Vasectomy & Tubectomy Reversal

Vasectomy Reversal A vasectomy is a minor surgical procedure in which the sperm duct, or vas deferens, is cut in order to achieve sterility. Vasectomy reversal restores fertility by reconnecting the ends of the severed duct, which is located in each side of the scrotum, or by connecting the vas deferens to the epididymis, the small organ on the back of the testis where sperm matures. These procedures can be successfully accomplished with precise microsurgical technique. A vasectomy reversal re-establishes the transport of sperm back to the ejaculate. After a successful vasectomy reversal, sperm are again present in the semen and you may be able to get your partner pregnant. Dr. Goyal is a trained micro surgeon and perform this procedure on regular basis with good results.

When planning for a vasectomy reversal, consider few things

Vasectomy reversals are generally most successful in the hands of a surgeon who is trained and uses microsurgical techniques. The procedure is most successful when performed by a surgeon who performs vasectomy reversals on a regular basis.

Before Surgery

Before vasectomy reversal surgery, your doctor will likely want to:

  • Check to see whether you can produce healthy sperm. For most men, having gotten a woman pregnant before is proof enough. Sometimes you may need additional testing.
  • Confirm that your partner is capable of having a child. Your doctor will want to see whether your partner has any fertility problems, especially if she has never conceive or is older than age 35.

You can have tests to see whether you have anti sperm antibodies in your semen before and after vasectomy reversal. If there are anti sperm antibodies in your semen after surgery, your partner is unlikely to become pregnant.

During the procedure

Vasectomy reversal is usually a day care procedure (without an overnight stay in the hospital). The operation is usually performed with general anesthesia as surgical microscope is used during the procedure and any movement is magnified under the microscope. The choice will depend on the preference of the surgeon, patient and anesthesiologist. The microsurgical approach is recommended. Use of an operating microscope provides better results.
During surgery, your doctor will make a small cut (incision) on each side of the scrotum and first remove the scarred ends of the vas at the point of blockage created by the vasectomy. The surgeon will then extract a fluid sample from the end closest to the testicle to see if the fluid contains sperm. When sperm are present in the fluid, the ends of the vas deferens can be connected to re-establish the passage way for sperm. If the fluid is thick or pasty, or if it contains no sperm or partial sperm, scar tissue may be blocking sperm flow. In this case, your doctor may choose to perform a vaso-epididymostomy. Vaso- epididymostomy is a more complex procedure than vaso-vasostomy due to the very small size of the tube inside the epididymis. In most cases, the surgeon decides during the operation which technique will work. Sometimes a combination of the two surgical techniques is needed — a vaso-vasostomy on one side and a vaso-epididymostomy on the other.

After the procedure

About three months after your surgery, your surgeon will request a semen analysis every two to three months after surgery until your sperm count either stabilizes or pregnancy occurs. Unless a pregnancy occurs, a sperm count is the only way to determine surgical success. When a vasectomy reversal is successful, sperm usually appear in the semen after a few months, but it can sometimes take a year or more. When successful, vasectomy reversal usually leads to pregnancy within two years. Unless you get your partner pregnant, checking your semen fr sperm is the only way to tell if your vasectomy reversal was a success.

How successful is vasectomy reversal?

Reported pregnancy rates after vasectomy reversal range from 50 to 90 percent. Many factors affect the success rate of a reversal procedure- the type of vasectomy you had, time elapsed since vasectomy and the experience of the doctor doing the reversal surgery. Chances of a successful vasectomy reversal decline over time. Reversal has the greatest chance of success when performed within 3 years of the vasectomy. Pregnancy rate is only about 20%-30% if the reversal is done 10 years after vasectomy. Over time, additional blockages can form, and some men develop anti sperm antibodies.

With vasectomy reversal surgery, there are two success rates to consider:

  • Patency Rate – Return of moving sperm to the ejaculate after vasectomy reversal
  • Pregnancy Rate – The successful attempt to have a baby.

Ultimately, what couples want is a baby. Both male and female factors contribute to that goal including timing factors, patient factors, surgical factors, female partner factors etc. All things considered, after a vasectomy reversal, about 50% -60% of couples have a baby within a 2-year period.

Tubectomy reversal

Tubal ligation is female sterilization surgery to close or block a woman's fallopian tubes so eggs released from the ovaries cannot enter the uterus and sperm cannot reach the egg. The procedure is done to prevent pregnancy. Tubal ligation reversal is surgery to reopen, untie, or reconnect a woman's fallopian tubes so she can become pregnant.

Why It Is Done?

Women decide to have a tubectomy reversal for a number of reasons, remarriage following a divorce or starting a family after the loss of husband or child. In these cases, surgery to reverse the procedure may be an option. This surgery is called tubal ligation reversal, tubal reanastomosis, or tubectomy reversal. Regardless of your reason, there are now advanced methods to restore your fertility.

Before procedure

Before surgery, your surgeon will likely recommend a complete physical examination for you and your partner to determine if pregnancy can be achieved after a tubal reversal. You will need a test called a hysterosalpinogram (HSG), to check the length and function of your remaining fallopian tubes. A sperm count and semen analysis is recommended for a male partner to rule out any infertility problems.

Procedure

Tubal reversal surgery is done in a hospital or outpatient center. You will be given general anesthesia Performing a standard tubal reanastomosis requires microsurgical techniques, however, obtaining access to the fallopian tubes first requires a standard surgical procedure called a mini laparotomy. In a mini laparotomy, a side-to-side incision is performed in the middle of the lower abdomen approximately 8-10 cm in length. The occluded segment of the tube is resected till there is complete excision of scar tissue. Precise alignment of the tissue planes using atraumatic technique is carried out. The benefit of using the magnification for this surgery is that we can see the tiny inner opening of the tube clearly, and thereby accurately reconnect it with stitches that are finer than a human hair and literally invisible to the naked eye. A meticulous microsurgical technique is necessary, and this, of course, requires considerable experience. Some surgeons are now performing tubal reversal surgeries through the laparoscope. However, this is a relatively difficult technique and there is not yet sufficient published data to know what pregnancy rates will be after laparoscopic tubal reversal. The surgery usually takes about two to three hours. Most women will need to be in the hospital for approximately 3 days following tubal reversal surgery.

How successful is tubectomy reversal?

Success depends on several things, including:

  • Your age
  • Time elapsed since tubectomy
  • Type of tubal ligation procedure you had
  • Your overall health and condition of your ovaries, uterus, and remaining fallopian tubes, especially their length and whether they still work properly
  • Amount of scar tissue in your pelvic area. Had you had surgery in the past for pelvic inflammatory disease or PID, fibroids or other gynecological disorders? Surgery can cause scar tissue, which may affect the success of the tubal reversal.
  • Results of your partner's sperm count and other fertility tests
  • Surgeon's skill and experience

In general, good candidates for tubal reversal are women younger than age 40 who had only small parts of their fallopian tubes removed, or whose tubes were closed using rings or clips. If the remaining fallopian tubes are healthy, and you and your partner do not have any other infertility issues, you have a good chance of becoming pregnant after tubal reversal. However, not every woman is able to become pregnant after tubal reversal. Older women are much less likely than younger woman to become pregnant after this procedure. In general, pregnancy success rates range from 40% to 80%. When pregnancy does occur, it usually occurs within the first year.
You will need another X-ray dye test (hysterosalpinogram) about three to four months after surgery to make sure your tubes are open and working properly.