Vasectomy Reversal | Vasectomy Reversals

In the world of male fertility, it has been recommended by the Practice Committee of the American Society for Reproductive Medicine to wait for an improvement in sperm parameters after a varicocele repair that is seen in approximately 2/3 of men. Researchers in Toronto, Canada decided to see if this claim held up in a group of Canadian men and published their work in January 2012.

Dr. Al Bakri and associates looked back at 100 men who had their varicoceles repaired with a baseline average sperm concentration of 18.2 million/mL. They watched how their sperm production improved over the first 6 months after the repair. They found that the average sperm concentration improved significantly by 3 months time. Moreover, waiting an additional 3 months did not seem to provide any additional improvement. Specifically the average sperm concentration improved by 53% at 3 months to 27.9 million/mL and by 38% at 6 months to 25.1 million/mL.

Bottomline: This novel research looking at the time line for improvement of sperm parameters after a varicocele repair needs to be confirmed; however, it does suggest that couples may be able to initiate alternate reproductive therapies such as inseminations or IVF by 3 to 6 months after a varicocele repair instead of waiting the previously recommended time of 12 months. Many thanks to this Canadian team for this exciting research which may help many couples better navigate their reproductive journey towards a building a healthy family.

Reference: Al Bakri 2012 J Urol 187: 227

Donating our time helping separate the good carrots from the bad at the Roadrunner Food Bank. Dr. Kuang caught holding one out of the many deformed carrots. The good carrots were being shipped to the a soup kitchen. We all had so much fun!!

The distance from the bottom of your scrotum to the top of your anus, the anogenital distance or AGD, may correlate with your testosterone levels. The AGD has been known to be a marker for the development of genitals. Historically, it has been used to identify the gender of animals, and the AGD has been found to be longer in boys than in girls. Moreover, recent studies have suggested that AGD correlates with better semen parameters. Researchers from Baylor College of Medicine in Houston, Texas recently looked at AGD and looked for correlations with reproductive hormones.

Dr. Eisenberg and associates in 2012 looked at 116 men with the average age of 36. They measured their AGD as well as the following reproductive hormones (FSH, LH, testosterone and estrogen). The averaged AGD was 3.4cm and the average testosterone was 316.5 ng/dL. They found that a man's testosterone increased by approximately 20 ng/dL for every 1 cm increased in AGD. Additionally, men with low testosterone (<300ng/dL) had a shorter AGD (3.2cm) as compared to men with normal testosterone (3.7cm).

Bottomline: This is definitely interesting research that we will hear more about in the future. It probably will not change how we evaluate men for male fertility since semen analysis and blood tests to look at hormone levels provide more definitive information; however, we just wanted to give guys a heads up just in case your male fertility doc near you whips out a ruler and starts taking measurements "down there". This way you won't be surprised!

Reference: Eisenberg et al. 2012 J Urol 187: 594

"The vasectomy reversal was the best option for us because in hopes to have more children after a vasectomy 5 years ago. The recent vasectomy and my age seemed to be the logical reason for this choice. We had no concerns with In Vitro Fertilization (IVF). We enjoy "natural" conception. Our advice for other couples who are looking at these options, I would say GO FOR IT! The procedure is not as bad as you'd expect and affordable. Dr. Kuang made us feel comfortable after speaking with him I was not as nervous at our first visit. The staff helped me relax and boosted my confidence. They were very knowledgeable. We specifically decided on Dr. Kuang because we read and explored his website and was impressed. The parts of the website and or You Tube videos that were most helpful was the procedural details and recovery instructions. What we valued most about our services was the compassionate care and reassurance that everything will be fine. Also the encouraging observation of sperm in my specimen. My experience on the day of my procedure was much better than I expected. The staff was extremely comforting and supportive. What helped make our experience as comfortable as possible was the drugs and caring staff and positive reinenformacment. My experience with conscious sedation was greater than expected. I slept through is all! I would recommend "mini-incision". Our impressions on the new procedure room, very impressive! Honestly, I didn't notice anything that needed improvement. It was amazing to see my own ejaculated sperm on the computer in the office! Truly fascinating. It took me about 2 weeks to recover after the surgery. It's still a bit tender, but that's to be expected for a while. Dr. Kuang's staff was most reliable in ensuring comfort ability to the utmost extent also keeping my wife updated with my status. We would recommend Dr. Kuang and his staff to other couples! How could you have served us better, nothing comes to mind. We sure did feel we were getting the best vasectomy reversal care currently available! And I would do it again."

J & J (Albuquerque, New Mexico)
Vasectomy 5 years ago. Vasectomy reversal 12/1/11.
Bilateral Vasovasostomy.
Sperm back 4 weeks later.

Varicoceles (dilated veins in the scrotum that may elevate the temperature at which the testicles work) are found in 15% of the general population and may be a contributory factor in up to 40% of infertile men. Obesity may negatively impact the reproductive capacity of men, and researchers in Milwaukee, Wisconsin recently published their findings in the Journal of Urology in January 2012 of the impact of obesity on varicocele surgery (varicocelectomy).

Drs. Pham and Sandlow reviewed the charts of 143 men who underwent a varicocelectomy for a varicocele that could be felt by the doctor. They subdivided the men based on their Body Mass Index (BMI) which is a measure of obesity: Normal weight (Group 1 with 38 men), overweight (Group 2 with 59 men) and obese (Group 3 with 46 men). They measured pregnancy rates and whether there was more than a 50% increase in total moving sperm. They found that there was no significant difference in total numbers of moving sperm (71% Group 1, 61% Group 2 and 59% Group 3) or pregnancy rates (44% Group 1, 44% Group 2 and 46% Group 3) between any of the groups.

Bottomline: Repairing a varicocele (varicocelectomy) can significantly improve sperm numbers in 59-71% of men and result in a pregnancy in 44-46% of these couples, and being obese does not seem to diminish a man's chances of success with this surgery.

Reference: Pham and Sandlow 2012 Journal of Urology 187: 219