Tue09162014

Your Health

Vasectomy reversal: Many options available

House Call

When a couple is having second thoughts about the man's earlier vasectomy, alternatives are available. There are numerous reasons why couples decide they'd like a child after the man has undergone the relatively simple tube-snipping operation - some have simply changed their minds; others have remarried; one couple lost their first child and wanted another in his memory.

There are several realistic opportunities for the post-vasectomy couple to conceive.

New technologies exist, such as sperm-retrieval directly harvested from the testicle with "in vitro fertilization" using an egg from the female partner. But this and similar techniques can be quite expensive. There are more successful and less costly methods to help infertile couples.

A common procedure performed by certain urologists is called "vasectomy reversal." But reconnecting the man's testicular tubes in a way to assure the best odds for conceiving another child is a bit more complicated than the original vasectomy.

With this procedure, the two ends of each vas deferens, the tubes that transport sperm from the testicles, are rejoined. There are many ways to perform this surgery, but the most successful method requires the use of a microscope for magnification.

The use of the operative microscope assures the most optimal way to rejoin the vas. With this type of magnification, the vas deferens, which is about the size of a strand of spaghetti, can be joined with very fine stitches, resulting in a repaired tube that can eventually carry sperm.

The success rate depends on a number of factors. These include the time passed since the vasectomy was done, the ages of the couple, post-operative scarring at the site where the vas was rejoined and, most importantly, the skill and technique of the urologist performing the reversal.

Men whose vasectomy was performed more than 10 years prior to the reversal have less chance for conceiving a child. Sperm may be present but are unable to fertilize the egg due to problems with sperm motility or ability to penetrate the egg. Depending on a combination of the above factors, successful pregnancy can occur in up to 60 percent of couples choosing reversal.

The reversal is generally performed with anesthesia in an outpatient center and recovery is usually fast. Of course, as in any surgical procedure, there is always some risk with bleeding or infection. Moderate swelling can also occur after the reversal. Strenuous activity should be avoided for three to four weeks, allowing the area to heal.

Although vasectomy reversal is not for all couples, it offers an opportunity to conceive in those partners who want children. Most health plans do not cover this operation. Other alternatives include in vitro fertilization, artificial insemination with donor sperm and adoption.

Couples should seek professional guidance when deciding the best alternative. If a couple chooses vasectomy reversal, they should consult with a urologist who is qualified to perform the reversal using state-of-the-art microscopic techniques to ensure the best chance of achieving a successful pregnancy.

Dr. Epstein is a urologist at the Palo Alto Medical Foundation. For more information, call 853-2988.

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