Shake Off Your Concerns About Vasectomy-Related Birth Defects | Minneapolis & St. Paul

A question that occasionally comes up regarding vasectomy reversals is whether or not the reversal increases the chance of future birth defects. Considering the lack of studies on this topic, it’s a completely warranted concern for couples who are planning their futures and who might find the potential risk unsettling.

While there have indeed been studies suggesting that men who previously underwent a vasectomy may experience higher rates of sperm abnormalities, follow-up studies have NOT been conducted to successfully link birth defects to vasectomy reversals. Furthermore, studies have suggested that the rate of birth defects may actually be higher among babies conceived through in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI). At the Scott Department of Urology at Baylor College of Medicine, researchers found that the rate of birth defects in conventional IVF was nine percent, while that of ICSI was roughly the same at 8.6 percent.

In a landmark study from the Vasovasostomy Study Group (VVSG) published in 1991, Dr. Arnold Belker and four other expert microsurgeons examined various facets of vasectomy reversal, including the risk of birth defects. Their trial, which followed 291 children born post-vasectomy reversal, found that only three of the 291 subjects displayed birth defects. That’s a one percent birth defect rate.

Compare this number to the overall birth defect rate in the entire U.S. population, and you’ll find that it compares quite favorably. According to the Physicians Committee for Responsible Medicine (PCRM), approximately three percent of children born in the US are born with major birth defects. After accounting for birth-related developmental abnormalities by the age of one, this number rises to about six or seven percent.

All in all, the risk of post-vasectomy reversal birth defects shouldn’t stop you from planning your future, as the odds don’t vary too much from that of the general population.

For more information on One Stop Medical Center’s no-scalpel vasectomy reversal procedure, please contact us for a consultation.

 

Can Sperm Antibodies Affect Vasectomy Reversal Results? | Minneapolis & St. Paul

You may be familiar with the term “antibodies” as “something that helps the body ward off disease,” but the notion of sperm antibodies might seem counterintuitive. After all, why would the body want to destroy perfectly good sperm?

Antibodies, small molecules that the body naturally produces to fight off infections, essentially stick to and kill off invading/unfamiliar cells. Sperm, however, are protected from being targeted by these antibodies via the blood-testis barrier, which physically prevents sperm from interacting with the blood stream. The body normally isn’t even aware of the presence of sperm.

However, when the blood-testis barrier is compromised due to surgery, trauma to the area, or abnormal development of the testis, sperm may be detected and targeted by antibodies. In the case of a vasectomy, the vas deferen is cut and may leak sperm, potentially allowing the body to “see” and detect sperm for the first time. As a result, the body naturally produces antibodies to fight the sperm, which can affect sperm function and overall motility. Research suggests that at least 70 percent of men have detectable antibodies following a vasectomy, with 50–80 percent of cases occurring in the first year after the procedure. A small percentage of patients who do not develop antibodies in the first year develop them in the second or third year.

While antibodies can cause problems for some patients, they aren’t usually responsible for post-vasectomy reversal infertility. A recent study published in Urology concluded that patients who experienced poor sperm quality actually had partially blocked vas deferens following a reversal. The patients’ initial post-reversal low motility wasn’t a result of sperm antibodies. After correcting the blockage issue, most patients were able to successfully conceive.

Furthermore, despite some research suggesting that antibodies may decrease the chance of pregnancy after a reversal, the high overall post-operative conception rate (50-70 percent) and the uncertain correlation between antibody testing and post-operative pregnancy rates make antibody presence a controversial predictor of fertility.

 

Recovering After Your Vasectomy Reversal | Minneapolis & St. Paul

After undergoing a vasectomy reversal, patients can expect a recovery process similar to that of their original vasectomy. Pain and swelling in the groin is to be expected for about 1-3 weeks, but most patients are able to return to work and daily activities within one week. Below is a breakdown of what to expect for post-surgery care and recovery:
 

Incision Care After Surgery

  • Thin, clear, pink-colored fluid may drain from the incision site for about 12-24 hours following surgery.
  • Your doctor may ask you to wear an athletic supporter (jockstrap) or supportive underwear for three weeks after the procedure.
  • After surgery, you may take a quick shower in 2 days. Make sure to pat the incision dry. Do NOT take a bath for about 7 days.
  • If a drain is placed in the mid of scrotum, it is expect to have it removed in 24 hours, unless your doctor instructs you not to. Any stitches should dissolve in 7-10 days.
  • An ice pack can help ease discomfort following surgery, but your scrotum is packed with thick dressing after procedure, therefore, it is not convenient to apply ice pack. If you do, place it against your scrotum (ideally wrapped in a thin cloth) for 10-20 minutes at a time, every 4 hours.
  •  

