Yearly Archives: 2017

Still not Pregnant after Vasectomy Reversal? | Minnesota

Few things are more disheartening than months and months of negative pregnancy tests. You talked with your husband, and you both agreed that you wanted children. He got vasectomy reversal for you, but a year later you still aren’t pregnant. It may seem frustrating, but you shouldn’t lose hope without knowing all the facts.

You won’t get pregnant immediately

This cannot be said enough. If there is no sperm in the ejaculate six months following a vasovasostomy, the reversal is said to have failed. Even if there is sperm, that doesn’t guarantee pregnancy. It can take months for a man to return to a normal sperm count. Once sperm has been detected it still takes time for sperm number and motility to reach normal levels, and this time can vary from person to person.

Conception

Getting pregnant takes patience. It is generally known that most men produce millions of new sperm every day. However, you might not know that these new sperm take about 2 ½ – 3 months to fully mature or that when sperm are initially formed they lack the ability to swim forward or fertilize an egg. It can take a couple of these cycles for sperm to regenerate. Even at this point it can take another 6 months for conception to occur. It’s important to remember that getting pregnant within months of a vasectomy reversal is not the norm. We do have a few patients who got pregnant in 2 months after vasovasostomy in the past few years.

To monitor progress, a sperm sample will be taken 6 weeks after the procedure. Follow up tests will occur every two months after the initial test. This way we can see whether sperm has returned and at what level. Once sperm count has reached reasonable or normal levels, pregnancy usually occurs within 6 months of having timed intercourse- that is, having intercourse every other day from four to five days before and after ovulation. If this does not occur, it’s possible the issue may be due to fertility in the other partner.

Birth Control Comparison Chart | Minnesota

All birth control methods work the best if used correctly and every time you have sex. Your choice of birth-control method is a personal one and depends on a number of variables, including short or long-term family planning, personal health, associated risks, failure rate and cost.

The vasectomy is one of the lowest failure rates among the birth control methods. The study showed the traditional vasectomy failure rate is 1-3 per 1000 cases; the failure rate would be less than 1 per 20000 in no scalpel vasectomy with the fascia clipping technique.

Birth Control Methods Comparison

Contraception Cost Failure Rate Duration Availability Advantages Disadvantages
Condom <10 18% one time OTC prevent STIs; no hormonal side effects local reaction & breakage
Vasectomy $700 – $2000 0.2% Permanent Office procedure No effect on hormones and sex drive No protection in the first 3 months, Surgical side effects
Female Condom $2-$4 21% one time OTC prevent STIs; use during menstruation local reaction & breakage
Spermicide $5-$10 28% one time OTC Lubricate, use with other BCP forms local reaction
Sponge $3-$5 24% Up to 24h OTC Lasts 24 hours Local effects and infections
Diaphragm $50-$300 5-20% Reusable Prescription Lasts 24 hours, reusable Insert challenging,local reaction
Cervical cap $50-$75 14-30% 48-72 hours, reusable Prescription Protect 48-72 hours Abnormal Pap smear, local reaction & infection
Birth Control Pill $15-$50/month 9% A month Prescription Regulate menstruation; reduce cramps and ovarian cysts Take daily, weight changes, and medical /risks/side effects*
Vaginal ring $15-80/month 9% Wear monthly Prescription Regulate menstruation; reduce cramps and ovarian cysts Weight changes and medical risks/side effects*
Contraceptive Patch $15-80/month 9% A month, replace weekly Prescription Regulate menstruation; reduce cramps and ovarian cysts Weight changes and medical risks/side effects*
Birth Control shot $35-75/injection 6% 3 months doctor’s visit 4 shots/year; reduces menstrual cramps and the risk of ovarian cysts/cancer and PID Take up to 8 months to return; medical risks/side effects*
Intrauterine device (IUD) $500-$1000 1% 5-12 years Doctor’s visit immediately effective Migrates, ovarian cysts, PID, and ectopic pregnancy
Hormone Implants $400-$800 1% 3 yearse Doctor’s visit reduce menstrual flow, cramping, and PID office procedure, local reaction, Medical side effects**
Tubal Ligation $1500-$6000 1% Permanent Outpatient surgery Permanent and immediate; does not impact sex drive More invasive, complicated than vasectomy, surgical side effect
Essure $1500-6000 1% Permanent Outpatient surgery Less invasive than tubal ligation 3 months to take effect; side effects:cramping,irregular menstrual cycle, GI reaction, and infection

* Medical risks and side effects: may increase risk of blood clots, stroke, breast cancer, heart attack, high blood pressure, depression and anxiety; may decrease sex drive; other side effects include weight gain, breast lumps, and hair loss or excessive growth.

**Medical risks and side effects: can cause loss of bone density and sex drive, and mood swings, weight gain, breast and abdominal pain, and allergic reaction.

References: Birth Control Guide. Food and Drug Administration Office of Women’s Health.

Three vasectomy myths debunked | Minnesota

Myth #1: A vasectomy will hurt:

It’s very natural to be afraid of pain, especially down there. Take a breath of relief, as vasectomy isn’t painful! local anesthesia is used, completely numbing the area. Mild pain or discomfort may be reported for a couple of days after the procedure, but it’s nothing most people can’t handle. Based on the vasectomy clinic survey, 50% vasectomy patient didn’t take any pain medications; 25% patients didn’t have pain, but they decided to take Tylenol; another 25% patients felt more pain and took Tylenol. This fear is temporary, and so is pain- it’s not a reason to refuse a vasectomy, which can have lifelong benefits to a man. You should take some time to think clearly when deciding to get a vasectomy, and not have your judgement clouded by fear.

Myth #2: Loss of masculinity:

Some people have this mistaken notion receiving a vasectomy will make them less of a man. This couldn’t be farther than the truth. There is no evidence that vasectomy decreases libido or change hormone levels in men. Men are still able to ejaculate and maintain erections after the procedure. You will not become more feminine if receive a vasectomy. Perhaps there is this sentiment that being infertile makes one less of a man, which comes purely from antiquated ideas surrounding masculinity. In fact, most women report greater sexual satisfaction with their partner after a vasectomy. When deciding whether or not a vasectomy is right for you, don’t be afraid of losing your masculinity.

Myth #3: Being out of work:

Luckily, modern vasectomy is not a very invasive procedure, especially with new No-scalpel Easy vasectomy®. Traditional vasectomy does have a long recovery time due to its bilateral big incisions and stitches, but no-scalpel vasectomy involves making a small hole instead of a large incision, and the vas deferens are pulled and severed through the hole. Because of how non-invasive this procedure is, the recovery time is very short- most people can return to work in two days, and exhibit a full recovery in one week.

A vasectomy is a big life decision, and not one that should be made lightly. However, many of the worries you may have regarding vasectomies are not worries at all. We hope this blog post has given you some insight into your choice.

How is Easy Vasectomy Reversal® (Vasovasostomy) Done without a Needle? | Minnesota

General anesthesia or intravenous sedation is needed in the traditional vasectomy reversal since a traditional approach to vasectomy reversal is to make two big incisions in each side of scrotum. Easy Vasectomy Reversal® with modern no scalpel technique and single mini incision reduces the trauma and pain, therefore, general anesthesia or intravenous sedation is no longer needed in the vasectomy reversal procedure (vasovasostomy).

Conventional needle anesthesia in vasectomy Reversal involves the use of a 27 gauge needle to raise a wheal at the skin of scrotum; it is then advanced to both ends of the vas on each side where further anesthetic solution is deposited. Since the opening is so small in the no-scalpel Easy Vasectomy Reversal®, it is easy to apply anesthesia without the use of needles. A spray applicator (MadaJet®) delivers a stream of anesthetic so fine that it penetrates the skin and diffuses to a depth of about 3/16 of an inch, enough to surround and anesthetize each end of vas tube in turn as it is lifted into position beneath the skin, attaining a close to 100% efficacy rate with no need for supplemental anesthetic in the initial vas grabbing.

The tiny opening in the dime-sized area of numb skin is made with a pointy hemostat: one tip makes a pinpoint opening, then the two tips are used to spread and enlarge the opening to about 1/3 of an inch. Since blood vessels in the skin are spread apart rather than cut, bleeding is less than when a scalpel is used.

MadaJet_2

MadaJetSprayApplicatorMadaJet

Once the vas ends are grabbed and lifted up, the complete local anesthesia is achieved by giving additional anesthetic with a fine needle, usually with no pain at all because of the partial anesthesia achieved with the MadaJet.

Age Restrictions on Vasectomies | Minnesota

While there are no laws expressly forbidding vasectomies to certain age groups, even for individuals under 18 with parental consent, federal programs providing financial aid require that recipients are at least 21 years of age and mentally capable of making that decision. Many doctors, such as myself, will not provide vasectomies for men under 21 with no children with an exception to those with specific health circumstances or those who clearly cannot raise children due to impairment. Other vasectomy providers may follow a different or more restrictive set of guidelines, as is their prerogative.

