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 is present there is never a blow out, probably because it acts as a pressure release valve.
How do we diagnose Blow out? One could never be one hundred percent certain about the blow out. However the following features help.
a. Colour and texture of the fluid from the tenticular end of the vas. Clear or off-white fluid is good sign. On the other extreme, white pastelike fluid almost diagnostic of Blow out.
b. Microscopic Testing of the fluid from the testicular end of the vas
If sperms are present then we should be capable of more than 95% success providing the tube is repairable. If sperms are not present and if the fluid is thick pastelike, then conventional reversal by vaso-vasostomy will not work and vaso-epididymostomy will be appropriate to do atleast on one side. So always check if the surgeons checks the fluid during the operation that is one of the most important parameters that will help to decide appropriate choice of procedure. It is also important to know this when patients seek redo-reversal as it helps if the reason for the failure first time was due to blow out or secondary blockage of the anaestamosis (joint of the vas). A redo-reversal will only be successful if the failure is due to scarring and blocakge of the first reversal. Alternatively if the blow out was the casue of the failure, one may wish to consider reversal by Vaso-epididymostomy or IVF.
Surgeons who do not perform this test on the testicular fluid seen during reversal (many have yet to adopt this procedure) cannot know what the true outcome of their reversal should be adn what procedure shold they do at the time of reversal.
c. Examination of the whole of epididymis during the operation by the surgeon. Some times the site of the blowout can be seen as small thinck white areas int he epidydimis which again due to sperm granuloma. This is due to the rupture and leakage of the sperms in the epidydimis that causes the blockage. Unlike th egranuloma at the end o fthe vas, granuloma at the epididymis is not a good news. If these features are present, the surgeon should consider Vaso-epididymostomy
The above slide is from a patient who definitely has suffered blow out. It shows round cells only, no sperms or sperms fragments at all. Round cells are the broken down remnants of sperms and other cells. The photo of the epididymis examined shows the most probable site of blowout at the epididymis.
Don't even contemplate having the reversal done by someone who doesn't use the operating microscope. Some surgeons still use Magnifying loups that give a magnification of 2-3 times. The operating microscope give magnification upto 25 times. We use appropriate levels of magnification at different stages of the procedure. Across all branches of surgery there is a rapidly advancing trend towards specialisation. Performing large numbers of the same procedure by the same surgeon and the same team yields amazingly better results. Here at Best Life Microsurgery the same surgeon and the theatre team routinely perform the procedures and the synergy of the team work is of paramount importance to achive the best results.
Our technique of Multilayered Microdot Vaso-vasostomy or Longitudinal Intussusception Vaso Epididymostomy are gold standard techniques for vasectomy reversals. Please click here to see the finer details of the procedure. Gold Standard MMVV
What are my chances of becoming fertile again?
This depends on the factors mentioned above but chiefly the length of time since your vasectomy was performed. This is because the likelihood of the tubes being blocked increases with each year that goes by, however, the operation is successful in more than 80 % of men who have the reversal within up to 10 years after vasectomy. Even if the vasectomy was done more than 10 years ago there is still a worthwhile chance of success.
Unfortunately we don't have control over the first three factors mentioned above. However, with our Expertise, Experienced team and Equipment resources we can assure you that we will do our best to mitigate the challenging factors and produce the best possible results.
Remember Time (since vasectomy) is a main factor
So Call us Today for your Free consultation
Why is the type of surgical Technique important in Vasectomy Reversal? Not all microsurgical Reversals the same. In… https://t.co/JzukiouiCM
Blowout or previous failure of reversal is not a problem. Thanks to advanced Microsurgery to revers the vasectomy b… https://t.co/9YfxMvVuRT
What is Blow out? Blow out is a rupture and blockage of the very thin epididymis tube (only 0.2 mm in diameter) situated on top of the ...
Post Vasectomy Pain (PVP) What is PVP? • A chronic relapsing testicular ache whose onset may be as little as 8 weeks to ...