Vasectomy Reversal Best Procedures

Vasectomy Reversal and microsurgery have become increasingly popular and available. The skill and experience of the microsurgeon becomes the most important deciding factor.

The most commonly performed procedure is Vasovasostomy in which the two ends of the tube that carries sperm are re-connected after the vasectomy scar is cut away. This is not always the right procedure. In many cases, the pressure that builds up behind the vasectomy blockage causes the delicate beginning portion of the tube, called the epididymis, to rupture, much like a flimsy garden hose might if the nozzle is kept closed while the water is turned on. When this happens, a new level of blockage forms at that level, and a successful vasectomy reversal requires reconnecting all the way back to that level. This is called a epididymo-vasostostomy. There is no way the surgeon can be certain if this type of reconnection is necessary unless he inspects the fluid coming out of the tubes with a microscope at the time of the operation. Dr. Spitz employs a phase-contrast microscope, especially configured for viewing sperm, right in the operating room. Many urologists who perform microsurgery stop short of performing epididymo-vasostomies because it is too technically challenging for them. Dr. Spitz performs this procedure routinely and successfully.

Many urologists who perform vasectomy reversal use only high powered eyeglasses, known as "loupes" to aid them in seeing the tubes when they are attempting to reconnect them. The opening that must be perfectly aligned is only one third of a millimeter across (300 microns). It is below standard of care to perform this connection with anything less than a high powered operating microscope. Dr. Spitz uses a state of the art, fully automated, high powered operating microscope for all his vasectomy reversal surgeries. Surgery is usually carried out in a surgical suite under a general anesthetic. It is normally an uncomplicated, half day check in and check out outpatient surgery. General anesthesia ensures absolutely no discomfort for the patient during his procedure. Furthermore, there is no pressure on the patient and surgeon of having to ensure that the patient continues to lie absolutely still so he will not disrupt the surgery at a key moment during a critical stitch.

Microsurgery ensures return of sperm to semen in 75 percent to 97 percent of cases and pregnancy in 30 percent to 75 percent of female partners. Success is also conditional upon the length of time from the vasectomy until the vasectomy reversal, as well as other known and idiopathic variables. In some circumstances it is wise to consider setting aside some sperm to freeze at the time of the vasectomy reversal surgery so that in the event the reversal did not successfully restore sperm to the semen, that sperm could be used at a later time for the alternative treatment of in-vitro fertility with intra-ctyoplasmic sperm injection (IVF-ICSI). Such freezing of sperm at the time of the vasectomy reversal minimizes the risk of having to undergo a secondary surgery to retrieve sperm for IVF-ICSI. Dr. Spits arranges for sperm freezing and storage for any patient that desires this service or for whom it is strongly recommended based on their particular circumstances.