Even for those who qualify, undergoing vasectomy is a huge decision for anyone. A few considerations for men, especially those under 30, seeking a vasectomy:

While it may seem like a good idea now, you may want children in the future, especially if you are young. People can change many times throughout their lives. Even if you don’t, your partner may change and desire children someday.

Currently, vasectomy reversals can be quite effective, but the later you wait the lower the chances of success are. There is technology that could potentially change this in the near future, but for the time being, it’s no guarantee a reversal will successful after a long period of time, which is often the case for young men who receive vasectomies.

Lots of relationships end. The “over 50% of marriages end in divorce” statistic is inflated due to serial divorcers, but in the end many relationships are a gamble. When a relationship ends and you find a new partner, you may find yourself wanting children once again.

Despite the existence of vasectomy reversals, vasectomies should be considered permanent as the success of a reversal is not guaranteed.

Young men should consider Sperm Storage, and very young men should discuss your decision with your parents. You’re legally an adult, yes, but they helped you get there.

How is the Easy Vasectomy ReversalⓇ Done without a Scalpel? | Minnesota

The patients always wonder how the Easy Vasectomy Reversal is performed without a scalpel. This blog explains it.

No-scalpel vasectomy instruments were originally developed by Dr. Shungiang Li, in China in the mid-70’s and introduced into the United States in 1989. Many years ago, Dr. Steven Shu innovatively improved his surgical techniques on vasectomy reversal procedure (vasovasostomy) by using the same principles and no-scalpel instruments.

A vasectomy reversal (vasovasostomy) is a microsurgical procedure that reconnects the vas deferens where it was interrupted by a vasectomy. A traditional approach to vasectomy reversal is to make two big incisions in each side of scrotum. Over the past decade, more surgeons adopted a single incision in the middle of the scrotum. In order to further reduce the trauma, the recovery time, the operative time, and the postoperative complications, the mini incision vasectomy reversal approach was proposed. Similar to no-scalpel vasectomy, the initial mini-incision is created using a sharp penetrating forceps that spreads the tissue apart instead of cutting it with a sharp scalpel.

hemostat_2

ring clamp_2

Dr. Shu uses two important no-scalpel instruments to perform the vasectomy reversal procedure. They are simply a very pointy hemostat, used initially to make a tiny opening into anesthetized skin of the scrotal wall, and a ring clamp, used initially to secure each vas tube in turn beneath this opening.

The refined techniques of no-scalpel Easy vasectomy reversalⓇ minimize trauma, pain and complications. The introduction of no-scalpel Easy vasectomy reversalⓇ has successfully allayed many men’s fears with regard to the scalpel.

Easy Vasectomy Reversal Receives Trademark from U.S. Patent and Trademark Office | Minnesota

Office proceduralist, Dr. Steven Shu, obtains a registered trademark from the United States Patent and Trademark Office, for his Easy Vasectomy ReversalⓇ, a minimal invasive office procedure with no scalpel and no needle techniques.

The introduction of Easy Vasectomy ReversalⓇ has successfully allayed many men’s fears with regard to the scalpel and needle. It is safer, less invasive, and has fewer complications and quick recovery. Under local anesthesia, only a tiny puncture is made at the midline of the scrotum skin, instead of bilateral big incisions done in the traditional vasectomy reversal.

Easy Vasectomy ReversalⓇ Service in One Stop Medical Center (OSMC)
OSMC developed a powerful website, EZvasectomy.com, with rich information on vasectomy reversal. All patients are required to review the important information on vasectomy reversal. Dr. Shu does the same day consultation to finalize the consultation on the day of surgery, so the patients don’t need another trip for the initial consultation if they live far away or out-of-state. Moreover, the patients are able to register their vasectomy reversal procedures by filling out the online registration form in the website.

In order to reduce the financial burden for our vasectomy reversal patients, OSMC offers very affordable price that is only fractional cost of the same procedure done in other medical facilities, and it doesn’t charge facility fee and anesthesia fee since it owns an accredited, private surgical center. This way, more families can afford to have their vasectomy reversed.

OSMC has simplified the vasectomy reversal care system to create a more affordable, friendly and convenient vasectomy reversal service.

Free Large Pizza for the Vasectomy Patients on 11/17/2017, 5th World Vasectomy Day | Minnesota

On November 17th, World Vasectomy Day, the largest male-focused family planning event in history with over 1,200 providers in 50+ countries, takes the world on a historic 24-hour vasectomy-athon organized out of our headquarters in Mexico. We will e-travel from country to country conversing with vasectomy providers, advocates for male involvement in family planning and the men who choose a vasectomy as an act of love. WVD kicks off at 5:00 p.m. on November 16 with a joint ceremony taking place in Mexico City and on the island nation of Kiribati (where it will be 10 a.m. on Friday, November 17th). With conversations, live vasectomies and dozens of films, and in partnership with DKT Mexico, DKT International and the Centro Nacional de Equidad de Genero y Salud Reproductiva (National Center for Gender Equity and Reproductive Health), we will explore the current state of male involvement in family planning, learn about global efforts to make vasectomies accessible and celebrate men everywhere who have made the heroic decision to care for their families, communities and our planet. Join us!

It might seem odd to dedicate an entire day to vasectomies, but for Dr. Shu and the other 1,200 doctors participating in World Vasectomy Day on November 17, it’s an important event that spreads awareness on the most effective but underutilized methods of contraception: the vasectomy.

With industrialization and modern medicine making it safer and easier to give birth and raise children, the world population has skyrocketed- current projections predict the world population will plateau at 11 billion. High population puts a strain on resources like food, medicine, and energy. In many areas of the world that are seeing rapid population growth, sexual education and medical resources have not caught up to other areas in society. Vasectomies are excellent for family planning in areas that are not well developed and do not have the resources that most of us take for granted.

This will be Dr. Shu’s 5th year participating in the event, and the One Stop Medical Center will offer free large pizza.

Dr. Shu Performed 50 No-scalpel Vasectomies During His 2017 Haiti Mission | Minnesota

This is the third time that Dr. Shu participated in the Haiti mission through No Scalpel Vasectomy Inc. (NSVI), and it is also the fifth time that he participated in the international mission in the past three years.

From Oct 25 to Oct 28, NSVI conducted its 15th vasectomy mission in Haiti. Vasectomies were performed on 163 men (average age 43.8) who had had a total of 842 children. Dr. Shu performed about 50 vasectomies during this mission. While the average number of children per man (5.17) is still very high, we have seen a slight decrease over the last three missions. We may be seeing a greater percentage of men who accept vasectomy after 3 children, enabling themselves to nurture those children with more attention and better education even with their limited resources.

Easy Vasectomy Receives Trademark from U.S. Patent and Trademark Office | Minnesota

Office proceduralist, Dr. Steven Shu, obtains a registered trademark from the United States PTO, for his Easy VasectomyⓇ, a minimal invasive office procedure with no scalpel, no needle and no stitches techniques.

The introduction of Easy VasectomyⓇ has successfully allayed many men’s fears with regard to the scalpel and needle. It is safer, less invasive, and has fewer complications and quick recovery. Under local anesthesia, only a tiny puncture is made at the midline of the scrotum skin. It can be done in less than 10 minutes.

Easy VasectomyⓇ Service in One Stop Medical Center
One Stop Medical Center developed a powerful website, EZvasectomy.com, with rich information on vasectomy and vasectomy reversal. All patients are required to review the important vasectomy information and watch a consultation video. A separate initial consultation is no longer required, and Dr. Shu will finalize the consultation on the same day of surgery, so the patients don’t need another trip for the initial consultation. Moreover, the patients are able to register their vasectomy procedures by filling out the online registration form in the website.

One Stop Medical Center developed a mailer system to eliminate another trip for patients. Patients who live far away may simply mail the specimen to the clinic instead of bringing it personally. Therefore, most patients are able to have a vasectomy done in just one trip to our clinic instead of three.

In order to reduce the financial burden for our vasectomy patients, the price of no scalpel vasectomy was cut in half. This way, more men can afford to have their vasectomy done.

One Stop Medical Center has simplified the vasectomy care system to create a more affordable, friendly and convenient vasectomy service.

Dr. Shu Participating in International Medical Mission in the Fifth Time | Minneapolis & St Paul

Minnesota physician Dr. Steven Shu, medical director of One Stop Medical Center, joins a group of doctors from the United States going to the Haiti in the last week of October, 2017 to provide free vasectomies for local residents. This is the fifth time that he has been part of an international vasectomy mission sponsored by the nonprofit organization, No Scalpel Vasectomy International Inc (NSVI).

The mission of NSVI is to promote and provide free No-Scalpel Vasectomy services worldwide, but especially in developing countries whose infrastructure and environmental resources are challenged by rapid population growth unchecked by established and/or effective family planning programs.

