Microscopic vasovasostomy, or what’s commonly known as Vasectomy Reversal, is a procedure performed to reconnect previously severed ends of the vas deferens, or to reconstruct a vas deferens that is partially blocked.
The intent of the procedure is to allow you to regain fertility and the ability to father children. Success is dependent on the quality and character of sperm cells. It may take as long as one year after the procedure to fully regain adequate sperm quality and quantity. Other factors which prevent a successful result should be eliminated before the procedure is attempted. These include primary testicular failure as determined by an elevated FSH (follicle stimulating hormone) level, testicular atrophy, a history of male infertility before the vasectomy, and infertility of the female partner. The method of previous vasectomy and its location along the length of the vas deferens may help in planning the reversal.
Who is a good candidate?
The best candidates for this procedure are men:
- who have had a vasectomy within 5 years of the desired reversal
- whose blockage has been less than 5 years duration.
- Longer intervals are associated with diminishing levels of success. Within the 5-year time period success rates are in the range of 70%.
- Beyond 5 years the success rates average 50%.Vasal reanastamosis has increased dramatically as a significant number of men who have had a vasectomy want to regain their fertility. Additionally, one complication of vasectomy, chronic testicular pain, may often be alleviated by reanastamosis.
Where is this procedure done?
In the operating room the anesthetic may be spinal, general, or local with intravenous sedation.
How is this procedure performed?
The vas deferens is the tube that carries the sperm from the testicle. There is usually one tube from each testicle. Bilateral vasovasostomy means reconnecting or reconstructing these tubes. This is done through bilateral, high scrotal incisions; the no-scalpel technique might be used if the ends of the vas are easily located on examination. An operating microscope is necessary because the inside of the vas deferens is only 0.3mm in diameter, and accurate anastamosis is the only way to assure a successful reconnection.
Is this procedure covered by insurance?
Vasectomy reversal is not covered by many insurance carriers. Any questions you or your wife have should be addressed and answered before the procedure. It is suggested that you come to the consultation / examination appointment and surgical appointment together.
You should investigate with your own insurance company before deciding to proceed. There will be a surgeon’s fee and an anesthetist’s fee. The fees are requested in advance for those who are self-pay, in the form of cash or a bank check .
Are there other options?
When there are no sperm cells in the testicular fluid from the lower end of the vas, or if obstruction of the epididymis has been determined, a similar procedure, the epididymovasostomy may be performed. Epididymovasostomy is a procedure in which the vas deferens is anastamosed to a tubule of the epididymis that contains fluid with a likelihood of containing sperm cells. The epididymis is a worm-like structure, closely attached to the testis, made up of tubules which carry sperm cells and testicular fluid from the testis to the vas deferens.
This procedure is performed by exposing the epididymis, and opening the covering over the epididymis to expose the underlying tubules. A tubule that appears to be distended with fluid is cut and anastamosed to the vas deferens. This is one of the most demanding procedures in microsurgery and may take as long as 5 hours to perform. Patency rates range from 60-85%, and pregnancy rates are from 35-50%. It can be as long as one year however, before sperm cells appear in the ejaculate. The epididymis is subject to the formation of obstructing scar tissue because of trauma and infection. Obstruction may follow vasectomy. If a vasectomy has been performed in a way that obstructs the vas, pressure may build up in the epididymis causing rupture of the epididymal tubules and obstruction of the site. Sperm granuloma formation occurs because of leakage of sperm cells and testicular fluid from the end of the severed vas, and is named this because of its appearance under the microscope. The formation of a sperm granuloma relieves the pressure in the vas and epididymis thus preventing epididymal rupture. This prevents the most important cause of unsuccessful vas reversal. Obstruction of the epididymis may also be congenital due to absence of the vas deferens.