Monthly Archives: April 2018

How do the Sperm Retrieval Techniques Affect the Qualification for Vasectomy Reversal? | Minnesota

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It is estimated that about 2 million couples each year face the problem of infertility. While assisted reproductive technologies (ARTs) have helped many couples conceive, vasectomy reversal is the main option for restoring fertility for the vasectomized men. Small percentages of couples who fail in ARTs change their mind and would like to have vasectomy reversal. The common questions they ask are how the sperm retrieval techniques affect their qualification for the vasectomy reversal. This blog specifically answers this question.

ARTs requires the collection of both egg and sperm to increase the likelihood of conception. The sperm-extraction methods vary depending on the men’s fertility, the ability of the surgeon to retrieve sperm and the needs of the couple.

The five main types of sperm retrieval techniques are:

Microsurgical Epididymal Sperm Aspiration (MESA): a small incision in scrotum is made to identify the epididymal tubules, then the sperms in epididymis are aspirated with a small needle.

Percutaneous Epididymal Sperm Aspiration (PESA): no incision is made, and a small needle is used to aspirate sperm percutaneously.

Testicular Sperm Extraction (TeSE): a small incision in the skin of the scrotum is made to explore the testicle. Small pieces of tissue from the testicle are havested and the sperm is extracted from that tissue.

Testicular Sperm Aspiration (TeSA): no incision is made, and a needled is used to percutaneously aspirate small amount of testicular tissue, then sperm is ten retrieved from the tissue.

Testis Perc-Biopsy: a larger gauge needle is used to harvest sperms from the testicles. The process is similar to that of TeSA, but allows for the collection of a greater amount of sperms.

The men with MESA and PESA are not good candidates for vasectomy reversal since both procedures could damage the vas tubules inside epididymis, and the tubules are easily blocked by the scar.

The men with TESE, TESA and Testis Perc-Biopsy are still good candidates for vasectomy reversal since these procedures cause small damage in the testicular tissue, and the vas tubules inside epididymis usually remain intact.

Male Birth Control: The 3 most promising new methods | Minnesota

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Traditionally, us guys don’t have a lot of options when it comes to contraception. There’s condoms, vasectomies, “pulling out”, and that’s about it. However, all of these methods have major setbacks. Condoms take a while to put on and can kill the mood. Vasectomies are convenient, but are not reversible without invasive surgery. And pulling out, well, is the hallmark of bad decision making.

Every now and then, there are headlines that give hope to all the men looking to avoid children in their lives. Like the Italian guy who invented a magical “switch” implant that is now on permanent hiatus. Headlines like those, which never seem to go anywhere.

Luckily, there are some new options in development for these men.

Gel contraceptive

This form of male birth control is closest to being put on the market. Called Nestorone-Testosterone, the gel contains two hormones, testosterone and progestin. The key ingredient here is the progestin, a synthetic version of the female sex hormone progesterone, which shuts down testosterone production by suppressing the gonadotropin hormones. Lower testosterone means lower sperm production, which means a lower chance of pregnancy.

Of course messing with hormones can have very negative consequences, which is why the gel contains some testosterone to ensure levels are not too low, which can cause low libido and delayed ejaculation.

A study funded by the National Institute of Child Health and human development revealed that 90% of men who used the gel had a sperm concentration lower than one million per milliliter, which is low enough to prevent pregnancy with minimal side effects.

Still, there is a long road to go. Right now trails are being performed on 420 couples around globe- if successful, the contraceptive could move onto the next stage, which involves trials on an even larger scale. It might be another ten years- but it’s a start.

Birth Control Pill

The problem with male BC pills is the short half life of sperm-suppressing hormones, meaning the drug decays very quickly, and so do its effects. However, a new study featuring an experimental male BC pill seems to show promise.

Dimethandrolone undecanoate, or DMAU, is a drug that works in a similar way to the gel contraceptive. Like the gel, it contains both testosterone and progestin. While its effectiveness and reducing sperm count is still unknown, the trials show that the drug is safe to take every day for a month, with minimal side effects.

Researchers at the UCLA and University of Washington are beginning a joint study that tests the efficacy of a DMAU injection, which could work several months at a time, which would be more convenient and more similar to injectable female birth control methods.

RISUG

RISUG, which I have written about previously, is a promising new procedure that is like an advanced form of vasectomy. The method was pioneered by biomedical engineer Sujoy Guha from the Indian Institute of Technology, and involves injecting a gel into the vas deferens (the tube that carries sperm to the semen), preventing sperm flow without affecting production or hormone levels. Unlike a vasectomy, this process is (theoretically) easily reversible, requiring only one other injection to dissolve the block. This avoids the inconvenience and possible failure of a vasectomy reversal, which is like stitching together the ends of two wet noodles. Not to mention, it’ll be a lot cheaper

It will be a considerable amount of time before this product hits the US market. The rights to the technology have been sold to the Parsemus Foundation, a nonprofit based in California, but there are unfortunately no human trials coming in the near future.

Regardless, we can expect to see many of these inventive new technologies in pop up in the next decade or two. Adoption of new birth control methods could mean a major reduction in unplanned pregnancies, especially in more developed countries as birth controls cheaper and more convenient worldwide.