Over the past 14 years, Dr. Shu has been enjoying making his contributions to local communities. Since 2015, he has been focusing more on his international volunteer work in Philippines and Haiti. In 2017, he became a founding president of Medical Volunteers International (MVI, medvolunteers.org), a new non-profit organization for the Chinese American physicians dedicating the medical missions in the poorest countries around world.

Find a Qualified Vasectomy Doctor | Minnesota

A vasectomy is a simple office procedure that most doctors can complete within 30 minutes. Dr. Shu of One Stop Medical Center usually completes a non-scalpel, no-needle, no-suture vasectomy within 10 minutes. A vasectomy usually requires only 1% Lidocaine for local anesthesia with either a needle injection or the no-needle technique with Madajet. The patient usualy relax and take things easy for a couple of days, and the no-scalpel vasectomy typically has few complications. However, for very nervous patients with significant anxiety issues, vasectomies can also be performed under oral sedation.
The vasectomy procedures are usually conducted by urologists, other surgeons, and family physicians. Here are some tips to help find a qualified doctor who can perform vasectomies.

1. Check doctors’ credentials; besides basic medical credentials, the most important questions you need to ask are:

  • How many vasectomies does the doctor performs every year?
  • How many years has the doctor been performing vasectomies?
  • What is the failure rate?
  • What is the complication rate?
  • Experience matters.

    2. You may ask if the doctor uses the new no-scalpel techniques. It makes a big difference in many aspects between modern no scalpel vasectomy and traditional vasectomy. Some doctors claim they perform no-scalpel vasectomy, when their actual techniques are not necessarily the best. For example, spending 10 minutes, 30 minutes, and even 60 minutes to perform a vasectomy will result in very different experiences. The recovery is related to how much trauma the scrotum experiences during the procedure. The two day recovery time from no-scalpel vasectomy is another big difference compared to a 1-2 week recovery from traditional vasectomies. Moreover, the complication rate is much lower than traditional vasectomies.

    3. There are a multitude of sources that offer information on vasectomy doctors in a patient’s area. These include Google searches, insurance companies, and primary-care doctors. If the patient knows any friends, family members and colleagues who have had a vasectomy, ask them about their personal experience with that particular doctor and clinic. This information may be more in-depth, and can also provide the patient with a better understanding of the whole process and what to expect.

    4. Once a number of vasectomy doctors have been identified, try to find out more about them. While credentials and clinical experience are important to consider, there are also practical considerations to take into account. These factors indirectly indicate how much the doctors are committed to vasectomy care and quality of vasectomy care.

    a. You should review their website to see if:

  • It is an informative and well-designed website
  • The contents are frequently updated
  • There is a user friendly online registration.
  • It is a dynamic website with ongoing blog posting
  • There are positive testimonials. There is a big difference in the evaluation of patient satisfaction between a few outdated testimonials and hundreds of recent testimonials.
  • b. If the price is affordable, ask about the total cost (consultation fee, procedure fee, and semen analysis fee).

    c. You should find the whole vasectomy care system to be a friendly and patient-oriented service. For example, One Stop Medical Center offers online consultation through its convenient online registration and one trip care system.

    d. Consider the office location and convenience.

    e. Evaluate the quality of customer service: how the patient is treated on the phone during inquires, the cleanliness of the office, the attitudes of the staff during initial contacting, the level of the procedure room (simple office room or higher level of Surgicenter), and other less-tangible measurements should also influence your decision.

    More about Sperm Banking | Minnesota

    Sperm banking, in the simplest of terms, refers to the practice of storing sperm for future use. Sperm can be stored indefinitely when cryogenically frozen, and can be thawed and used to fertilize an woman’s egg. A pregnancy conceived using frozen sperm is no different from a normal pregnancy.

    There are two types of sperm banks- private sperm banks, and donor sperm banks. Donor sperm banks, which many of you may have heard of, purchase sperm provided by donors and sell it to those who want children. Donors are screened and added to a database, and buyers can select which donor they prefer.

    A private sperm bank, unlike a donor sperm bank, only cater to individual families. Private sperm banks may be associated with a fertility clinic, or may be a branch of a national corporation. The sperm sample is either collected locally, at a clinic, or mailed overnight through a home collection kit. Many doctors may recommend two samples taken on separate days, just to be safe.

    Before the sperm can be collected, the donor’s blood must be tested for diseases that could be transmitted through sperm. This includes HIV, hepatitis B and C, and many more. If the donor tests positive for any of these the sample may be unusable.

    Once collected, the a small portion of the sample is tested to see how well it holds up to freezing and thawing, and whether or not it will be viable for future use. If all goes well, the sperm is slowly frozen in liquid nitrogen tanks at -190C, where they can be kept stable almost indefinitely. Even twenty year old sperm can still be useable.

    When the time comes for the sperm to be used, the bank coordinates the transfer of the frozen sperm to the fertility clinic, where it is thawed and prepared for the insemination procedure. Usually, only a small amount of sperm is required. That way, if it doesn’t work the first time, there will be enough for future attempts.

    Why Sperm Banking?
    Private sperm banking is excellent for men who wish to conceive a child but have lost reproductive function or have issues with infertility. It is also great for men who are unsure if they want a child, but wish to have the option later on in life. Men who plan to undergo vasectomy are good candidates to have their sperm frozen. Sperm banking is highly effective and well established method of ensuring future reproductive success.

    5th World Vasectomy Day | Minnesota

    It might seem odd to dedicate an entire day to vasectomies, but for Dr. Shu and the other 1,000 doctors participating in World Vasectomy Day on November 17, it’s an important event that spreads awareness on the most effective but underutilized methods of contraception: the vasectomy.

    With industrialization and modern medicine making it safer and easier to give birth and raise children, the world population has skyrocketed- current projections predict the world population will plateau at 11 billion. High population puts a strain on resources like food, medicine, and energy. In many areas of the world that are seeing rapid population growth, sexual education and medical resources have not caught up to other areas in society. Vasectomies are excellent for family planning in areas that are not well developed and do not have the resources that most of us take for granted.

    At World Vasectomy Day, local Mexican and international doctors will provide free vasectomies, along with live-streamed interviews with family planning experts, patients, and their families. This will be Dr. Shu’s 5th year participating in the event, and the One Stop Medical Center will offer free large pizza.

    This year’s World Vasectomy Day is being held in Mexico. Doctors around the world participating in World Vasectomy Day will provide as many vasectomies as possible in a span of 24 hours. The goal of World Vasectomy Day is to spread awareness of vasectomies and to dispel myths associated with them through community outreach and open dialogue.

    Understanding Male Infertility

    Infertility, simply put, is the inability to conceive children. There are several causes for male infertility: low sperm count, low sperm motility, and poor sperm morphology. Each of these can make conception difficult. Each of these can be a result of genetics or environment. These days, it seems like the list of things that’ll give you cancer or a disease is increasingly long and confusing, so I’ll try to make it simple.

    Low sperm count is simply the lack of sperm of in semen. A lot of this is caused by environmental factors such as excessive alcohol and drug abuse, sexually transmitted disease and infections, exposure to toxins, hazardous chemicals, and radiation. These can be usually be avoided by taking the proper precautions. Not to mention the many other negative side effects that accompanies them. Low sperm count can also be influenced by exposing the testicles to high heat (from a fever), and genetic causes such as Klinefelter’s syndrome, or cystic fibrosis.

    Abnormal sperm refers to sperm that is not a normal shape and is thus unable to swim or function normally, preventing conception. This can be caused by testicular inflammation, twisted or swollen veins in the scrotum, exposure to heat, as well as environmental influences such as exposure to toxic chemicals.

    Infertility can also be caused by other issues such as premature ejaculation, retrograde ejeculations, erectile dysfunction, and other structural problems related to the male reproductive organs. Although men do not suffer the same loss of fertility that women do with age, men past the age of 70 may exhibit decreasing sperm quality. Many medical conditions such as diabetes, HIV, thyroid diseases, organ failure, heart attack, and anemia can cause infertility as well.

    Various drugs can also cause infertility, including: steroids, cimetidine (Tagamet), sulfasalazine (Azulfidine), salazopyrine, colchicine, methadone, methotrexate (Folex), phenytoin (Dilantin), among many others.

    Vasectomy is obviously a common reason for male infertility.

    The best way to treat male infertility will be different for everyone. Obviously, preventative measures such as moderating drug, tobacco, and alcohol abuse, avoiding working with toxic or radioactive materials, using protection, and limiting sexual partners. Other solutions will depend mostly on the cause- like treating ejaculation issues or a disease that is causing infertility. The vasectomized patients may consider the vasectomy reversal procedures to restore their fertility.

