Vasectomy Reversal
Tubal Ligation Reversal


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Reversal Procedures

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We provide classic microsurgical vasectomy reversal procedures, along with techniques such as MESA, TESA and PESA (see below) which include simple, through the anesthetised skin, needle aspiration of sperm, and methods to overcome failed vasectomy reversals.

A vasectomy reversal is a microsurgical procedure performed by a urologic surgeon to reverse sterility caused by a vasectomy. VR is performed by microsurgically reconnecting - in either single or multiple layers - the cut ends of the vas deferens, the small tubes that carry sperm from the man's testicles. The fine sutures used are no thicker than a human hair. The rejoined vas can again become a passageway for semen to be ejaculated at orgasm. Surgical success is indicated if sperm is detected in the fluid inside the vas after initial incision. At times when a blockage (causing increased pressure in the epididymis) is suspected, the blockage must be bypassed in an alternate reversal procedure known as a "vasoepididymostomy."

An effective vasectomy reversal simply allows sperm to rejoin the seminal stream during ejaculation and should not affect your sexual drive, your ability to have an erection and orgasm or your ability to have and enjoy sex. Sperm is only a small fraction of the total liquid in your semen. The amount of fluid, intensity - even color and texture - does not appear to change once your seminal fluid again contains sperm.

The most common type of a reverse vesectomy, the vasovasostomy, has statistically greater chance of success than does the more complex reversal procedure known as a vasoepididymostomy. The chances of successfully impregnating your partner are very dependent on time, and the quality of your sperm. Reverse vesectomy has the greater chance of success if the vasectomy was performed more recently. As time passes, the statistical likelihood of a pregnancy following a vasectomy reversal declines. The most significant decline occurs at 15 years or more where pregnancy rates are typically about 30%. The more recent the vasectomy, the greater likelihood of success.

Also, over time, the body's natural response to accumulated (not ejaculated) sperm in the testicles may result in damage to the shape, number and motility of sperm. The potency (number and quality of sperm released in seminal fluid) are just as important as the patency of the connection.

During Surgery

An important predictor of success is the quality of the fluid coming from the vas end at the vasectomy site.

If the surgeon finds fluid with sperm cells coming from the vas, he or she can generally build an open channel by reconnecting the vas ends in greater than 90% of patients. The actual pregnancy rate, though, is less because the actual sperm may no longer be able to complete the process of fertilization. Nevertheless, pregnancies can result in greater than 60% of such cases.

If only fluid without sperm can be seen coming from the vas end, the surgeon can build an open channel through the vasectomy site in somewhat greater than 50% of patients. The actual pregnancy rate is frequently closer to 40%.

If the fluid is poor, the vas can be directly connected to the epididymis ("epididymovasostomy") and there is a further reduction in the success rate.

Before Surgery

We can look at the time between the original vasectomy and the time of the vasectomy reversal to predict the success of the vasectomy reversal. In general, men who are less than 10 years out from their vasectomy have a better chance of success.

When vasectomy reversal fails

Many men choose to have their sperm frozen, ensuring during vasectomy reversal procedures. During the surgery, your doctor will identify healthy sperm using a microscope. Later, a procedure, known as intracytoplasmic sperm injection (ICSI) can be used to directly implant your sperm into the egg of your partner. Vasectomy reversal is considered a failure if no sperm is found after twelve months. You should choose well-trained Urologist who has a record of success to perform your surgery.

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