Challenges of the Difficult Vasectomies | Minnesota

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Easy VasectomyⓇ is a minimal invasive office procedure with no scalpel, no needle and no stitches techniques, and it takes less than 10 minuets. Dr. Shu performs about 400 vasectomies every year, some of them could be very challenging.

The common reasons of the difficult vasectomies:

1. Large scrotum with obesity
2. Tight and thick skin with small scrotum
3. Short Vas Deferens
4. Small size of Vas Deferens
5. Previous history of scrotum surgeries
6. Scrotum with hydrocele, hernia or other diseases

Dr.Shu has extensive experience of doing no scalpel vasectomy, and he loves to do the challenging vasectomies. He has never referred any vasectomy patients out. Dr.Shu has never had a chance to tell any vasectomy patients that they need general anesthesia because he always can finish it under the local anesthesia regardless how difficult it is.

Yesterday, we had a vasectomy case with the hydrocele and extensive scars inside the left scrotum. Dr.Shu successfully performed it although it did take extra 10 minutes to do it. He was telling the patients that, during his vasectomy missions trips in Haiti, some Haitian patients with huge hydroceles were much more challenging ones.

Here is the testimonial published by one of our patients with the difficult vasectomy last month.

“I highly recommend Dr. Shu and the EZ Vasectomy. It is refreshing to have a clinic that takes the patient experience into consideration. Everything from scheduling, to the follow up sample testing is done in a way that puts value on my time and makes it easy for me. Not to mention I received a consultation from a urologist before I saw Dr. Shu. They recommended general anesthesia that would have come at a $6,000+ cost to me plus the extra recovery time from the more invasive procedure. Dr. Shu was able to complete the procedure in 7 minutes with local anesthesia at 10% of the cost. For the recovery, I was able to function like normal, just took it a little easy for 2 days. I wouldn’t even call it a painful recovery. A sunburn is more painful than the recovery I experienced.”

If you are told by any urologists or family physicians that

1. You are a very difficult vasectomy case, or
2. You need a sub-specialist to do it in the operating room, or
3. You need to be done under general anesthesia in the hospital.

Please come to the Procedure Clinic and try Dr.Shu’s vasectomy skills. You will be surprised to know that how much time and money you will save, and how much pain and suffering from vasectomy can be avoided or reduced. Easy VasectomyⓇ is your choice!

Is a Vasectomy Reversal the Best Option for You? | Minnesota

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Vasectomy is a permanent sterilization surgical procedure. But at some point in the future, life circumstances may change:

• Some couples may simply regret it.
• Some couple may have a much different situations in their health or finance now.
• With a 50% divorce rate in the US, a new partner may have a much stronger desire for children than his ex-partner does.

When this happens, you and your partner will need to look at the options available and decide whether a vasectomy reversal is the best option for you. These options include vasectomy reversal, in vitro fertilization, donor sperms, and adoption.

If you’re considering a vasectomy reversal, you need to know several important factors that affect the success rate.

Years after vasectomy
The single most important factor in whether a vasectomy reversal procedure will be successful is the interval in time (years) between vasectomy and vasectomy reversal. Studies have consistently shown that vasectomy reversal procedures have a higher rate of success when the procedure is performed closer to the date of vasectomy. Theoretically, the sperm recovery rate drops two percent every year after vasectomy. This is because the likelihood of obstruction due to scar formation in the epididymis increases—especially after 7-10 years. Additionally, the anti-sperm antibodies in man’s body may limit or reduce sperm production.

Type of reversal procedure
There are two types of reversal procedures—vasovasostomy (VV) and vasoepididymostomy (VE). The aim of VV is to reconnect the vas where it was severed at the time of vasectomy, whereas during a vasoepididymostomy the surgeon connects the severed end of the vas deferens directly to the epdidymis (the tube attached to the testicle where sperm mature). A VE is more complex and technically demanding than a VV, and it a lower rate of success than vasovasostomy.

Experience matters
The vasectomy reversal procedures are usually conducted by urologists and other surgeons. You need to check surgeons’ credentials. Besides basic medical credentials, the most important questions you need to ask are:

• How many vasectomy reversal does the doctor performs every year?
• How many years has the doctor been performing vasectomy reversal?
• Are the minimal invasive procedure with no scalpel and no needle techniques?
• What are the failure rate and the complication rate?

Cost
Most vasectomy reversal clinics charge expensive facility and anesthesia fees. If you are one of the few for whom vasectomy reversal does not succeed, it will be difficult enough, without a $7000-$10,000 bill!

One Stop Medical Center provides premium reversal services with affordable price by not charging any facility and anesthesia fees.

Reversal tends to be the least expensive choice, but the costs of IVF and other Assistive reproductive technologies (ARTs) could be much higher than that of vasovasostomy, and IVF may require several cycles before conception is achieved and has a lower overall success rate.

ARTs may be a better alternative if vasectomy reversal is not a viable option, or if you don’t want to undergo a second surgery, or your reversal procedure fails.

Age
Although age is not the main factor for considering a vasectomy reversal , but a woman’s fertility begins to decline more sharply after age 35.