    Robotic Vasectomy Reversal- The future of vasectomy reversal? | Minnesota

    Vasectomy is the most effective method of male contraception, with an estimated 500,000 vasectomies per year and rising. Naturally, as divorce rates have been steadily increasing, there has been a corresponding increase demand for vasectomy reversals. This poses some challenges- while vasectomies have become increasingly simple, quick, cheap, and noninvasive with techniques such as no-scalpel vasectomy, vasectomy reversal is still a relatively complicated microsurgical procedure that requires time, skill, concentration, and money. To give you an idea, the opening of the vas deferens (the tube which carries sperm to the semen) is 0.1mm wide, about as wide as a human hair. Knowing that, it makes sense why vasectomy reversals are harder than vasectomies; it’s a lot easier to cut it in half than stitch it back together. That’s not to say vasectomy reversal isn’t effective as it is now. Patency rates (moving sperm) have risen from 5-30% to 85-90% today with the advent of microsurgical techniques.

    How can it get better?

    Of course, vasectomy reversals aren’t always perfect. As time goes on, the chance of pregnancy goes down considerably. Also, the procedure is time-consuming and highly dependant on a physician’s skill. Robotic surgery is an exciting alternative that could theoretically mean a higher patency rate if there are no other complicating factors. Robotic surgery also theoretically has several potential advantages:

    Smaller incisions- Little robot arms are a lot smaller than a doctor’s hands. Also means less scarring.
    Visualization- Robots mounted with cameras can give detailed magnified images that the eye could not resolve
    Pain- Robotic surgery is usually less painful and likely to develop complications
    Time- Robotic surgery has the potential to be much faster than hands.

    What does the research say though?

    There have been vasectomy reversals that have been performed using robotic-assisted vasectomy reversal, but so far it does not offer a lot of advantages. Studies have given different results, but on average, robotic-assisted vasectomy reversals take just as long and are equal in patency rates. With no significant advantages over a regular vasectomy reversal, it’s not worth it for most hospitals and doctors to spend a lot of money on expensive robotic-assisted surgery equipment. However, that doesn’t mean robotic-assisted vasectomy reversals should be discounted. The technology is still in its infancy; who knows where it might be in 20 years down the road. As robots and AI get more advanced, operating time, precision, and effectiveness should increase, and the physical role of the surgeon will go down- not just for vasectomy, but all surgical procedures. It’ll be a while before that happens though. Your best bet right now is the tried-and-true vasectomy reversal, done by your local human doctor.

    Vasectomy and Sex Life | Minnesota

    Vasectomy is undeniably the most effective long term birth control for men, with half a million men undergoing the procedure in America every year, but some remain hesitant despite being assured of its safety and reliability. Faced with the idea of being infertile, the vasectomy can be a daunting proposition to many men. Fertility and sexual virility is heavily tied with the masculine identity, and to some vasectomy may be equivalent to surrendering some of it. Here’s why you shouldn’t worry.

    A fear of many men looking to get a vasectomy is the loss of sexual desire or satisfaction after getting snipped. What many people don’t seem to realize is that vasectomy rarely affects sexual pleasure physically- when men suffer erectile dysfunction or loss of sexual arousal after vasectomy, it is almost always psychological. Physically, vasectomy should not affect libido- vasectomy is simply the severance and obstruction of the vas deferens. Besides the semen containing no semen, there should be no difference in sexual function after a vasectomy. Of course, complications exist but with innovations such as no-scalpel vasectomy making the procedure increasingly less invasive, they are incredibly rare.

    Getting a vasectomy shouldn’t be seen as losing your manhood. Most men who are nervous about losing their manhood quickly realize that their sex is just as good as it was before, if not better. A study done on the effects of vasectomies on the sex lives of couples proved just that. In the study, a sample of 76 heterosexual couples were given a survey, one for the man and one for the woman, which score parameters such as sexual desire, coital satisfaction, erectile function, etc, before and after the procedure and the results were very interesting!

    In men, scores on the questionnaire revealed that quality of the sex was about the same before and after the procedure. Erectile function, orasm function, sexual desire, sexual satisfaction all either increased a slight amount or stayed level. The result, though unsurprising, should put some potential patients at ease. What was much more interesting was that in women, scores were higher in almost all areas, showing significant increase in sexual desire, arousal, lubrication, orgasm, and overall satisfaction. Women in relationships tend to be more satisfied sexually after their partner gets a vasectomy. This is further evidence that most issues with sex after vasectomy are psychological rather than physical.

    Another study examined the relationship between vasectomy and frequency of sexual intercourse in populations of vasectomized and non-vasectomized men. The results also seemed to support that sex is better after vasectomy- vasectomized men had sex an average of 5.9 times a month compared to 4.9 times per month in non vasectomized men. Furthermore, vasectomized men were 81% more likely to have at least once a week.

    So if the idea of losing sexual potency after a vasectomy scares you, don’t be- there’s really nothing to worry about. Studies have shown that vasectomy either has no effect or increases sexual satisfaction, and that vasectomy actually increases the frequency of intercourse.

    Introduction of Sperm Banking | Minnesota

    Cryopreservation (rapid freezing) is the method of preserving sperm for future use. There are many reasons an individual would choose to prepare for possible sterility, including

    1. Pending cancer treatments
    2. Elective vasectomy
    3. Infertility (use frozen donor semen)
    4. Initiating hormone therapy
    5. Having a high risk job.

    For some men, sperm banking is almost a necessity. Men diagnosed with cancer during their early 20’s face a course of chemotherapy likely to provide a cure but also likely to adversely affect sperm production. Their only hope of fathering children is with preservation and storage of sperm obtained prior to chemotherapy. For years, sperm banks have been providing this service.

    On occasion, a vasectomy candidate will ask about storing his sperm prior to undergoing vasectomy. The question is whether sperm freezing and storage (cryopreservation) might be considered a reasonable alternative to vasectomy reversal in the unlikely event that the individual wishes to father children in the future.

    For another group of men, infertility has necessitated use of donor semen. While these men may be infertile for a variety of reasons, use of donor sperm allows their wives to experience pregnancy and childbirth, obviously not part of the adoption process. Nearly all donor sperm used nowadays is obtained from frozen semen. Fresh semen is almost never used because infected donors may not test positive for hepatitis and AIDS until weeks after donation. Cryopreservation of semen provides the safety net needed to confirm that sperm donors are healthy and have negative tests weeks or months after donating.

    Frozen semen can be stored for an indefinite amount of time. It can be used effectively in different types of fertility treatments, including in vitro fertilization (IVF), intrauterine insemination (IUI), or gamete intrafallopian transfer (GIFT).

    Effects of Anti-sperm Antibodies in Patients with Vasectomy Reversal | Minnesota

    What are Anti–sperm Antibodies?

    An antibody is a blood protein produced by your body’s immune system in response to the stimulation of a specific antigen. Common antigens include multiple antigens in bacteria, viruses, cancer cells and foreign substances in the blood. The antibodies combine chemically with antigens and serve to help the body target and fight-off theses “dangerous” or “unwanted” cells or substances. However, it is possible for antibodies to work against the body’s own cells; such is the case in many autoimmune diseases. In cases of vasectomy, especially after long periods of time after the surgery, it is possible for the body to form antisperm antibodies. This is a concern for many patients seeking vasectomy reversal.

    This is normally not a problem with sperm cells as they technically not in the body, in the same sense that the inside of our digestive tracts are not considered to be inside the body. Sperm is created in the testes, transported by the vas deferens, mixed with seminal fluid, and exits the body during ejaculation- at no point does sperm ever contact blood, as direct contact is prevented by the testes/blood barrier.

    When the blood-testis barrier is compromised under certain circumstances, such as trauma/surgery, infection, cancer and congenital defect, sperm could be exposed to blood and trigger the immune responses, which leads to antibody development. Development of anti-sperm antibodies after vasectomy is thought to be related to the breakdown of the blood-testis barrier and leakage of sperm antigens from the epididymis. For this reason, the body may treat sperm as a foreign pathogen, creating antibodies that correspond to the antigens on the surface of the sperm cell. A vasectomy, especially if a long period of time has passed since the procedure, can result in higher concentrations of anti-sperm antibodies.

    Antisperm antibodies are found in between 8% and 21% of men in the general population, 9% and 36% of infertile patients, and 70-100% of men after vasectomy. Studies have provided convincing evidence that a vasectomy does not lead to development of autoantibodies in men other than anti-sperm antibodies, and there is no evidence of any immunologic or other diseases related to development of anti-sperm antibodies following vasectomy.

    What is the Relationship of Anti-sperm Antibodies with Vasectomy Reversal Procedures?

    Antisperm antibodies can affect fertility in the male if they are in high concentrations. Fertility loss can come at varying degrees; the more antibodies one has, the lower fertility will be. B- immune cells create multiple types of sperm antibodies. Some antibodies will cause sperm to stick together, forming large clumps that hinder mobility of the sperm. Other antibodies act as a “flag” for natural killer cells, and others can even bind with the antigens on the surface of the egg in the womb, causing its destruction.

