Is Vasectomy Reversal right for you?
Deciding if Vasectomy Reversal is right for you
We receive requests for a 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 go straight to IVF (ICSI). We feel very strongly that reversal can be clearly the procedure of the first choice for many. Successful reversal enables the couple to enjoy an infinite number of chances to have a natural baby between them. We find that patients are sometimes misinformed about the potential success of reversal by doctors and others, an attitude which probably goes back to the pre-microsurgery days. Those men with female partners over 40 may have to think carefully if it is okay to have a reversal and wait for nearly 12 months to see the return of fertility while their partner's biological clock is ticking fast. IVF may be a preferable option for some though many of those men do choose reversal to achieve a possible natural pregnancy.
Special cases – Previous reversal and previous IVF
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 connection of the vas. 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).
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 to show that PESA is less damaging than we expect and that reversal often works in these cases.
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. The other options for managing post-vasectomy pain will be to take advice from a pain clinician or consider removal of the thickened tubes (epididymis) or in extreme cases removal of testis.
‘Back to normal. ( Beware of what you desire and what we cannot assure)
A small minority of patients this but a real reason for reversal nonetheless. 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 may feel that sex is not the same after vasectomy. Some choose to have the vasectomy reversed. However, from our point of view, just performing the reversal is what we will be able to do. We don't have any control over and will not be able to give any assurance that the operation would bring the state and sense of normality that you desire.