The microsurgeons of the Vasectomy Reversal Center of America - Dr. Karen Elizabeth Boyle and Dr. David M. Fenig - receive many questions from both our patients and their partners. Here are some of the most frequently asked questions about vasectomy reversals.
1. Do men stop making sperm after a vasectomy?
No, the body continues making sperm in the testis. After a vasectomy, the sperm cannot travel out of the testis through the vas deferens since it has been transected, so they are simply absorbed into the body's surrounding tissue. This is normal. The body absorbs unused sperm whether a man has had a vasectomy or not.
2. How are sperm produced and transported?
Sperm are produced in the testicles. They are stored and reach maturation in the epididymis, a tightly coiled, muscular tube that is 15 to 18 feet long and leads into the vas deferens. The muscle of the epididymis and the vasdeferens contract to propel the sperm through these structures and into the urethra at the base of the penis so the sperm eventually can fertilize an egg.
3. Is a vasectomy reversal painful?
For most men a vasectomy reversal is not that painful. You may be sore for several days, but your doctor will prescribe narcotic pain medication or you may find that over-the-counter Motrin or Advil will relieve your pain.
4. Does it matter how long it has been since a man had a vasectomy?
No, it does not matter. What is important is the skill and training of the surgeon. At the Vasectomy Reversal Center of America, we routinely have had success reversing vasectomies for men who had theirs more than 15 to 20 years ago and even longer. One of our physicians successfully reversed a vasectomy for a patient who had a vasectomy 35 years earlier and was not only a father already, but a grandfather. Our longest time interval between vasectomy and reversal is 42 years and this couple successfully conceived.
5. When can I begin having intercourse after a vasectomy reversal?
You can start having regular intercourse and ejaculating again after two weeks. Frequent regular ejaculation will help keep the pathway for the sperm open and help the sperm travel into the ejaculate.
6. How long will it be after the vasectomy until we can conceive a baby?
It depends on what type of procedure you needed for your vasectomy reversal. It can take up to three months for sperm to return to the ejaculate following a vasovasostomy and six months to one year following an epididymovasostomy. However, we have had patients who have conceived babies within weeks after the reversal.
Six to eight weeks following your reversal, you will have a semen analysis performed, and the results will be reviewed at your postop appointment. We will continue to monitor your semen analysis on a regular basis for up to one year or until your sperm count stabilizes.
7. What is the difference in the success rates of a general urologic surgeon who performs vasectomy reversal and a fellowship-trained microsurgeon who is a male infertility specialist?
The difference in success rates is dramatic. The success rate of the general urologic surgeon is about 30 to 40 percent, while the fellowship-trained experts at our center have a success rate of over 90 percent.
8. Why is microsurgery the best way to perform a vasectomy reversal?
The channel of the vas deferens through which the sperm swim is only .3 to .4 millimeters in diameter. Therefore, the most effective way to reconnect the vas deferens is by doing microsurgery with the assistance of a state-of-the art operating microscope that provides 16 times magnification of the operating image. The surgeon uses microscopic sutures, which are so small they cannot be seen by the naked eye. The microsurgical training and precise skill of the surgeon is of the utmost importance to the success of the surgery.
9. How important is the skill and experience of the surgeon?
The only way to help ensure the success of a vasectomy reversal is for it to be performed microsurgically by a urologist who is a fellowship-trained male infertility specialist and who performs vasectomy reversals on a regular basis. Choosing a surgeon with a vast amount of experience and a proven track record is the best option to help you achieve your dream of having a child naturally.
The skill of the surgeon is most important since precise suture placement is necessary. The surgeon must also have expertise in performing the more challenging epididymovasostomy for men who have a blockage in the epididymis. This is impossible to diagnose until the vasectomy reversal is being performed. A fair percentage of vasectomy reversals require epididymovasostomy. Therefore, our microsurgeons are also experts at epididymovasostomy.
10. What is the success rate at VRCA?
Drs. Karen Boyle and David Fenig have very high success rates of over 90 percent, and take on the most complex cases including re-dos. They are experts at the more delicate microsurgery called epididymovasostomy, needed in many patient cases when a blockage is discovered in the epididymis. They've have had success performing vasectomy reversals on patients whose vasectomies were performed over 40 years ago.
11. What is the first step to getting treated?
The first step on your journey is to come into VRCA for a consultation with one of our infertility specialists. If you are long distance, we can also arrange for Dr. Boyle or Dr. Fenig to do your consultation by phone or through computer webcam/Skype. Even before your consultation, our staff or one of our physicians will make initial contact with you to make sure that you feel prepared and comfortable and will answer your questions. Our patient coordinators will familiarize you with what to expect prior to the appointment. Our philosophy of care is to accommodate, inform, and take care of you. From the beginning, we are only a phone call or an e-mail away.
The consultation usually takes about one hour, during which the physician will take a detailed medical history and discuss any medical concerns and medications that you're on, in addition to learning about your fertility history and that of your partner. Men are encouraged to bring their female partners with them to the consultation, if it's possible. Your VRCA physician--Dr. Karen Boyle or Dr. David Fenig --will take the time to explain the anatomy and production of sperm and discuss in detail the two types of blockages that may be involved as well as the reconstruction process. You'll be informed about what to expect pre-operatively, the day of surgery, and during your recovery.
12. What can I expect before and the day of surgery?
Following your consultation, our patient coordinator who will go over details concerning your pre-op preparation, the types of testing you may need, the timing of your procedure, what your insurance may cover, and financing options. We are here to hold your hand through the entire process.