    How Anti-sperm antibodies affect fertility following vasectomy reversal is not clear. While 79% of men that are tested after a vasectomy have elevated antisperm antibodies, the levels at which they are present are not significant enough in most men to cause a significant drop in fertility. Most experts, including those from the American Urological Association, agree that there are rarely significant long-term side effects that arise from vasectomy.

    The practice guidelines of the American Society for Reproductive Medicine and the Society for Male Reproduction and Urology stated:

    “Overall postoperative conception rate (following vasectomy reversal) is relatively high (50% to 70%) and the presence of antisperm antibodies does not correlate closely with postoperative fecundability. Consequently, the value of preoperative antisperm antibody testing remains controversial and unproven.”

    Here is a summary of research evidence:

    1) Despite almost all men having detectable antibodies following a vasectomy, two thirds of vasectomy reversals are successful in achieving a pregnancy.
    2) The presence and levels of antibodies following vasectomy reversal inconsistently predicts what couples will be successful in achieving a pregnancy.
    3) The subjects of most research were infertile men. Research data from fertile men is lacking.
    4) Testing for sperm antibodies is not well standardized. There are different types of antibodies and different locations in the sperm. The influences from each antibody are unclear.

    RISUG- An Exciting, Potential Vasectomy Alternative | Minnesota

    Reversible inhibition of sperm under guidance (RISUG) is a procedure that could someday replace vasectomy as a long-term form of birth control. While RISUG and vasectomies have similar goals, the way they achieve those goals are quite different. Vasectomies involve cutting the vas deferens, and tying/stapling/cauterizing the open ends of the vas deferens. Even with the minimally invasive no-scalpel vasectomy, it is still a surgical procedure. RISUG is different- there is no cutting involved. Instead of severing the vas deferens, a polymer known as styrene maleic anhydride (SMA) is injected into the vas, which quickly hardens. This barrier does not block sperm; rather, it renders all the sperm that passes through it inactive, preventing conception. Reversing it simply requires another injection which dissolves the polymer, allowing the passage of motile sperm.

    RISUG provides a solution for a couple of problems that still affect vasectomies. First, it prevents backpressure from sperm in the epididymis and granulomas, which, while rare, are still a potential inconvenience for some who have a regular vasectomy. While RISUG procedure is not permanent (~10 years), it is very affordable and can be replaced indefinitely. It’s impermanence is a feature for some, as it is very easy to reverse the procedure. In the past few years, vasectomy reversals have become very effective, but they’re still known to fail and are costly compared to the initial vasectomy. The recovery time is short, and couples may resume intercourse within a week.

    Unfortunately, its development both here and abroad has been rocky. As of last year, advanced clinical trials on humans had very few volunteers- just 64 out of a targeted 500. In the US, the intellectual property rights are owned by the Parsemus Foundation, a non-profit, and is called “Vasalgel™”. Animal trials so far have been successful, but it still may be some time until human trials begin. Hopefully, this technology will one day revolutionize male birth control, but for now no-scalpel vasectomies are the best option for those seeking long-term male birth control.

    Why Male Sterilization Is the Way to Go? | Minnesota

    Around 2.4 percent of all men have had a vasectomy worldwide. Male sterilization is most common in developed areas of the world, especially North America, Asia, and Western Europe, where birth rates have declined. In America, 7 percent of men have had a vasectomy, 9 out of 10 of them married men. This number has been static since 1990s, and shows no signs of changing.

    The alternative to male sterilization is female sterilization, usually tubal ligation, wherein the fallopian tubes are cut and blocked up. It is commonly referred to as “getting your tubes tied”. This keeps eggs from being released into the womb, preventing conception.

    A similar method known as the tubal implant method involves placing spring-like coils into the fallopian tubes, causing scar tissue to form, which blocks the tubes. This can take up to 3 months to be effective.

    Vasectomy is both more effective and safer than tubal ligation. Vasectomies are nearly 100% of effective and less likely to fail compared to a tubal ligation. Furthermore, complications are less likely with a vasectomy. Part of this is due to vasectomies being inherently safer and less invasive than a tubal ligation due to where the vas deferens are located compared to the fallopian tubes. Thus, vasectomies are also more convenient and more affordable compared to tubal ligation.

    Despite this, tubal ligation is still more popular than vasectomy worldwide, by a factor of four or five times. Why is this the case? Well, historically reproduction was a duty that women were responsible for. In the past it was left to the woman to put on that condom, take her birth control pills, or get an abortion. Also consider, even today, that much of the male identity was tied with his fertility and ability to raise kids. Being sterile is not considered “manly”. So why would men get vasectomies when it was easier to just make women get a tubal ligation? The society we live in today is thankfully a little less sexist, and now it’s accepted that some of the responsibility lies on the man’s shoulders as well. Vasectomies are the best form of birth control, hands-down.

    What about Ejaculation After Vasectomy? | Minneapolis & St Paul

    Men in Minnesota who plan to have a vasectomy always wonder what their ejaculations will be like afterwards. This is not an unusual question’ many are simply curious, while others have anxiety about this sort of thing.

    Generally speaking, patients haven’t had any issues of ejaculation after vasectomy. Post-vasectomy ejaculation should be no different than it was before the procedure.
    This blog is going to address some common questions related to initial post-vasectomy ejaculations.

    1. When is the earliest time for the first ejaculation after the procedure?
    Most doctors recommend waiting for a week, other doctors recommend a few days. There is no “scientifically” correct answer. Regardless of when you start sexual activities, the most important thing is that you still use protection until you are cleared.

    2. Are the initial ejaculations painful after the vasectomy?
    Most patients should not have painful ejaculations after a vasectomy. A few patients reported mild discomfort in the first ejaculation. If the patient starts sexual activities very early (within a week), they may experience some discomfort due to local swelling, bruising, or tenderness.

    3. Do the ejaculations change after a vasectomy?
    No, the ejaculations after a vasectomy will be pretty much the same as they were before the vasectomy procedure. There are no noticeable changes in volume, color, or smell of semen. The force of your ejaculations will also remain same after your vasectomy.

    The only thing that really changes in post-vasectomy semen is that it no longer contain any sperm. Sperm only accounts for less than 5% of the volume of a man’s ejaculate, so the tiny change is not going to be noticeable. In fact, the volume of semen naturally varies at that rate based on fluid intake, diet, physical activities, frequency of ejaculation, etc.

    4. Should I be concerned about blood in ejaculations after a vasectomy?
    Blood in the ejaculate often causes great concern to the men who experience it after a vasectomy. This is due to a condition called hematospermia, or hemospermia. It could occasionally happen in the first month after a vasectomy. If you can imagine, the vas tube has been opened and any resultant blood from the wound or ruptured capillary vessels can pass through the tube during healing.

    Post vasectomy hematospermia is an uncommon finding after a vasectomy however it is not alarming. Most cases of hematospermia after vasectomy are generally self-limited, and it usually resolves within a few weeks. No further diagnostic workup is needed; however, in some patients, hematospermia may be the first indicator of other urologic diseases such as prostate or seminal vesicle (male sex glands). If it persists, it may be wise to consult with a urologist.

    Why do Vasectomy Reversals Fail? | Minnesota

    First, it’s important to distinguish patency rate and pregnancy rate. Patency rate refers to the likelihood of the vas deferens remaining open and providing unobstructed flow of sperm cells. High patency rate means that flow is unobstructed and sperm has a high likelihood returning to fluid. Pregnancy rate refers to likelihood of pregnancy. Pregnancy rates are lower than patency rates, as there are multiple factors that affect pregnancy.

    One reason is abnormal sperm quality. Some men might just have low sperm quality to begin with, which a vasectomy reversal alone would not be able to fix, no matter how unobstructed the vas deferens is. Options for those wanting to have children with this condition include IVF or a trial of steroids and lycopene supplement.

    Another common reason for failure is anti-sperm antibodies, which immobilize sperm. These antibodies are typically found in the blood, so it is not common to find it in seminal fluid. Studies suggest 8-21% of men that have not had a vasectomy have anti-sperm antibodies in their fluid. By contrast, studies on vasectomized men show that 50-80% of men develop concentrations of these antibodies after the first year post-vasectomy. It is unclear how much this affects fertility after a reversal, as there have not been many studies done that confirm it, and there is not a surefire method of testing for antibodies in the semen either.

    Another possibility is simply scarring, which is not uncommon but possible as a result of vasectomy reversal. It can be treated with anti-inflammatory medication and/or repeat of the procedure. Even if none of these affect you, those who have had vasectomies for a very long time may experience epididymal dysfunction (e.g. the ability for sperm to move through the epididymis), which will either clear up on its own, or may require that you use IVF.

    Finally, many times it is the female partner that results in low pregnancy rates. Women over 35 experience a drop in fertility, which may be one reason why there is a discrepancy between patency and pregnancy rates.