    Pain Medications

  • Over-the-counter pain relievers such as Tylenol or ibuprofen (Motrin or Advil) should suffice in helping control any discomfort in the first few days. Try not to take Ibuprofen in the first 2 days to reduce the chance of bleeding
  • Take all pain medicines exactly as directed by your doctor.
  • If your doctor prescribed antibiotics, take them as directed. Continue taking them even if you start feeling better.
  • If you take blood thinners, such as warfarin, clopidogrel, or aspirin, your doctor will let you know when it’s appropriate to restart those medications again.
  • If your pain medicine is making you feel sick and unable to stomach food, take your medicine after meals (unless instructed not to), Or switch to over-the-counter pain relievers such as Tylenol OR ask your doctor for a different pain medicine.
  •  

    Returning to Regular Activities

  • Lie down and stay off your feet as much as possible in the first four days. Make sure to rest whenever you feel tired. Do not overexert yourself!
  • After four days, you can start easing back into walking everyday. Increase your walking distance bit by bit each day to regain circulation in your body. Again, rest immediately if you feel tired.

  • Most patients are able to drive and return to work in a week after surgery. However, if your work requires more physical strain on your body, it may take at least two to three weeks before you return.
  • For approximately 3-4 weeks after surgery, avoid strenuous activities like biking, jogging, weight training and high-impact exercises.
  • In the first two weeks, avoid lifting anything heavy that may strain your body. This includes heavy groceries, children, boxes and heavier household items.
  • Ask your doctor when it is appropriate for you to have sex again. Patients are typically advised to refrain from sex for about 3 weeks after surgery.
  •  

    Food/Diet

  • You’re free to return to your normal diet after surgery.
  • If your stomach bothers you for any reason, try eating plain, low-fat foods like rice, broiled chicken, toast and yogurt.
  • Unless otherwise directed, drink plenty of fluids!
  •  

    Follow-Up Appointments

    You are not required to have an office visit for follow up less you develop complications. Our staff will call you next day to check how you are doing. About 6 weeks after surgery, you should go to a local lab for semen analysis to see if the operation was successful.

     

    Clearing Up Vasectomy Reversal Myths | Minneapolis & St. Paul

    You may have contemplated whether or not a vasectomy reversal is the right option for you. But even after weighing the pros and cons, you may still be wondering if you have all the facts—after all, there’s a ton of information out there. It’s crucial to know what’s true and false about vasectomy reversals, so let’s break down some of its most common myths below.

    Myth: Vasectomy reversals are NOT effective for older men.

    It is entirely possible for an older patient to successfully undergo a vasectomy reversal and conceive a child. However, just as women may have more difficulty becoming pregnant as they advance in age, older men can also experience lower quality sperm that affects their overall chance of conceiving.

    Myth: After 10 years, a vasectomy reversal will NOT work.

    While it’s true that higher success rates are associated with vasectomy reversals performed closer to the original vasectomy date (within five years), the average success rates for ALL reversals—including those performed even 15 years after—are still fairly high. Your chances of a successful reversal increase greatly by finding a highly-skilled doctor to perform the procedure.

    Myth: In Vitro Fertilization (IVF) is quicker and easier than having a vasectomy reversal.

    Many couples tend to assume that IVF is both easier and more cost-effective, but IVF can be extremely draining and time-consuming. In fact, the cost of IVF is actually more expensive than that of vasovasostomy (the most common type of vasectomy reversal) performed in an office setting. IVF often requires multiple cycles and treatments, potentially becoming much more expensive than initially believed.

    Myth: Vasectomy reversals are 100 percent guaranteed to work and lead to fatherhood.

    Success rates change depending on individual patient circumstances and do not solely rely on whether or not a reversal procedure was performed. Important factors to consider include the time between the original vasectomy and the vasectomy reversal, the type of vasectomy originally performed, and the surgeon who performs the reversal. Furthermore, what should be considered a “success” is evidence of responsive sperm—not simply the intended result of having a child.

    Myth: Couples should not try to conceive right after a vasectomy reversal for fear of a “leftover, defective sperm.”

    New sperm are constantly created and reabsorbed by the body, meaning they don’t stick around and “age” and grow defective. Immediately following a reversal, any “older” remaining sperm from pre-reversal that are still being broken down will quickly lose their motility and have little chance of meeting the egg. There is also no evidence to suggest that an early pregnancy following a vasectomy reversal is linked to higher risk of miscarriage, birth defects or health problems in babies.

    Myth: Some vasectomies are not reversible due to how they were originally performed.

    This is simply false. While there are different ways to perform a vasectomy, it is very rare for one to be irreversible in the hands of a skilled surgeon, regardless of how it was originally performed. However, it’s important to note that if the long segment of a patient’s vas deferens is cut away, or the position of the cut in the vas deferens is either too high or too low, then the reversal procedure and success rate could potentially be affected.

     

    What Type of Vasectomy is Most Reversible? | Minnesota

    Fundamentally, what a vasectomy does is to prevent the flow of sperm from the testicle to the urethra by cutting and blocking off the ends of the vas deferens, the tube which carries the vasal fluid. There are many ways to block off the vas deferens.

    Suture is very common, where a thread is tied around the end of the vas to prevent the flow of sperm.

