Vasectomy Reversal Houston
Dr. Larry Lipshultz performs vasectomy reversal at his Houston practice.
Increasing numbers of men are coming to the urologist for vasectomy reversals, most commonly because of remarriage and the desire to initiate a pregnancy. Vasectomy reversals are also requested by couples who have merely "changed their minds," as well as by couples who have lost a child and are attempting to initiate another pregnancy. Fortunately, microsurgical advances are now resulting in significant pregnancy rates.
A vasectomy reversal is typically an out-patient operation that should be performed by a microsurgeon who specializes in vasectomy reversal. There are two types of vasectomy reversal:Microsurgical Vasovasostomy and Microsurgical Epididymovasostomy. To learn more about vasecomy reversal, contact our Houston practice today.
Frequently Asked Questions about Vasectomy Reversal
Do you have questions about vasectomy reversal? Visit the Vasectomy Reversal FAQs page for answers to common questions.
Microsurgical Vasovasostomy is the more common technique for vasectomy reversal, where the two cut ends of the vas deferens are sewn back together. The vas deferens is responsible for directing and propelling the sperm from the testicle into the urethra. This procedure is only performed if sperm and fluid are still present in the vas deferens at the time of surgery. If I perform a microsurgical Vasovasostomy on both sides, there should be a 95% chance of having sperm return to the semen after this type of vasectomy reversal.
If sperm are not found in the testicular end of the vas deferens at the time of surgery, an obstruction has likely occurred further upstream of the vasectomy site. Thus, the more complex Epididymovasostomy procedure may necessary. This procedure involves reconnecting the vas deferens directly to the epididymis.
The entire procedure is performed under a special microscope. If it is necessary for me to perform an Epididymovasostomy on both sides, success rates are 50-60% because the tubes of the epididymis are one-fifth the size of the vas deferens. Most surgeons will recommend sperm cryopreservation (freezing of the sperm) for backup at the time of the vasectomy reversal, especially if a bilateral epididymovasostomy is performed.
ALTERNATIVES TO VASECTOMY REVERSAL
For some men, sperm is not present in the ejaculate. Obstructive azoospermia is the result of a blockage in the male reproductive tract, typically due to vasectomy, an absent vas deferens or epididymal obstruction. In this case, sperm production is normal in the testicle but the sperm are trapped inside the epididymis; this entity is known as obstructive azoospermia. Non-obstructive azoospermia (NOA) is when sperm production is impaired or non-existent.
Patients diagnosed with these conditions who wish to initiate a pregnancy may be candidates for sperm retrieval combined with Intracytoplasmic Sperm Injection (ICSI). ICSI is an advanced micromanipulative technique in which a single sperm is injected into an oocyte (immature egg cell) retrieved through an in vitro fertilization (IVF) cycle. Now, men previously considered untreatable and incapable of fathering their own genetic offspring are potentially able to initiate a pregnancy with ICSI. There are two main techniques for sperm retrieval: Microsurgical Epididymis Sperm Aspiration (MESA) and Testicular Sperm Extraction (TESE).
Microsurgical Epididymis Sperm Aspiration (MESA)
Microsurgical Epididymal Sperm Aspiration (MESA) has perhaps been the procedure most commonly performed in men with vasal or epididymal obstruction. A scrotal skin incision is made, and the testis and epididymis are exposed. Using an operating microscope, a single epididymal tubule is opened and sperm are aspirated (extracted). This procedure may be performed with a general anesthetic, or a local anesthetic with intravenous sedation.
MESA has been our procedure of choice because of the ability to retrieve large numbers of sperm that may be cryopreserved (frozen) and used in future cycles. Thus, the need for future procedures is eliminated and the amount of epididymal damage limited. Many men may be candidates for a reconstructive Epididymovasostomy (connection of the vas and epididymis, thereby bypassing a blockage) at the same time of sperm harvest, thus increasing the chances of having sperm appear in the ejaculate. Recovery time from this operative procedure is only a few days, and complications, such as infection or excessive bleeding, are rare.
Testicular Sperm Extraction (TESE)
Testicular Sperm Extraction (TESE) is similar to the MESA technique, but only involves the testis (testicle). A small skin incision is utilized to expose the testis. The biopsy specimen is obtained under direct vision and may be immediately assessed for sperm. The performance of an open testis biopsy for extraction of sperm is an out-patient procedure and may be performed with either a local or general anesthetic. For men with severe impairment of sperm production, only microscopic areas of mature sperm may be present. To find these areas, a careful dissection of the testis is performed using the operating microscope. Known as microsurgical testicular sperm extraction (micro TESE), this technique has enabled sperm retrieval that was previously impossible.
Contact our Houston office to learn more about vasectomy reversal.