Increasingly, more men are presenting to the urologist for vasal reconstruction. This is because pregnancy rates with the microscopic techniques are equal to if not better than those from in vitro fertilization and at a significant cost savings. The most common indication for vasal reconstruction is due to the marriage of an individual who previously had a vasectomy and now desires the initiation of a subsequent pregnancy. Vasal reconstruction is also requested by men who have been involved in a longstanding stable relationship and who have merely changed their mind.
The success of a vasectomy reversal depends on two factors:
- The skill of the surgeon
- The findings at the time of the reconstruction
The individual who is trained in microsurgical technique, uses an operating microscope, operates more frequently and performs vasovasostomies as well as vasoepididymostomies will have improved technical expertise and better outcomes. I received my microsurgical training during my infertility fellowship at Baylor College of Medicine in Houston, Texas. I perform a two layer anastamosis utilizing microscopic suture, the latest microsurgical equipment and an operating microscope. I perform approximately two of these procedures a week.
The surgical findings are also important in determining the outcome of vasal reconstruction because if sperm are found at the site of the vasectomy then a vasovasostomy is performed and 96% of patients will have sperm return to their ejaculate. If no sperm are present at the site of the vasectomy during the procedure then sperm must be identified in the epididimis and a vasoepididymostomy performed. This type of reconstruction results in 86% of patients having sperm return to their ejaculate.
I prefer to have my patients operated on as an outpatient. This returns them home or to a nearby hotel immediately after the procedure and saves them a considerable expense. I have many patients travel from outside the metro Atlanta area for their procedure. I work out of the surgery center based in my office which has a superb outpatient facility and is fully staffed by an anesthesiologist and nursing team trained specifically for patients having vasal reconstruction.
The operating time for most vasal reconstructions is between three to five hours. A general anesthetic is used in order to keep the patient as still as possible while under the operating microscope. I prefer out of town patients to stay in Atlanta one day following their surgery. Post operative care includes a semen analysis at eight weeks and examination of the incision. Semen analyses are performed every two months until a pregnancy is achieved or the semen parameters stabilize.
If you have any further questions I would be very happy to speak with you further. Just contact my office at 404 256 6987.