    Reasons of Vasectomy Failure | Minnesota

    While vasectomy has long been thought of as permanent, ending your ability to have kids, this is clearly not the case for Jets quarterback Antonio Cromartie, who had twins last year with his wife Terricka, conceived well after his vasectomy a couple years ago. The couple found out about the pregnancy completely on accident one day when his wife went to the ER with a bad stomach. However, it was clearly not an issue for the footballer and they kept the baby. He’s now welcoming their 14th child into their home.

    Why do vasectomies fail?
    Vasectomy failure is the occurrence of pregnancy or failure to achieve azoospermia after a reasonable period of time following vasectomy. The positive result of Post Vasectomy Semen Analysis (PVSA) can be stressful for couples looking forward to anxiety-free intercourse, without the threat of pregnancy.

    The most common reason is intercourse immediately after the vasectomy without protection. Even after the vas deferens (the tube that carries sperm) is cut and sealed, sperm will still be in the tube and it takes some time in order to ensure the vas is completely cleared out. Men typically have to ejaculate 20-25 times before all the sperm is gone. Unprotected sex before this time can definitely lead to unintentional pregnancy. This is the reason that you continue to use protection for three months after your vasectomy.

    The second most likely, though less common, is recanalization failure. Actually, recanalization is the most common reason for technical failure in vasectomy, and it could happen even in a experienced surgeon. In vasectomies, the vas deferens is cut and the ends are blocked. Recanalization occurs when the sperm is still allowed to pass and go into the ejaculate. Sperm try and often succeed in penetrating through the end of the blocked vas. After a couple months of this, there can be many tiny holes in end of the vas deferens where sperm may flow out through pseudo channels.

    Recanalization following vasectomy should be suspected if motile sperms or rising sperm concentrations are seen after a initial or routine PVSA has shown azoospermia or Rare Non-motile Sperms (RNMS). Recanalization can be either transient or persistent based on the results of serial PVSAs. Pregnancy due to recanalization is estimated to occur after approximately 1 in 2000 vasectomies or less often. The incidence of recanalization is very likely greater than the reported rate of pregnancy after post-vasectomy azoospermia because not all recanalizations result in pregnancy.

    About half of the recanalizations will close (seal by scarrring) by itself in 6 months and contraceptive success will be achieved, the patients don’t need to repeat vasectomy. Other 50% patients who have persistent recanalization need to repeat vasectomy.

    The third and least common is technical failure resulting from a surgical error such as occluding one vas twice without occluding the other vas or failure to identify the very rare situation of vas duplication on one side. An extra vas is a very rare condition. Very occationally, the wrong tube (unusual large blood vessels) can be mistakenly blocked. Technical failure is characterized by persistently normal or nearly normal motile sperm counts and sperm motility after vasectomy, as if the procedure was never done! It happens more often in a inexperienced family physicians or surgeons.

    It is recommended to get sperm tested three months after the vasectomy to ensure that it worked. But our patients usually don’t need to have a semen analysis periodically if the vasectomy performed in our clinic is confirmed to be successful. Dr. Shu has performed about 1500 cases of vasectomies, all of them being successful!

    Vasectomy is a big life decision. It is important to know if the vasectomy was successful or not, so get your sperm tested after your vasectomy!

    Dr. Shu Led the Chinese American Physicians and Established the International Volunteering Physician Organization

    Medical Volunteers International (MVI) is a volunteer organization initiated and created by Chinese physicians in the United States. It is non-profit, non-religious, and non-affiliated to any political group. It is for all Chinese physicians and other physicians of other ethnicities in the world to join, collectively promote, and develop international medical volunteering.

    Dr. Shu is the founder of Medical Volunteers International (MVI), and he is currently serving as MVI President.

    MVI’s aim is to provide Chinese physicians and physicians of other ethnicities with useful information about international medical volunteering, and to build a platform for volunteers exchanging and sharing personal experiences. Through connection and communication with other international medical volunteer organizations, MVI will help their members find suitable volunteer projects. Meanwhile MVI will actively create and initiate its own projects in Haiti, Cambodia and Senegal beginning in 2018. These projects will focus on helping areas in urgent need of medical resources and supplies, as well as patients in need of necessary medical treatments.

    In 2014, Dr.Steven Shu joined the “No-Scalpel Vasectomy International, Inc”, an international medical volunteer organization led by Dr. Doug Stein. Dr.Shu made a total of four trips to the Philippines and Haiti in the past two years.

    Dr. Shu’s personal experience led him to a larger vision, driven by a sense of individual responsibility and ideology. He realized that an individual’s strength is often limited. However, if individuals come together to build an organization, this organization’s power will be unlimited. There are more than 6,000 Chinese physicians in the United States, hundreds of thousands around the world, and much more in Mainland China, Taiwan, and Hong Kong.

    With the power of social media and social networking, overseas Chinese physicians should be able to set up an organization, such as MVI, to connect with people around the world to help those in need of medical aid. Through communicating with other Chinese physicians, Dr.Shu learned that many physicians share similar interests and goals, and are willing to be involved in medical volunteering, but most of them do not know how or where to start. He also learned that some physicians in North America are already at the forefront of such endeavors, the most prominent being Dr. Jun Xu. Dr. Xu has visited Senegalese, Africa for medical mission trips every year since 2013, and Dr. Junkui Zhang and Dr. Tiebo Fu have participated in medical volunteer activities in Central America. Therefore, at the end of 2016, after careful and thorough consideration, Dr.Shu decided that the time for advocating overseas Chinese physicians to establish an international medical volunteer platform has come.

    After discussion with Dr. Jun Xu and other physicians who showed great enthusiasm and support, a council of nine members was formed. On January 29, 2017, MVI was established and started to recruit new members immediately. In the meantime, fund-raising efforts have begun.

    MVI was incorporated on February 8, 2017. By April 30, 2017, a total of 99 people joined the MVI with 64 official physician members. IRS approved the MVI’s 501 C3 tax exempt status in the March, 2017.

    Comparative Analysis of Anticipated Pain Versus Experienced Pain in Patients Undergoing Office Vasectomy.

    Advances in vasectomy technique have minimized patient discomfort; however fear of pain remains a primary concern. The Urologist Dr. Furr at the University of Oklahoma just published the clinical research article on the pain related to vasectomy in Canadian J Urol. (2017 Apr;24(2):8744-8748), the research was to determine how the anticipation of pain associated with vasectomy compares with patient’s actual intraoperative experienced pain levels.

    A cohort of 172 patients undergoing clinic vasectomy was analyzed, and the result indicated that the actual pain experienced by a patient is significantly lower than their anticipation of vasectomy pain. This clinic research data will aid clinicians in appropriately counseling patients and minimizing pre-procedural anxiety.

    Modern no-scalpel vasectomy is a minimally invasive office procedure that performed near painlessly under local anesthesia. Fear of pain is still the number one reason for men in Minnesota to resist getting a vasectomy because they don’t want to have surgery near their genital organs. A good consultation before vasectomy the helps to relieve anxiety.

    Conventional needle anesthesia in vasectomy involves the use of a 27 gauge needle for local anesthesia. Dr. Shu applies local anesthesia with a special spray applicator without the use of needles. A spray applicator (MadaJet®) delivers a stream of anesthetic so fine that it penetrates the skin and diffuses to a depth of about 3/16 of an inch, enough to surround and anesthetize each vas tube in turn as it is lifted into position beneath the skin, attaining a close to 100% efficacy rate with no need for supplemental anesthetic.

    Dr. Shu uses the modern no-scalpel technique, exposing each vas in turn through a tiny opening in the front scrotal wall without using scalpel, the trauma in the scrotum is so minimal that significantly reduces the pain during the procedure and post-operative period.

    The patients always states right after their vasectomy, “it is amazing”, “Wow, much better than I thought”, “I worried for nothing”, “It is truly a easy vasectomy”, “easy vasectomy which is understated”, “it is almost painless”.

    MadaJet_2

    MadaJetSprayApplicatorMadaJet

    Microsurgical Vasovasostomy | Minnesota

    Microsurgery involves the use of an operating room microscope or surgical loupes (magnifying glasses) to conduct very small scale operations on the body. Microsurgical reconstruction of tissue is often a complex and very technical procedure. In the early 1900s, Carrel and Guthrie pioneered microsurgery techniques through experimental procedures on animals, replanting and transplanting tissues and organs such as amputated limbs, and kidneys. The first use of optical magnification was recorded in 1921, where a monocular microscope was used for ear surgery by Nylen. It was during this time period microsurgical instruments, operating microscopes, and other advancements in medical technologies paved the way for microsurgery.

    Advancements in vasectomy reversal closely mirror those in other procedures in well. The first successful vasovasostomy was in 1919, although its efficacy was questionably. By 1948, 18% of urologists had tried it, and the success rate was only 40%. The first microsurgical vasectomy reversal took place in 1971, by Owen. The next big advancements came in 1977, with the development of 2-layer and modified microsurgical suture techniques. The patency rate has rose to more than 90% with these advancements if vasectomies are done with nine years. Microsurgery continues to see advancements every year. Robots with hands far steadier than any human now have the capacity to perform operations as small as vasectomy reversal.

