are extracted (TESE) from the man’s testicle(s) with a small outpatient procedure. The female is placed on injectable hormones for several weeks and then has a small outpatient procedure to extract her eggs. In the lab, the sperm are either injected into the egg or mixed with the egg. The embryos are then incubated in the lab and transferred back to the female’s uterus at a later date. Follow up testing is required to determine if there is a viable pregnancy.

Pros for this approach include: minor procedure to get sperm from testicle, may be a more direct route for couples where time is of the essence, high success rates in appropriately selected couples (dependent on female age), and may be a great option for couples that only desire one child.

Cons for this approach include: injectable hormones for the female, outpatient procedure to retrieve her eggs, higher risk for multiples (twins), typically more expensive, and potential ethical issues for some couples regarding leftover embryos.

Success rates: 50% to 60% pregnancy rate per cycle with approximately 45 To 50% live birth rates. Live birth rates are typically higher for younger female patients and first IVF cycles. These are very general guidelines. For patient specific numbers, the couple would need to set up an appointment to be evaluated by a female reproductive specialist. We are happy to arrange these referrals as needed.

If you would like more information regarding other options, we are happy to arrange a consult with a female fertility specialist.

What About the Cost?

Regional Urology offers very competitive pricing. This procedure is typically NOT covered by insurance and we offer package pricing (cost of general anesthesia, surgical supplies, and surgeon fee).

This is generally less than the cost of sperm extraction (TESE) and in vitro fertilization (IVF).

We encourage patients to inquire about pricing before or after their initial consultation to get the most up to date pricing package. Financing options are available through our financial institute partners. 318-683-0411.                 

 

There are certainly physicians who offer vasectomy reversals at heavily discounted prices, but these physicians may not be urologists, be capable of performing a V-E when needed, or use an operating microscope.

What If I Am Not From The Area?

We are more than happy to work with folks outside the area! In this scenario, we would ask the patients to call the office and let us know if you are from out of town and you are interested in discussing vasectomy reversal.

The office will then set up a free phone call with Dr. Moss to discuss the surgery. We prefer that this type of visit be reserved for patients greater than 3 hrs travel distance.

If you decide to proceed, we would like you to be in Shreveport at least 24 hours prior to procedure. Dr. Moss requires an office visit the day prior to surgery to examine you, review the details surrounding the procedure, and make sure all paperwork is complete.  Also, if you are freezing sperm as a precaution during the surgery, you will also need to meet with E and A Labs on the day prior to surgery (more info on this below).

If you need a hotel in the area and we are happy to make recommendations.  There are many upscale hotels located in downtown Shreveport / Bossier which are associated with the casinos and Louisiana Boardwalk.  These accomodations are about a 15-minute drive to our office / surgery center.

http://louisianaboardwalk.com

https://www.hotels.com/de1687356/hotels-near-louisiana-boardwalk-bossier-city-united-states-of-america/

For those loking for accomodations closer to our office / surgery center: 

Hampton Inn is located very close to our office / surgery center. It is rated 4.5/5 stars on TripAdvisor and reasonably priced.

We would ask that if you are greater than 3 hours travel distance that you stay the night after surgery and leave the following morning if feeling ok.

It is very important to ice surgical sites for the first 24 hours after surgery and this can be difficult when traveling long distances, so we ask that you stay the night in Shreveport following your procedure if you live more than three hours outside the region.

What About Freezing Sperm ?

Freezing sperm at the time of vasectomy reversal is also an option for couples. This is optional as success rates for sperm returning the ejaculate are very high for most men and freezing sperm adds additional cost (cost to freeze and cost to store sperm). Regardless, patients should be informed of this option.

Although, most men that receive a microsurgical reconstruction will not need to use frozen sperm for in vitro fertilization (IVF), we encourage men to consider freezing sperm at the time of vasectomy reversal, especially men that are more than 10 years out from their initial vasectomy as success rates are lower.

If a man scars down completely after his surgery and has no sperm in his ejaculate, then he will need another minor procedure to get sperm out of his testicle(s) in order to proceed with IVF. This is typically not covered by insurance and can be very frustrating for patients if the scenario arises.

The addition of freezing sperm does not add any additional cost/fees from Regional Urology’s standpoint. The patient, however, will have the additional cost of processing and freezing sperm through our local lab.

If you are planning to freeze sperm at the time of vasectomy reversal, we prefer that you coordinate with the local lab here in Shreveport: E and A Labs.

E and A Labs
2401 Greenwood Road Suite B
Shreveport, LA 71103
318-841-5808 

Link

E and A Lab's pricing for freezing sperm at the time of vasectomy reversal is approximately $490. This includes the cost to process, freeze, required infectious disease blood tests, and storage for 6 months.

Storage fees after the first six months will then take effect. Storage costs AFTER the first six months are approximately $25/month or $320/year. Cost issues must be discussed with E and A Labs as Regional Urology does not control these costs.

Freezing sperm is NOT done through Regional Urology. It MUST be coordinated with a local lab PRIOR to surgery.

The lab is happy to coordinate timing of collection and freezing with us as long as they are given proper notice. They will be able to discuss cost as well as available dates. They also will have separate paperwork, blood work, and consents that must be signed prior to freeing sperm.

If the couple chooses to freeze sperm at the time of vasectomy reversal, Regional Urology will provide a medical courier to deliver the specimen to E and A Labs.

Postoperative details:

  • Please alternate ice packs to scrotal incisions for the next 24 hours.
  • Ok to remove scrotal support the following day at noon and then shower. No tub baths as stitches in the skin are absorbable.
  • No heavy lifting (greater than 10lbs) for the next 48 hrs. After that it is ok to ease back into activity. Common sense rules apply: if it hurts, don’t do it.
  • No ejaculations for 2 weeks
  • Please wear supportive briefs until follow up appointment.
  • Swelling, mild bruising, and discomfort are very normal. Most men require narcotic pain tablets for 48-72 hours.
  • Please call the office if you do not have a follow up appointment scheduled. We generally like to see you back in the office 2 weeks following your procedure.
  • We will resume semen testing two months after surgery and then every 3 months for the first year. This is important as delayed failure is typically 10%.
  • It is important to keep in mind that most men will NOT have sperm return to the ejaculate on their first test.
  • Please continue to take your anti-inflammatory (NSAID) until told to discontinue by physician.

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