Martin
D. Bastuba, MD
Male Fertility Specialists
6699 Alvarado Road, Ste. 2207
San Diego, CA 92120
Ph: 619-286-3520 Fax: 619-286-5412
Email: info@malefertility.md
Website: www.malefertility.md
Each
year in this country, approximately 500,000 males choose
vasectomy as a means of permanent birth control. This
represents the population of a city about the size of
Long Beach, California! About five percent of these
males ultimately seek vasectomy reversal. Reasons can
include remarriage, desire to increase family size,
loss of a child or, on occasion, discomfort.
The
initial goal of vasectomy reversal is the return of
sperm to the ejaculate so that couples can make babies
at home the old-fashioned way. The operating microscope
and microsurgical techniques using suture finer than
a human hair have greatly enhanced success rates to
greater than 90 percent if active sperm are found at
the vasectomy site (vasovasostomy). If the sperm passage
is blocked upstream closer to the testicle where sperm
are produced, much more advanced techniques are required
to bypass this blockage (vasoepididymostomy) with sperm
returning to the ejaculate in 70% to 80% of patients.
Pregnancy is the ultimate goal of vasectomy reversal.
It is a miraculous and complex process that depends
on much more then just the presence of sperm Because
pregnancy is a "couples" phenomenon, this
rate is always lower than the patency rate (presence
of sperm) after vas reversal and is in the 50% to 70%
range.
The
procedure does not require an overnight hospital stay
and lasts from 3 to 5 hours at an outpatient surgery
center. Local anesthetic with IV sedation or general
anesthesia provides complete pain control during the
procedure with patients routinely returning back to
desk type work in approximately three days. Due to the
superficial nature of the procedure risks, post op discomfort
an disruption of normal activities are limited.
Contrary
to popularly held beliefs, the chance of success with
vasectomy reversal does not suddenly decline after 10
years. Experienced microsurgeons have successfully reversed
patients up to 30 years following vasectomy with pregnancy
occurring as early as a few months post-op. Like all
extremely specialized and technical procedures, the
best results for vasectomy reversal are typically obtained
by surgeons with extensive training in microsurgery
and who perform many such procedures each year. It is
critical that your surgeon has extensive experience
in all facets of reconstruction especially epididymovasostomy
(EV) since the first attempt at reconstruction is the
best shot. Most surgeons with limited experience are
wise enough not to attempt epididymovasostomy due to
its technical difficulty. For experienced microsurgeons
these demanding procedures are routine and performed
at no extra cost. In experienced hands, even a second
attempt at vas reversal after an initial failure has
proven cost effective.
Starting
or enlarging a family may require more than just the
vasectomy reversal. Inadequate post-op care seems to
happen all too often in practices not dedicated to the
real reason couples seek male fertility care in the
first place … babies. Therefore, after the procedure
is complete, close follow-up is important until desired
family size is achieved. Often this attention to detail
leads to more timely and successful pregnancies! Some
typical strategies include initial evaluation of the
female partner, sperm freezing at time of reversal and
/ or sperm banking after successful return of sperm to the ejaculate. These are details, which are the true
measures of a caring male fertility expert.
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