Is Vasectomy Reversal Right For You? Dr Dawson’s Experienced Views

Is Vasectomy Reversal right for you?

Deciding if Vasectomy Reversal is right for you - Dr Dawson’s experienced views.

Is Vasectomy Reversal right for you?

We receive requests for reversal from three groups of people. Those who;

  • Wish for a return to fertility, usually with no history but sometimes after previous reversal surgery or after failed IVF
  • Have Post Vasectomy Pain
  • Just want to be returned to normal, to feel whole (some would say rejuvenated).

Return to fertility – reversal or IVF?

After vasectomy, couples do have a choice of treatment, reversal or to go straight to IVF (ICSI). We feel very strongly that reversal is clearly the procedure of first choice. Successful reversal gives the couple enables the couple to enjoy an infinite number of chances to have a natural baby between them. Only if reversal fails or is unsuitable, (a rare event!) do we recommend IVF. We find that patients are sometimes mis-informed about the potential success of reversal by doctors and others, an attitude which probably goes back to the pre-microsurgery days. Another myth is that the anti-sperm antibodies radically reduce your chances of conception – they don’t (see elsewhere on this matter).

Special cases – previous reversal and previous IVF

Previous reversal.
It is always wise to consider a re-do reversal if the first attempt has failed, no matter how many years have gone by since the vasectomy. Cases that fare particularly well are those where there has been an initial (even very low) sperm count which goes on to dwindle away to nothing. Here the initial connection has scarred over and essentially all we need to do is excise the scar and re-fashion a new microsurgical join. However a pre-op examination is especially useful to ensure that a re-do is surgically feasible (owing to the potential build up of scar tissue).

Previous IVF.
This is an interesting subject as the results are better than we dared to hope for just a few years ago. The potential problem is that to undergo IVF first there has to be sperm extraction from the testis. This is almost always by PESA, i.e. a needle is passed through the scrotal skin into the epididymis, just on top of the testis, to extract some sperms. In doing so the epididymis is traumatised and can obstruct forming a man-made ‘blow out’ or obstruction to the flow of sperms up the tubes to the vas. However we now have a large body of evidence from our patients to show that PESA is less damaging than we expect and that reversal often works in these cases (see statistics).

Post Vasectomy Pain (PVP).
This is a chronic relapsing testicular ache suffered by a small percentage of men after vasectomy. Whilst there has been some controversy over the cause of this there can be little doubt that PVP is caused by the pressure increase below the vasectomy site which follows vasectomy. The principal effect is to stretch the epididymis which is painful to some men. We have over 20 PVP patients all of whom have benefitted from reversal leading to a 95-100% alleviation of pain. Interestingly, we find that where PVP exists (and it can go on for some years), blow out does not occur and reversal restores fertility.

‘Back to normal’.
A small minority of patients this but a real reason for reversal none the less. A few men just want to go back to the way they felt before vasectomy as they believe that sex is not the same after vasectomy. All in the mind? Well, maybe, but sex cannot be the same after vasectomy. A vasectomised man releases only the seminal fluid from the prostate leaving a build up of sperms in the system so he does not feel the relief of ejaculating these. Our oldest ‘back to normal’ patient is aged 67 and he was delighted with the result at the start of his new life in the Spanish sunshine!

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