On the day of surgery, you'll arrive at our microsurgical suite and be introduced to our microsurgical team. We are unique because we have an entire team dedicated to our vasectomy reversal patients. This includes your operating room nurses and recovery room nurses.
13. What type of anesthesia is used during the vasectomy reversal?
It is essential during a vasectomy reversal that the patient is still and doesn't move. The surgery is performed using the operating microscope and the precise placement of micro sutures is essential for the success of the surgery. For this reason, patients require general anesthesia. Local, long acting numbing medications are also placed in the surgical area to assist in pain control after surgery, and all patients are given prescription for oral pain medication if needed postoperatively.
14. What can I expect after surgery?
You will receive a call in the evening after your surgery from either your physician or one of our nurses to check on you. Our physicians provide their cell phone numbers to their patients in the event you need to reach us. For those patients who have travelled from out of town and are staying in a hotel , your physician will follow up with you before you leave for home. Patients who are local come for a follow up visit to our office two weeks after their reversal.
15. What makes VRCA physicians unique?
Our physician staff is unique because all physicians are highly experienced microsurgeons who completed fellowship training in male infertility and microsurgery at the prestigious program for male reproductive medicine and surgery in the United States, Baylor College of Medicine.
Dr. Karen Boyle and Dr. David Fenig are part of an elite group of the top vasectomy reversal specialists in the United States. Only two percent of board-certified urologists in the U.S. have this fellowship training.
Our doctors have very high success rates of over 90 percent and take on the most complex cases including re-dos. They are experts at the more delicate microsurgery called epididymovasostomy, needed in many patient cases when a blockage is discovered in the epididymis. They've have had success performing vasectomy reversals on patients whose vasectomies were performed 40 years ago and even longer.
16. Are there different types of vasectomy reversals and why?
There are two types of vasectomy reversals, vasovasostomy and epididymovasostoamy. Your micorsurgeon will choose the type of vasectomy reversal that is right for you. The operating time for either type of vasectomy reversal is approximately three to four hours.
Vasovasostomy: Though there are various techniques for performing a vasovasostomy, we prefer a strict, two-layer procedure that produces the most optimal watertight result when reconnecting the vas deferens. This is done with microscopic sutures, using the most advanced microsurgical equipment and the Zeiss operating microscope. The two-layer procedure involves suturing the mucosal inner layer and a muscular tissue layer of the vas deferens. Facilitating the two-layer sutures properly requires a higher level of training and experience, which our surgeons have. It is very important for the closure be watertight so that sperm do not leak out at the closure site, potentially causing inflammation.
Epididymovasostomy: This is an even more complex and delicate procedure that is performed when a blockage is discovered. The epididymovasostomy requires greater surgical expertise that the vasovasostomy. The vas deferens is attached directly to the epididymis. An incision is made to an epididymal tubule, where sperm are stored, just prior to the obstruction. The tubule is gently squeezed for fluid. The fluid is checked for sperm. If sperm are absent, a more proximal incision is made and checked again. For epididymovasostomy to be successful, sperm must be present within the tubule at the site of the anastomosis, which is where the sutures will join the two streams (the tubule and the end of the vas deferens). The anastomosis is performed using two layers of very fine suture and is also done using the operating microscope.
17. Can sperm be harvested at the time of a vasectomy reversal and is this cost effective?
Sperm can be harvested at the time of a vasectomy reversal if living, motile sperm are found in the vasal fluid or if an epididymovasostomy is performed. Most frequently however, the vasal fluid may not demonstrate motile sperm or sufficient numbers for cryopreservation. If a couple desires sperm harvesting and cryopreservation, this needs to be coordinated in advance with a fertility lab for processing and freezing of the sperm. A study conducted by Dr. Karen Elizabeth Boyle, co-director of the Vasectomy Reversal Center of America, demonstrated that it is not cost effective to harvest and cryopreserve sperm at the time of a vasectomy reversal. With such a high vasectomy reversal success rate of more than 90 percent, the majority of patients will not need a backup plan, and would have incurred the additional fees of harvesting, sperm processing and freezing, unnecessarily. In the small number of patients in which the vasectomy reversal is unsuccessful, sperm retrieval can easily be performed by either a simple needle aspiration or a small extraction procedure for IVF.
18. Why choose Vasectomy Reversal Center of America?
The Vasectomy Reversal Center of America has two fellowship-trained microsurgeons dedicated to the performance of vasectomy reversals and associated male infertility procedures. Both of our microsurgeons, Drs. Karen Elizabeth Boyle and David M. Fenig, obtained their training in male reproductive medicine and surgery at Baylor College of Medicine. The surgeons at the Vasectomy Reversal Center of America have the ability to perform more complex microsurgery procedures such as re-do vasectomy reversals and epididymovasostomies as well.
Our success rates at the Vasectomy Reversal Center of America are among the highest outcomes nationally, with over 90 percent of our patients having a normal number of sperm in their ejaculate by six to eight months. Our pregnancy success is 70%.
VRCA has a dedicated microsurgery suite with state-of-the-art equipment and specialized nurses trained in the care of microsurgery patients.
VRCA provides a comfortable outpatient experience with the highest chance of providing our patients with their dream of being able to conceive children again naturally.
VRCA is a boutique practice dedicated to the comfort and return to fertility of our patients. When you become our patient, you become part of our extended family. The ability to take care of you is a privilege to us. We like to keep up with our patients and hear how they are doing. We love receiving news of pregnancies, birth announcements, and photos of our patients' children.