Vasovasostomy
Encyclopedia
Vasovasostomy is a surgery by which vasectomies
are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy
.
can be reattached but, in many cases, fertility is not achieved.
There are several reasons for this, including blockages in the vas deferens, and the presence of autoantibodies which disrupt normal sperm
activity. If blockage at the level of the epididymis
is suspected, a vasoepididymostomy
can be performed.
Return of sperm to the ejaculate depends greatly on the length of time from the vasectomy and the skill of the surgeon. Generally, the shorter the interval, the higher the chance of success. The likelihood of pregnancy can depend on female partner factors.
Over half of men who have undergone a vasectomy develop anti-sperm antibodies. The effects of anti-sperm antibodies continue to be debated in the medical literature, but there is agreement that antibodies reduce sperm motility
.
Vasovasostomy is typically an out-patient procedure (patient goes home the same day).
The procedure is typically performed by urologists
. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional anesthesia
.
If sperm were seen in one or both vas contents at the time of surgery, or sperm reached the patient’s semen only transiently after the reversal, microsurgical vasovasostomy may be successful. Unfortunately, surgeons performing only an occasional vasectomy reversal often neglect examining the vas contents for presence or absence of sperm. A surgeon cannot determine sperm presence or absence by the naked eye. The most common cause for failed vasectomy reversals is the inappropriate non-microsurgical technique using sutures that are too large to achieve watertight reconnections. The failure of a competently performed microsurgical vasovasostomy following the absence of any sperm in the contents of each vas usually is due to “blowouts” in the epididymides. Under these circumstances an operation should be performed only by a micro-surgeon with proven vasoepididymostomy
expertise, bypassing the blowouts.
The presence of sperm granuloma
s improves the likelihood of restoring sperm to the semen with a vasovasotomy. A local urologist can easily determine whether you have 0, 1, or 2 sperm granuloma
by a painless examination of each vasectomy site. This exam can be fairly inexpensive,
if you inform his office in advance that this is the only service you wish and you obtain the cost for only this specific examination.
If the interval since your vasectomy is less than fifteen years, your prognosis will be 70% or better and this local examination is probably not needed.
A sperm granuloma develops from post-vasectomy sperm leakage and somehow it behaves like a safety valve preventing internal pressure build up and ruptures of the delicate epididymis tubules with subsequent obstructive scarring.
will be required.
Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy
Vasoepididymostomy
Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy....
.
Limitations
In most cases the vas deferensVas deferens
The vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
can be reattached but, in many cases, fertility is not achieved.
There are several reasons for this, including blockages in the vas deferens, and the presence of autoantibodies which disrupt normal sperm
Spermatozoon
A spermatozoon is a motile sperm cell, or moving form of the haploid cell that is the male gamete. A spermatozoon joins an ovum to form a zygote...
activity. If blockage at the level of the epididymis
Epididymis
The epididymis is part of the male reproductive system and is present in all male amniotes. It is a narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens. A similar, but probably non-homologous, structure is found in cartilaginous...
is suspected, a vasoepididymostomy
Vasoepididymostomy
Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy....
can be performed.
Return of sperm to the ejaculate depends greatly on the length of time from the vasectomy and the skill of the surgeon. Generally, the shorter the interval, the higher the chance of success. The likelihood of pregnancy can depend on female partner factors.
Over half of men who have undergone a vasectomy develop anti-sperm antibodies. The effects of anti-sperm antibodies continue to be debated in the medical literature, but there is agreement that antibodies reduce sperm motility
Motility
Motility is a biological term which refers to the ability to move spontaneously and actively, consuming energy in the process. Most animals are motile but the term applies to single-celled and simple multicellular organisms, as well as to some mechanisms of fluid flow in multicellular organs, in...
.
What is required for a successful vasovasostomy
Only two conditions must be satisfied for sperm to be returned to a patient's semen with vasectomy reversal by vasovasostomy. First, the patient must have sperm available to pass through at least one reconnection. The second condition is that each reconnection must be as watertight as possible. The surgeon's goal is to achieve a very precise circumferential reconnection of the sperm canal edges by using meticulously placed microsurgical sutures.Procedure
Vasovasostomy can be performed in the convoluted or straight portion of the vas deferens.Vasovasostomy is typically an out-patient procedure (patient goes home the same day).
The procedure is typically performed by urologists
Urology
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
.
If sperm were seen in one or both vas contents at the time of surgery, or sperm reached the patient’s semen only transiently after the reversal, microsurgical vasovasostomy may be successful. Unfortunately, surgeons performing only an occasional vasectomy reversal often neglect examining the vas contents for presence or absence of sperm. A surgeon cannot determine sperm presence or absence by the naked eye. The most common cause for failed vasectomy reversals is the inappropriate non-microsurgical technique using sutures that are too large to achieve watertight reconnections. The failure of a competently performed microsurgical vasovasostomy following the absence of any sperm in the contents of each vas usually is due to “blowouts” in the epididymides. Under these circumstances an operation should be performed only by a micro-surgeon with proven vasoepididymostomy
Vasoepididymostomy
Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy....
expertise, bypassing the blowouts.
Prognosis
The prognosis for each patient should be determined by a pre-operative examination of the vasectomy sites and consideration of the time interval since vasectomy.Rate of pregnancy
The rate of pregnancy depends on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. The reversal procedures are frequently impermanent, with occlusion of the vas recurring two or more years after the operation.The presence of sperm granuloma
Sperm granuloma
A sperm granuloma is a lump of extravasated sperm that appears along the vasa deferentia or epididymides in vasectomized men. Sperm granulomas are rounded or irregular in shape, one millimeter to one centimeter or more, with a central mass of degenerating sperm surrounded by tissue containing blood...
s improves the likelihood of restoring sperm to the semen with a vasovasotomy. A local urologist can easily determine whether you have 0, 1, or 2 sperm granuloma
Sperm granuloma
A sperm granuloma is a lump of extravasated sperm that appears along the vasa deferentia or epididymides in vasectomized men. Sperm granulomas are rounded or irregular in shape, one millimeter to one centimeter or more, with a central mass of degenerating sperm surrounded by tissue containing blood...
by a painless examination of each vasectomy site. This exam can be fairly inexpensive,
if you inform his office in advance that this is the only service you wish and you obtain the cost for only this specific examination.
If the interval since your vasectomy is less than fifteen years, your prognosis will be 70% or better and this local examination is probably not needed.
A sperm granuloma develops from post-vasectomy sperm leakage and somehow it behaves like a safety valve preventing internal pressure build up and ruptures of the delicate epididymis tubules with subsequent obstructive scarring.
Statistics
Vasovasostomy can be effective regardless of how long it's been since the original vasectomy. However, if more than 15 years have passed since the original vasectomy, one may have a lower chance of having enough healthy sperm in one's own semen to father a child. Also, the longer the obstructive interval, the more likely it is that a vasoepididymostomyVasoepididymostomy
Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy....
will be required.
External links
- Vasectomy Reversal : How it Works
- Vasectomy Reversal : Pictures
- Vasectomy Reversal American Urological Association sponsored site.