Vasectomy Reversal | Vasectomy Reversals

Ever wonder how many guys are having vasectomies in the United States? The National Centers for Health Statistics reported their most updated data from the National Survey of Family Growth and it was reviewed by Eisenberg et al. from Houston, Texas at Baylor University. From 2001 to 2007, it is estimated that over 1.9 million vasectomies were performed. The average is 322,838 vasectomies per year with the maximum being 512,277 vasectomies in 2006. The average age of men at vasectomy is 33 years old.

Bottomline: If you are looking at having a vasectomy reversal, then you are definitely not alone. Considering that up to 5% of vasectomized men decide to have a vasectomy reversal, that means that 16, 142 vasectomized men may seek out a reversal every year. When thinking about having a vasectomy reversal, definitely seek out a vasectomy reversal specialist near you. Ideally, they are fellowship-trained, can perform both the more simple and the more complex "bypass" reversal procedures and can help you optimize your fertility as a couple. Equally as important is to realize that there is probably someone you know who may have had one who can also be a great resource for you.

Reference: Eisenberg et al. 2011 Journal of Urology 185: 1541

Vasectomies are performed with the intent of "blocking off" the main pipes or “vas deferens”. The cut ends of the pipes are sealed off with heat, metal clips or surgical threads. 25% of the time, the end of the pipe that connects all the way back to the testicle is not completely sealed off. As a result, a small amount of sperm leaks out of that cut end and into the surrounding tissues in the scrotum.

Fortunately, the cut end of the pipe does not continue leaking sperm since your body seals off the area with a special type of scar tissue called a granuloma. Since it is scar tissue that surrounds sperm, it is called a “sperm granuloma.” If you have a sperm granuloma, it may feel like a firm bump that is about the size of a small marble. That is probably what your vasectomy reversal doc felt when examining you.

As you know, there are two types of vasectomy reversals: a more simple connection right where you had the vasectomy (the vasovasostomy) and the more complex "bypass" reversal (the vasoepididymostomy) where the main pipe or “vas” is plugged straight into the refinery behind the testicle (Click here to learn more). Men with sperm granulomas are twice as likely to need only the more simple connections. In 2004, Boorjian et al. from Cornell looked at 213 men who had underwent vasectomy reversals. Of the men who had sperm granulomas, only 14% required the more complex bypass reversal whereas 31% of men without sperm granulomas required that surgery.

Bottomline: If you have sperm granulomas, it’s a good thing. It means that you are twice as likely to need only the more simple connections. That’s good since these connections can be done through super-small openings via the “Mini-Incision” technique that allows us to work through an opening that is only 5 millimeters wide. With smaller incisions, your recovery tends to be faster which is always “a good thing”.

While tiny incisions are nice, it is more important that the proper type of reversal is performed. Just because you have sperm granulomas, there is still a 14% chance that you may require the more complex bypass reversal, so make sure your vasectomy reversal specialist is prepared and trained to do that more complex "bypass" surgery for you is the quality of fluid coming out of the pipe mandates a epididymal exploration and a vasoepididymostomy (Click here to see if you are likely to require the more complex reversal).

Reference: Boorjian et al. 2004. Journal of Urology. 171: 304-306.

In April of 2010, Kumar et al. from the All India Institute of Medical Sciences in New Delhi, India published their success rates for performing the more complex "bypass" vasoepididymostomy surgery. In the US, the predominant reason for blockage of the sperm pipes or "vas deferens" is a vasectomy. In this Indian study, they looked at a subset of 23 men whose sperm pipes were blocked but not due to a vasectomy. The reasons for the blockage was unknown. Possible causes are unrecognized episodes of infection, inflammation or trauma. Within this group of men, 5 underwent the more complex bypass procedures on both sides and 80% had sperm return to their ejaculate! While the size of this group of patients was small, it is great to see that this procedure that was developed by Drs. Berger and Marmar in the US is being used with success as far away as the Asian continent. Hats off to Dr. Kumar and his surgical team. We look forward to seeing their success with future patients!

Bottomline: In the US, the more complex "bypass" vasectomy reversal, the vasoepididymostomy, may be required in men who have had a vasectomy as recently as 4years prior. It is important to find a male fertility specialist with fellowship training who can perform two critical parts of a state-of-the-art vasectomy reversal: First, the fluid coming out of the sperm pipes must be inspected with a table top microscope at 400x magnification to look for complete sperm, sperm parts or the proper fluid to determine whether you need the more complex "bypass" reversal. Second, if the "bypass" surgery is what must be done, then your vasectomy reversal surgeon must be ready to perform it using the ultra-fine surgical threads that are only 1/3 the diameter of an eyelash using a microscope that improves the visualization by 25 x. Click here for more information.

At the 2010 American Society of Reproductive Medicine national meeting in Denver, Colorado, Parekattil et al. from Gainesville, Florida evaluated 66 vasectomy reversals performed using a microscope versus a robot. The use of the robot decreased operative times by 26-40 minutes. In this preliminary study, the patency rates were higher for the robotic vasectomy reversals as compared to the conventional microsurgical vasectomy reversals (92% vs 76%).

Bottomline: Preliminary studies such as this suggest that the use of computer-assisted surgery (i.e. robotic technology) will likely revolutionize how we do microsurgery. This single surgeon-single institution study is the first stepping stone. More male-fertility fellowship-trained specialists need to work with this robotic technology before a evidence-based decision can be made and extrapolated to all vasectomy reversal patients in general. Dr. K and the Southwest Fertility Center for Men are in the process of submitting our pre-clinical research on using the robot to perform vasectomy reversal. We aim to fully explore this surgical option in anticipation that it may one day be a viable option for vasectomy reversal surgery. Learn more about vasectomy reversal.
(American Society of Reproductive Medicine, Denver, Colorado, 2010; 94 (4):P-135)

In November 2010, Eisenberg et al. from San Francisco, California and Houston, Texas investigated the data on 4928 men from the 2002 National Survey of Family Growth survey population. Between 1998 and 2002, it is estimated that 175,000 to 354,000 vasectomies were performed annually in the United States. It is estimated that 6% of vasectomized men will later on pursue a vasectomy reversal for various reasons: new relationship, loss of a child, premature decision-making, etc. That would mean that 10,500 to 21,240 men of these men will one day have a vasectomy reversal.

Bottomline: If you are looking at having a vasectomy reversal, you are not alone. Up to 21,240 men on an annual basis will one day hope to restore sperm to their ejaculate with either the more simple vasectomy reversal (vasovasostomy) or the more complex bypass reversal (vasoepididymostomy)(Journal of Urology 2010; 184: 2068)


Click here to learn more about Vasectomy Reversal.