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A Second Chance: Vasectomy Reversals

They’re expensive and complicated, but vasectomy reversals may be worth it for men who want a second lease on fatherhood.

A Big Decision continued...

Before conducting the procedure, Marks consults with the man’s female partner to try to increase the chances that she is fertile. If the woman is over 35 or has menstrual irregularities, he suggests that she visit a reproductive endocrinologist to investigate fertility issues. “There’s nothing worse than investing financially and emotionally [in a reversal] and finding out that there’s no way the female partner can conceive,” Marks tells WebMD.

In Marks’s surgical suite, the reversal procedure typically takes about three hours. McCroskey remembers making jokes throughout the procedure as he felt the effects of laughing gas. The aftermath was somewhat more painful -- McCroskey’s privates were packed in ice for much of the time. “I remember thinking, vasectomy’s got nothing on this,” he says.

A Tale of 2 Procedures

The success rate of vasectomy reversals is generally related to the length of time that has elapsed since the vasectomy performed. That’s because men who had vasectomies a long time ago are more likely to require a more complex and challenging form of reversal procedure.

In the most common form of reversal, the surgeon simply sews together the severed ends of the vas deferens. But in some cases, blockages have formed in the vas deferens or the tube between the vas and the testicle, known as the epididymis. In that case, the vas deferens must be directly connected to the epididymis. This procedure is known as a vasoepididymostomy, or “VE.”

The chances that a blockage has formed -- and that a VE is necessary -- increase with time. Craig Niederberger, MD, chief of urology at the University of Illinois at Chicago, estimates (based on existing studies) that the chances of needing a VE in both vas deferens tubes increase to 20% for a patient who had a vasectomy more than a decade ago.

And the success rate of a VE is lower. Niederberger, for example, reports that more than 90% of patients in his clinic who undergo ordinary reversals succeed in producing sperm. By contrast, 71% of his VE patients succeed in producing sperm.

But success in producing sperm does not guarantee that a man will get his partner pregnant. The pregnancy rate for Niederberger’s patients, for example, is about two-thirds for patients undergoing ordinary reversals and about 50% for VE patients. This is most often due to fertility problems in the woman, Niederberger says.

Unfortunately, there’s no way of knowing until a patient is on the operating table whether he will need a simple reversal or the more complex VE. That’s why many urologists say it’s important to find a doctor who has a lot of experience in vasectomy reversals.

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