    Ultimately, microsurgery is a powerful contemporary surgical technique with many different applications, not least of which is vasectomy reversal. It is because of microsurgery and its advancements that effective vasectomy reversals are possible, now with minimal pain or downtime at Procedure Clinic. It will be fascinating to see what this procedure could look like many years into the future!

    Possible Vasectomy Alternative in the Future? | Minneapolis & St Paul

    Many men in Minnesota wonder if any vasectomy alternatives are available in the future. Yes, a simpler, reversible vasectomy alternative is in the works at the Parsemus Foundation in California. This works by injecting a gel into the vas deferens, blocking it and preventing sperm from entering the ejeculate. The difference is that another dissolving gel can be injected that restores fertility by removing the original gel barrier.

    The technology was tested on rhesus macaques monkeys who were allowed to mate for two years after the gel was injected, and in the that time no monkeys were birthed. In the words of Dr. Colagross-Schouten: “We were impressed that this alternative worked in every single monkey, even though this was our first time trying it.”

    Gel functions like a reversible vasectomy, blocking or filtering out sperm. It is made from a dense web of molecules that form a viscous barrier in the vas deferens. The resulting gel implant remains in a soft gel-like state that allows water-soluble molecules to pass but not larger structures such as spermatozoa. This quality is thought to be a benefit for preventing back-pressure on sperm storage areas, which helps to reduce “blow out” in the epididymis.

    The whole process of procedure will be almost same as the no scalpel vasectomy. A small amount of local anesthesia is placed into the scrotal skin and around the vas deferens. A tiny puncture is made with a pointy hemostat in the numbed area of scrotal skin. The vas deferens are then secured and pulled out with a ring clamp through the small opening. The surrounding fascia is stripped with a sharp instrument to expose the vas deferens, and the gel was injected in the lumen of vas deferens. The complications of post bleeding and hematoma are expected to be lower.

    Since tests in monkeys were successful, human trials will begin shortly. Pretty soon, this alternative vasectomy method may be available across the globe which come with the benefits of vasectomy, but are easily reversible.

    Hematospermia After Vasectomy | Minnesota

    An anxious patient recently called my office two weeks after his vasectomy. “I think I might have problem with my recent vasectomy,” he said anxiously. “My wife and I had sex last night, and she noticed that there was blood in my semen.”

    Blood in the ejaculate often causes great concern to the men who experience it after vasectomy, a condition called hematospermia, or hemospermia. It could occasionally happen in the first month after a vasectomy. If you can imagine, the vas tube has been opened and any resultant blood from the wound or ruptured capillary vessels can pass through the tube during healing.

    Post vasectomy hematospermia is an uncommon finding after a vasectomy however it is not alarming Most cases of hematospermia after vasectomy are generally self-limited, and it usually resolve within a few weeks, and no further diagnostic workup is needed; however, in some patients, hematospermia may be the first indicator of other urologic diseases such as prostate or seminal vesicle (male sex glands). If it persists perhaps it might be wise to consult with an urologist

    Vasectomy Reversal and Other Alternatives | Minnesota

    Traditionally vasectomies were considered to be permanent procedures, but headways in science and medicine have made reversal attainable for the average person. Vasectomy reversal is a procedure that involves the surgical reattachment of the severed vas deferens, with the end goal of restoring fertility in men that have had a vasectomy in the past. There are many reasons why someone would want a vasectomy reversal. Most couples want more children, often following a remarriage, some couples that at one point did not want children change their minds, and a few have unfortunately lost children and desire more.

    Other methods of having children besides vasectomy reversal are available as well. IVF, (in-vitro fertilization), known colloquially as having a “test tube baby”, involves taking one of the female’s eggs and retrieving sperm from the male, and manually combining them outside of the body without sexual intercourse. The embryo is then transferred to the uterus. ICSI (intracytoplasmic sperm injection) is a more recent innovation that involves directly injecting a single sperm into an egg, and is very effective for severely infertile men whose semen lacks enough motile (moving) sperm cells.

    The average cost of basic IVF in the US is around $12,500, and medications run another $3,000-$5,000. Pre-implantation genetic diagnosis (PGD) step of the process another $3,000 to $6,000. Altogether, conservatively speaking, The cost of basic IVF is about $20,000 … for each attempt to have a healthy child utilizing a procedure that is successful (most optimistically) about 40% of the time, depending upon factors such as maternal age and the specific medical circumstances of the parents.

    Adoption or sperm donation are other options as well, but many naturally desire to raise their own biological children. Sperm donation is the cheaper option, and usually costs $400-$1,000. Adoption is considerably more expensive ($5,000-$40,000) and the process can take years to accomplish. The final, and often least desirable option is a child-free lifestyle.

    For couples where the child-rearing partner is reproductively healthy, vasectomy reversal seems to be the most cost effective way of having biological children. One Stop Medical Center offers vasovasostomy at $2,490, considerably cheaper than IVF and adoption while still making biological children of both parents attainable, which cannot be said of sperm donation.

    Vasectomy and prostate cancer- Is there a link? | Minneapolis & St Paul

    Vasectomy is one of the most common methods of male contraception in Minnesota, and is popular due to its efficacy and permanence. It was estimated that 15%, or about 50 million men had vasectomy procedures done in the United States. The first mention of an association between vasectomy and prostate cancer were in the late 1980s, where a study showed a positive link between vasectomy and risk in developing prostate cancer. Further studies throughout the years since then have been contradictory or inconclusive as to whether or not vasectomies actually increase the risk of prostate cancer.

    For the most part, prostate cancer is nothing to fear for men considering a vasectomy. A recent 2015 meta-analysis of 9 different cohort studies was statistically analyzed in order to determine if a possible correlation between vasectomies and prostate cancer. The study concluded that there was no evidence that vasectomy increased the risk of prostate cancer. While there was slight positive correlation, it was deemed not statistically significant. Furthermore, correlation does not equate causation- there is no reason why vasectomy would actually cause prostate cancer. There is no proven biological mechanism that relates these two together.

    There are many reasons why early studies may have shown a correlation between the two; for an example, men who have had a vasectomy were more likely to have tests for prostate cancer under a urologist. Also, prostate cancer diagnoses in general have risen in recent decades in part due to an aging population and better testing methods. Most authorities, like the National Cancer institute and the American Urological Association, agree that vasectomy does not increase the risk of developing prostate cancer.

    Regardless, the decision to get a vasectomy is not one to be made lightly. It is an important family planning decision and permanent as well- vasectomy reversals are becoming more and more easily attainable but they are still expensive compared to a vasectomy and are not guaranteed to work, especially if the vasectomy was done a long time ago. Please take the time to decide whether a vasectomy something that you really want.

    Post Vasectomy Pain Syndrome (PVPS) | Minneapolis & St Paul

    Some men in Minnesota experience chronic pain after a vasectomy, known as post-vasectomy pain syndrome (PVPS). While pain is normal for a few days post-vasectomy, those with PVPS will continue to have pain months after the procedure. The pain can be severe enough to interfere with daily life. It can be a dull, general pain, or be sharp and localized, and many report that the pain gets worse during intercourse. In the past, the incidence of PVPS was thought to be very low (<1%), but recent surveys have shown that up to 15% of men who get a vasectomy experience PVPS, while 2% experience chronic pain that significant effects quality of life. Dr.Shu performed about 1000 vasectomies, only one patient came to have a follow up due to ongoing post vasectomy pain after three months of vasectomy.

    Treatment and cause of PVPS may be different patient-to-patient, as everyone responds differently to the procedure.There are multiple potential causes of post-vasectomy pain syndrome, including sperm granulomas (small clusters of sperm cells), neuroma (pinched nerve) due to inflammation, vasectomy being too close to the epididymis and epididymal congestion.

    Generally, PVPS is treated initially treated conservatively, via heat/cold therapy, scrotal support, NSAIDs, etc. If this isn’t enough, other drug therapies are sued. If pain is debilitating and continues despite treatment, it may require the excision of a granuloma, epididymectomy (removal of epididymis), or vasectomy reversal. These methods, while more invasive, have a fairly high rate of resolution.

    While PVPS is certainly something to take into account when deciding on whether or not to get a vasectomy, it is not common and in most cases very mild. For most, the freedom granted by a vasectomy far outweighs the (very low) potential of complications.

    Fertility After a Successful Vasectomy Reversal | Minnesota

    Many couples are concerned about the attainability of pregnancy after a successful vasectomy reversal- after a year of negative pregnancy tests, any couple may naturally feel discouraged. It is important to stay positive during this time, as pregnancy will not happen immediately. Here are some things couples should know:

    First, it takes time for the sperm count to return to normal. For the first couple months, the absence of sperm is not unusual. After a vasovasostomy, sperm should be present in the ejaculate after three months, otherwise the vasovasostomy probably was unsuccessful, although we usually call it failure if no sperm is seen after six months. For an epididymovasostomy, this could take even longer. Keep in mind however, the mere presence of sperm does not guarantee conception. Sperm count must reach an adequate level in order for conception to be possible.

