Vasectomy Reversal | Vasectomy Reversals

Great question. In the last two decades, vasectomy reversal specialists have developed the more complex "bypass" vasectomy reversal technique. It is called a "vasoepididymostomy" or "epididymovasostomy." The farther out you are from your vasectomy, the more likely it is that the more simple vasectomy reversal (the "vasovasostomy") may not be the best operation for you. For guys who had their vasectomy more than 14 years ago, up to 50% of them will need the more complex reversal on one or both sides. If it has been more than 3-5 years, definitely ask your vasectomy reversal surgeon whether he can and will do the more complex reversal if he gets in there and finds that you need it. It can definitely maximize your chances of getting sperm back in your ejaculate. We looked back at our first 132 men and performing the more complex reversal when needed allowed for a 97% success rate for men <10 years out from their vasectomy and a 95% success rate for men 10 or more years out ("success" defined as getting sperm back in the ejaculate).

Bottomline: If it has been more than 10years, you can still be an excellent candidate for a vasectomy reversal with a success rate of 95%. Just make sure your surgeon knows how to perform a more complex "bypass" vasectomy reversal at the time of surgery if that is what you need.

As prostate cancer screening becomes more widespread, younger men in their 40's and 50's are being diagnosed with this life-altering disease. A proportion of these men may be hoping to start a family of their own. The effects of radiation brachytherapy on fertility is unclear, and researchers from Canada performed a pilot study to explore the impact on semen parameters and sperm DNA.

Dr. Singh and associates in 2011 enrolled 5 men who underwent brachytherapy for prostate cancer. While they had normal hormone levels, seminal volume, sperm concentration and sperm motility were significantly decreased. More over, sperm DNA damage (fragmentation) was significantly higher versus fertile controls (46% vs 13%).

Bottomline: This pilot study of only 5 men merits further investigation on a larger scale and suggests that men diagnosed with prostate cancer at a young age need to be advised that their fertility potential may be affected. Plans for paternity should be explored and could include options such as sperm cryopreservation prior to any therapy for prostate cancer.

Reference: Singh et al. 2012 Journal of Urology 187: 987

Chlamydia is the most commonly sexually transmitted bug! Worldwide, 90 million cases of Chlamydial infection are reported annually. Chlamydia is known to cause an inflammatory response within the urethra, epididymis (the sperm refinery behind the testicle), prostate and even the testicle where sperm are made. Investigators from Mexico and Spain looked into the possible adverse effects of Chlamydia and other bugs such as Mycoplasma on sperm.

In 2011, Dr. Gallegos and his team followed 143 men with both a Chlamydial and Mycoplasma infection and compared these guys with 50 normal healthy fertile men*. They found that the percentage of damaged (fragmented) sperm DNA was 3.2x higher in the infected men (35.2% vs 10.8%). They then followed 95 of the infected men after they received antibiotics (macrocodes, tetracycline or quinolones) and were encouraged to see that the DNA fragmentation decreased from 37.7% to 24.2%! Moreover, for the 16 couples who tried to get pregnant before completing antibiotics, the pregnancy rate was only 12.5% whereas 85.7% of the 14 couples who finished antibiotics were able to get pregnant.

Bottomline: Asking men about possible sexually transmitted diseases can identify infections that can be treated with antibiotics to improve the quality of sperm DNA which can optimize the fertility potential of men.

Reference: Gallegos et al. 2008 Fertility and Sterility 90:328
* Interestingly, as compared to the fertile men, there was a slight decrease in sperm concentration and motility in the infected men but it was slight and still within the normal range.

The last two decades have seen an explosion of knowledge that has improved our understanding of male infertility and its causes. Moreover, support for infertile men has grown and more men are getting evaluated sooner by male fertility specialists. As a result, it is not surprising to see that researchers in Israel have found that a male infertility factor may be a contributory cause in more than 50% of couples.

Drs. Farhi and Ben-Haroush in 2011 looked back at 1992 infertile couples where a definitive cause of infertility was found. A male factor alone was found in 37.5% while a male factor in combination with a female factor was found in 21%. In total, a contributory male factor was found in almost 59% of couples.

Bottomline: A male factor for infertility is found in at least 50% of couples (makes sense since it takes "two to tango"). Getting a man evaluated can be as easy as just getting a semen analysis and some blood tests (follicle stimulating hormone or FSH and a testosterone) as well as a comprehensive examination by a male fertility specialist near you!

Reference: Farhi et al. 2011 Israel Med Assoc J 13(1): 51

Ever wonder how your diet and lifestyle choices may impact your fertility potential? Researchers from Sao Paulo, Brazil, did and looked into how dietary and social habits affect a man's reproductive capacity.

In 2012, Dr. Braga and associates looked at 250 men who underwent IVF/ICSI cycles and studied what they ate, whether they were obese (a high Body Mass Index, BMI) and lifestyle choices such as smoking and alcohol. For this group of men, they found that sperm concentration decreased if the man was more obese or drank more alchohol while the concentration increased as the man ate more cereal or increased the number of meals in a day. Motility also decreased with increased obesity and alcohol, but also decreased with increased smoking. In regards to IVF/ICSI, the fertilization rate decreased with increased alcohol consumption. Additionally, eating red meat and being on a weight loss program was associated with decreased implantation rates/pregnancy rates.

Bottomline: We all know that what we choose to put in our bodies is going to affect our health and our fertility as a result. Eating healthy and exercise in a balanced fashion always makes sense. Definitely touch base with your local male fertility specialist to identifiy dietary and/or lifestyle choices that may be negatively impacting your reproductive potential. Every little thing can help.

Reference: Braga et al. 2012 Fertility and Sterility 97(1): 53