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Question

21 Jul 2006

vASTECTOMY
Dear dr,

My husband had a vastectomy done after our last child (7 Years)
ago.
How can he "reverse" this procedure and what is the latest technology regarding this matter, and what will the cost be (more or less)?

MANY THANKS
MIETS
Answer 516 views
Expert
Fertility expert
fertility expert

01 Jan 0001

Dear Miets

A vasectomy reversal is, a surgical procedure that restores the flow of sperm through the vas deferens. It is usually performed by an experienced microsurgeon using specialized instruments, including an operating microscope. The sutures used in vasectomy reversal are finer than human hair.

There are two types of vasectomy reversals: vasovasostomy and vasoepididymostomy. A vasovasostomy is the operation most frequently performed for vasectomy reversal. It entails stitching the cut ends of the vas deferens together.
A vasovasostomy is the surgery of choice for vasectomy reversal. However, if excessive inflammation or scarring has occurred in the epididymis, sperm may be blocked from getting to the vas deferens. If a blockage has occurred in the epididymis, merely connecting the two cut ends of the vas deferens (as is done in a vasovasostomy) will not solve the problem. To bypass the blockage in the epididymis, a vasoepididymostomy must be performed.

A vasoepididymostomy is performed by connecting the vas deferens directly to the epididymis
One end of the vas deferens is stitched directly to the epididymis.

Success rates vary. Some of the factors that have an effect are the age of the man, and the time elapsed since vasectomy. Although it is quite common to hear success stories of older men having a reversal many years after their vasectomy and becoming fathers again, generally speaking the younger the man is, and the shorter the interval between vasectomy and reversal, the better the success rate is.

There are many factors involved here. Antisperm antibodies (in both men and women) being one potential issue. About 60% of men have an increase in detectable antisperm antibodies after their vasectomy. This may affect the ability to get you pregnant post reversal. Age of the woman and time since reversal are also factors that may have an influence.
It is best that you discuss costs and options with a urologist.

The option of reversal of vasectomy is not one that we would encourage. Depending on the 'definition' of a successful reversal, many patients will have sperm in the ejaculate after a reversal of vasectomy. HOWEVER, for the purpose of viability, a vast majority of ejaculates after a reversal will not result in adequate quality of sperm production for natural conception to occur.

The option here is ICSI - Intra-Cytoplasmic Sperm Injection. The technique is to remove sperm from the epidermis by a process called aspiration, and fertilise an egg by selecting one sperm and injecting it into the egg. The fertilised egg is then implanted using conventional IVF techniques. The technique does offer a chance to father a child, but the whole process is expensive, and IVF does not have a 100% success rate.
The option of reversal of vasectomy is not one that we would encourage. Depending on the 'definition' of a successful reversal, many patients will have sperm in the ejaculate after a reversal of vasectomy. HOWEVER, for the purpose of viability, a vast majority of ejaculates after a reversal will not result in adequate quality of sperm production for natural conception to occur.

For information on cost structures I would recommend that you contact a urologist.
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
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