    Second, a man renews his sperm reserve every 3-4 months, and it can take a couple turnovers, or about 6-8 months, for sperm count to reach optimal levels. Even after that, it could be up to six months to reach the proper conditions for conception. For some couples, conception could take just a few months, while others may take longer. Everyone’s body is unique- it is important not to lose hope.

    The best way to ensure conception is to monitor sperm content and mobility over time. The first lab test is done six weeks after the procedure, and is repeated as required. Once it has been determined that sperm count has reached adequate levels and that the sperm is mobile, conception should occur within six months assuming the couple is having intercourse often and regulaarly and at the most fertile points of the woman’s cycle (a few days before and after ovulation). If there are still issues, and the sperm is fine, the issue may lie with the female partner’s fertility.

    Conception can be a long and trying process for many couples. Again, it is important to stay positive and not be discouraged, as it can take quite a long time to meet the conditions required for conception, and there are many factors that affect pregnancy. Patience is often rewarded.

    Scalpel vs. No-Scalpel vasectomy | Minnesota

    Vasectomy is a surgical procedure that involves severing or tying the vas deferens, the tubes that carry sperm from the testicles. This is a very effective, permanent form of birth control.
    During a conventional vasectomy, the doctor must first make two big incisions in both sides of the scrotal skin. The vas is surgically separated from the other structures in the spermatic cord. The vas is then tied off cut, and separated. The incision is then sutured back together.

    In no-scalpel vasectomy, there is no big incision; instead, a small single hole is made in the skin of middle scrotum using a special sharp hemostat, and the vas deferens are lifted using a ring clamp. The surrounding fascia is removed to expose the vas. The vas deferens is cut, and the upper ends are cauterized. The titanium clips are placed on to keep the opened ends of the vas deferens out of alignment. The vas deferens are then placed back into the scrotum. A scrotal support is applied and the procedure is done; no sutures are used on the hole.

    No-scalpel vasectomy offers several advantages. No-scalpel vasectomy is inherently less invasive, and safer. The chances of complications with conventional vasectomy is 5-10% as a result of bleeding, scarring, infection, etc, while chance of complications with no-scalpel is less than 1%. No-scalpel vasectomy is takes 10 minutes; conventional vasectomy takes 30 minutes. No-scalpel causes less pain, and it also takes less time to heal completely. Most can resume normal physical activity the next day. They are both equal in effectiveness. Ultimately, it seems clear the no-scalpel vasectomy is the better option of the two.

    Dr. Steven Shu in the procedure clinic has performed more than 1000 non-scalpel vasectomies with 100% success rate, Zero percent wound infection, and the extremely high patient satisfaction.

    Three Common Questions Men Have About Vasectomies | Minnesota

    How effective is it?
    A vasectomy is 99.85% effective as a birth control method. Typically, a year after vasectomy, only two women out of 1000 become pregnant. So far, Dr. Shu’s techniques have proved to be very effective, and he performed about 1000 vasectomies without any failure (100% effective).
    Post-vasectomy pregnancy usually occurs soon after the procedure due to residual sperm in the vas deferens and late occurance due to vas recanalization. It usually requires 20-25 ejaculations before no sperm is present in seminal fluid; prior to that partners should take caution during intercourse, and it is strongly recommended to have a follow up test for sperm in ejaculate after the procedure.

    Tubal ligation, or “getting your tubes tied” is often seen as the female equivalent, and is similarly effective; however, it is considerably more invasive and poses higher risk of complications.

    Does it effect sexual pleasure/performance?
    Physically, vasectomies have no effect on sexual performance or libido. Vasectomies only involve cutting the vas deferens, the path that leads from the testes to the urethra. Sperm is still produced in the testes after a vasectomy, but it is absorbed into the body rather than enter the urethra. Erection, orgasm, and ejaculation all function as normal, just in the absence of sperm in the ejaculate. The testes function normally and continue to secrete hormones as they did before the surgery. Psychologically, some men may feel sexual anxiety, as fertility is seen by some as a crucial aspect of masculinity, in which case understanding and reassurance is required. That said, most partners seem to find that a vasectomy makes their sex lives better as fear of pregnancy is no longer an issue. Studies show that couples where the men has had a vasectomy tend to have sex 5.9 times per month on average, compared to 4.9 times a month for the average couple.

    Is vasectomy reversible?
    Yes! Vasovasostomy is a procedure where the severed vas deferens is reconnected to allow the passage of sperm. It is a minimally invasive procedure that can be done under local anesthesia in the office. Dr. Shu uses the no scalpel technique with minimal trauma, so the patients usually have a quick recovery. A vasoepididymostomy, done when vasovasostomy is not possible, involves connecting the vas tube to the epididymis, which is a far more invasive and is beyond the scope of an office procedure. Generally, success depends on how long the man has had a vasectomy.

    Can Lycopene Increase Fertility in Men? | Minnesota

    Lycopene is an organic compound that gives tomatoes their distinctive red color, but recent research has found that taking lycopene may increase fertility in men.

    Previous studies, led by Ashok Agarwal, have demonstrated that taking lycopene can boost sperm count by 70%. These studies also showed improvements in swimming speed, and reduced amount of abnormal sperm. Hypothetically, lycopene could protect sperm from DNA damage, increasing the quality of the sperm.

    This is the focus of a 2016 study from the University of Sheffield in England. This study involves a 12 week trial that will determine whether or not lycopene can reliably increase fertility in men. The study involves 60 male subjects, ages 18-30, who will be divided into two groups. One group takes a lycopene supplement, and the other takes a placebo. If lycopene does indeed affect fertility, the results should be apparent based on test results on the subject’s sperm and blood.

    While the link between lycopene and male fertility is far from concrete, these discoveries may bring new hope and new life to couples trying to have a baby in Minnesota.

    Men’s Birth Control | Minnesota

    Currently, there are very few methods of birth control available to men, as that responsibility has largely been assigned to the woman until recently. Today, however, due to rapid cultural shifts through the past few decades, there is a great and increasing number of men around the world looking to take birth control into their own hands! Still, there are few male contraceptives available to couples that engage in intercourse, which are male condoms, which are used by (15.3%) of contraceptive users, withdrawal (4.8%), and vasectomy (8.2%). The remaining 71.7% of users are using exclusively female-oriented birth control methods, such as the pill, IUD, diaphragm, spermicide, etc. Hormone-based birth control for men, like a pill or an implantable contraceptive, has the potential to be widely used but is not yet available for use.

    So, of the three listed, how do they compare?
    The most popular by far are male condoms– understandably so, as they are single serve, reliable, and do not require commitment. They offer some protection against STDs. They also don’t affect hormones, since it is a physical rather than physiological form of contraceptive, which is a relief for women that do not want the side effects of birth control. That said, condoms must be used every time a couple has intercourse to be fully effective, which can be annoying. The process of putting the condom on can often kill the mood, and many feel that having a condom on makes intercourse less pleasurable. Also, if used incorrectly, they can break, compromising their effectiveness. Whether or not condoms are worth the hassle is quite subjective, as every couple is different and may not have the same sexual requirements as others.

    Withdrawal, also known as the pull-out method or coitus interruptus is the least common of the three. The advantages to withdrawal are easy to see- it is free, there are no side effects, and it’s obviously better than nothing. However, the effectiveness of withdrawal is questionable. At it’s best it can be 96% effective, but at its worst there is a 27% chance of pregnancy. It really all depends on the male partner’s ability to pull out in time, so a high level of trust between sexual partners is required. Even if male partner is reliable however, it is possible for pre-ejaculate to contain sperm left in the urethra that can still cause pregnancy. For some it could also make intercourse less enjoyable due to nervousness and sexual interruption. It also does not protect against STDs.

    This leaves vasectomy. Vasectomy is a surgical procedure that involves blocking the tubes that carry sperm, effectively resulting in sterilization. There is still ejaculate, just no sperm in it. This makes vasectomies the most reliable form of contraception of the three. It is a one-time procedure that lasts indefinitely, as opposed to most other forms of contraception that require routine usage or usage during intercourse. It also does not affect hormones, unlike female birth control. One of the biggest concerns of getting a vasectomy is fear of it affecting the quality of sex, but it does not affect libido or sexual pleasure for either partner. Likewise, it is not a cure a lack of sex drive or erectile dysfunction. Some couples may want kids in the future, and conception is not possible after a vasectomy. A vasectomy can be reversed but requires another, more costly surgical procedure. Vasectomies also do not protect against STDs- only pregnancy.

    Ultimately, the best option depends on the needs of the patient. Deciding to get a vasectomy is a commitment and should definitely be given some prior thought.

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