What chance of success should I expect?
Successful reversal depends on 4 main factors. (Time, Tube, Testis & Technique)
The standard definition of success if 'patency rate' which means the presence of sperms in the semen at the three months check of the semen after the reversal.
1) Time Since Vasectomy
With every passing year since vasectomy, the risk of back pressure damage to the long slender epididymis tube, its rupture and blockage (Blow-out) goes up. See below for full explanation and remedy for Blow-out. So don't be thinking for too long before deciding to go for reversal. The quality of sperm may also go down with passing years after vasectomy.
The patency rate and pregnancy rates related to time since vasectomy as per established literature
2) Tubes (Length and Quality)
Here we mean of course that there needs to be sufficient healthy vas remaining after the vasectomy for the reversal surgeon to able to re-join at least one vas. (We are frequently asked whether long gaps can be bridged by artificial tubing. Sadly the answer is no. The vas is a living muscular tube that acts as a pump so artificial implants do not work well).
Quality and length of the remanants of Vas that are left with after the previous vasectomy is very variable. You must remember,the surgeons who did the vasectomy did that with the single aim of acheiving permanant sterility minimising any risk of failure. Therefore the vasectomy surgeons remove varying lengths of the tube. Some surgeons, to make it even more challenging for reversal, cauterise the lumen of the vas to varying lengths. So one could end up with loss of the tube as much as 1.5 to 2 inches. We have to trim back until we get to the healthy ends of the vas. Overall nearly all men (more than 95%) have at least one tube suitable for reversal. Where the vasectomy has been done through an incision on each side under local anaesthetic and without diathermy (an intense electrical heat used to close the vas) the vas is likely to remain in best condition. Men who had vasectomy be two attempts usually second one under general anaesthetic will be usually left with very short remnants of the vas.
We are always very happy to see prospective patients for consultation and advice before deciding to go ahead with making a reversal appointment. We can learn a lot from gentle external examination. The vas is a very distinct, quite firm to the touch so we almost always make a good assessment of your suitability for reversal and even the likely outcome! A vasectomy that has been done towards the middle of the scrotal part and has a short gap between ends (1-2cm) is best. If we also find a granuloma (that is reaction of the tissue to the leaked sperm at the site of vasectomy) then success is almost certain. Very rarely we find that the vas has been so badly destroyed on both sides that attempting reversal by vaso-vasostomy is not worthwhile. But good news is , we can do Vaso-epididymostomy atleast on one side and preferably on both at the same sitting or another sitting as per the time taken during the procedure. This gives some chance of success if not as good as vaso-epididymostomy.
3) Testis, Sperms and Blow Out
There is decline in the testicular function with age and also due to passing years after vasectomy. Other factors that can affect the testicular fiunction include infection (orchitis), cancer and treatments for cancer such as radiotherapy and chemo therapy, regular exposure to very hot conditions at work, intake of any toxins, smoking and intake of external hormone such as testosterone or anabolic steroides.
What is Blow out? How is it diagnosed? What can be done about it?
With every reversal that we do, we place some of the fluid emerging from the testis end of the vas on a microscope slide to check that sperms are present as in the photo above. This proves that there has been no ‘blow out’ blockage of the epididymis and that reversal will succeed. Blow out is a rupture of the very thin epididymis tube (only 0.2 mm in diameter) situated on top of the testis. It is caused by the back pressure of fluid trapped in the tubes below the vasectomy and peaks during ejaculation. Blow out is painless, so vasectomised men would not feel this happening. Statistically the chances of a man developing ‘blow out’ after vasectomy start at zero immediately after the vasectomy and increase by approximately 2% per year. There is one exception to this rule, and that is when a sperm granuloma is present. Granuloma is a firm swelling on the lower end of the vas and varies in size from a small pea to a Murray mint. It is caused by leakage of sperm from the cut end of the vas immediately after vasectomy and is quite common, about 1 in 3 men. We have found that where granuloma at the vas is present there is never a blow out, probably because it acts as a pressure release valve.
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