reason4: I am contacting you for another reason
Other_Reason: I have just recently had a vascetomy reversal (3 weeks, 5 days). I’m still experiencing testicular pain. Is that normal? Also apparently at 42 years old, I experienced a noctournal emision approx 1 week after the surgery. Although my surgeon assured me it’s not uncommon, I’m still concerned about possible seepage around the vas deferens reconnection site. The left connection was a normal connection with littie difficulty, the right however, was, according to the surgeon, quite difficult as due to a sizeable granuloma (appro 1” in length) the vas needed to be cut further up. Thus causing the connection to be infinitly more difficult because the vas narrows the further up it goes. Now my right testical is higher in the scrotom, which i’m not concerned about asthetics, but it feels like its pulling due to the void below it. The left vas connection feels lumpy to the touch and the right one feels slightly lumpy as well. Is that normal and should I be concerned? The!
  findings in the original sperm count weren’t even +/- anything. The right side had a few motile sperm present with tails, and the left side had heads with no tails and zero motility… quite disheartening to say the least. Is there any hope for us?

Dear Jonathan from Missouri,
You have real concerns and I would hope that your surgeon would be open to talking with you to answer your questions. Obviously, I do not have all the details of your surgery (only your surgeon would) but perhaps I can alleviate some of your concerns based on my experience with my vasectomy reversal patients:
1. Nocturnal emission should not injure the connections. We ask our men to not have intercourse after a vasectomy reversal for 3 weeks and that is mostly to avoid the traumatic impact of intercourse. I have had men with nocturnal emissions one week after and it has not affected the outcome of the surgery.
2. It sounds like the more simple connections (vasovasostomies) were performed on both sides. On the right side that showed motile complete sperm, the more simple connection was an appropriate surgery to do. That’s good. On the left side, it is hard to know what they saw without being there. Sperm heads can sometimes be confused for simply debris in the fluid. If no sperm or sperm parts are seen and it has been a long time since your vasectomy, an exploration of the epididymis (the refinery behind the testicle) is often merited to make sure there is not another area of blockage behind the testicle that would require the more complex bypass reversal (vasoepididymostomy).
3. The right testicle may be riding high due to some residual swelling and inflammation. Have your doc do an exam. If it is due to inflammation, the testicle should start to relax and come down some over the next weeks to months. It sounds like he did quite a bit more work on that right side so there probably will be more swelling.
4. Don’t give up “hope”. For right now, it is what it is. We will send all of our positive energy your way with the hope that it helps you heal quickly and sperm returns to your ejaculate.
5. You may want to touch base with your doc about using NSAIDS like ibuprofen or even steroids to see if it may help in your healing process.

Hope this helps. Hang in there. Be patient. Trust your body, but also make an appointment to see your surgeon and get your questions addressed.
Thinking of you,
Dr. K

p.s. For other readers out there…Look for a male fertility fellowship-trained microsurgeon who is prepared to do the more complex bypass reversal if the fluid in the pipes does not look favorable. Just ask whether they do that type of surgery and how often. It can give you peace of mind knowing the right operations were done to give you the best chances of getting sperm back in your ejaculate.