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Pre and Post-Operative Considerations |
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A pre-operative assessment with your physician will identify important issues that will impact the final outcome, the ability to conceive a child with your partner, including:
- If the man was having trouble conceiving before his vasectomy this might be the case again.
- The length of time from vasectomy to reversal. Success rates are lower the longer the interval has been. This is due to the increased likelihood of pressure damage sustained in the epididymis or of a blowout or blockage in the epididymis.
- Any history of complications following the vasectomy such as scrotal hematoma (a sizeable bleed into the scrotum) or epididymitis (infection of the epididymis).
- The reproductive health of the woman should be assessed and established before embarking on reconstructive surgery for the man.
- Finally, your physician also will try to obtain your surgical notes from your vasectomy to ascertain, if possible, how your vasectomy was done, i.e., if the vasectomy was performed quite high up on the tube or quite low down close to the epididymis, which might make reconstructive surgery more challenging.
Your physician will also examine you to get a better understanding of what he will encounter during the reconstructive surgery. He will be looking at the following areas for information:
- Small soft testes
Can suggest impaired sperm production and project a poor outcome.
- The epididymis at the back of the testicle
A swollen or irregular epididymis often predicts secondary epididymal obstruction that may require a vasoepididymostomy.
- Sperm granuloma at the testicular end of the cut vas
A sperm granuloma is a palpable nodule made of leaked sperm and the body's inflammatory response to that leaked sperm. Finding this is actually a good prognostic sign, because these sperm granulomas allow for the venting of high pressure away from the epididymis, protecting it from pressure-induced damage. Men with a sperm granuloma have improved prognosis regardless of the time interval since the vasectomy.
- Vasal gap
This means the gap between the two cut and blocked ends of the vas tube. When a very destructive vasectomy has been done, it is possible that large portions of the vas have been excised or cut out. This may require higher extensions of the incisions to establish a tension-free reconnection. This could involve a more prolonged surgery.
- Varicocele
A varicocele is a bag of veins that sits in the scrotum that often feels like a bag of worms. The presence of a varicocele may also reduce the chances of establishing fertility.
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Increasing Success |
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Naturally, if a successful result is obtained by re-establishing sperm flow in the man, a successful pregnancy can only be obtained providing the woman is also able to conceive.
The woman should arrange for a gynecological exam to ensure that her fallopian tubes are viable, and that she is not menopausal or close to it. How close she is to menopause can be an issue because of the number of months, and sometimes years, that it might take for sperm flow to be re-established in the male after a successful vasectomy reversal.
In this case, a couple may want to consider alternatives to a vasectomy reversal, which are outlined on the Alternatives page of this site.
Related Questions
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