    Cauterization is also a common method, using heat to create scar tissue that will block the flow of sperm.

    Another very common method is the use of metal clips, which clip off the ends and are embedded in the scar of the vasectomy site.

    It’s not uncommon to have a small portion of the vas removed as well- up to an inch.

    Dr. Shu uses 3 steps to insure complete occlusion: he cuts the vas deferens and destroys the lining of the tube on upper end with cautery (scarring it) and places small titanium clips in the vas fascia to separate the opened ends of vas deferens.

    No-scalpel vasectomy is performed by making the tiny opening in the middle of scrotum with a pointy hemostat. The vas is then pulled out, severed, and blocked off.

    Another method is open-ended vasectomy, where the vas end closer to the testicle is left open instead of being blocked off in order to reduce the post vasectomy. It also save more vas to make a reversal easier.

    Vas crimping with VasClip or Pro-Vas was not favorable because of the high failure rate. These still require surgery for a vasectomy reversal, so the idea of crimping rather than severing is a moot point.

    Ultimately, none of these ways seem to affect the chances of a reversal being successful. The type of vasectomy, how it was blocked off, how the incision was made, etc, will not actually have an effect on the success rate of the reversal.

    What really makes a difference when it comes to success of the reversal is time (years after vasectomy). Time is the single most important factor. Each year after vasectomy patency gets lower.

    There are two metrics when looking at success rate: sperm patency and pregnancy rate. Sperm patency has to do with the motility of the sperm, that is, how much sperm is present and how much of the sperm in the semen is moving and healthy. The pregnancy rate is typically lower, since not everyone chooses to have a child after a reversal, and sometimes there can be issues on the woman’s end, or there is simply not enough motile sperm.

    Is the Chance of Birth Defects Higher After a Vasectomy Reversal? | Minnesota

    Some patients are concerned over the possibility of birth defects being higher after a vasectomy reversal. The decision to continue having kids after a vasectomy can be a big one and it’s natural to want all your bases covered. So, what does the science say about it?

    A landmark study known as the Vasovasostomy Study Group (VVSG) trial sought to answer to that question. Published in 1991 by Dr. Arnold Belker, he and four other surgeons conducted the trial accross five different centers. Described by Herrel as a landmark surgical study in “Meta-analysis of the Microsurgical Vasovasostomy literature”, this study holds quite a bit of weight.

    The study followed 291 children born after a vasectomy reversal, tracking their development and medical histories to see what effects, if any, vasectomy reversal had. The study found that, out of the 291, 3 had birth defects- or about 1%.

    So how does that compare to the prevalence of birth defects across the nation? Well, according to the Annual Summary of Vital Statistics, published in Pediatrics by Hoyert in 2006, the annual birth defect rate is said to be 3%. Other studies fluctuate between 3% and 5%. The defect rate was actually lower for children born post-vasovasostomy.

    Now, does vasectomy reversal reduces or increases the risk of birth defects?
    Probably not. Based on what we know, vasectomy and vasovasostomy does not affect the genetic quality of the sperm. In actuality, there is almost certainly no difference in the rate of birth defects regardless if you had a vasectomy reversal or not.

    Back in 2006, a study conducted at Chulalongkorn University in Bangkok showed that chromosomal abnormalities of sperms were more common in vasectomized men than men with healthy fertility. However, the authors of the study acknowledged that they were unsure whether these findings would support the theory that the risk of birth defects was higher after vasectomy reversal. So far, there have been no follow-up studies to confirm that such a link exists.

    Although vasectomy reversal birth defects are among the possible risks discussed during the consultation, most men are pleased to hear that there is no definitive evidence to suggest that the rate of birth defects after vasectomy reversal is significantly higher than that among the general population. In fact, the rate of birth defects may actually be higher among those who achieve pregnancy through in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI), which has been indicated in many researches.

    Based on the available scientific literature and our own experiences, if you are looking for a vasectomy reversal, you have nothing to worry about as far as having healthy children go.

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

    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.

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

    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.

    Understanding of the Risks, Complications, and Side Effects Related to Vasectomy Reversal Procedures

    Similar to Easy Vasectomy, the complications from Easy Vasectomy Reversal are rare because of minimal invasive approach, but any surgery carries some degree of risk. Vasectomy reversal is much longer and more complicated microsurgery than a vasectomy, it has a greater chance of side effects.

    Most common vasectomy reversal complications include bleeding and infection following the procedure.

    Anesthesia: Dr. Shu performs the vasectomy reversal under local anesthesia which avoids the risks and complications from general anesthesia. If it is performed under the intravenous sedation or general anesthesia, patients must be cleared medically prior to the surgery. Anesthesia-related complications include reaction to the anesthetic medications, breath diffculty, and cardiac problem.

    Postoperative pain: The patients usually have mild or moderate pain for a few days after surgery. The pain can be managed with prescription narcotics or over-the-counter pain medications. The patients should avoid anti-inflammatory pain relievers (such as ibuprofen and aspirin) for the first 48 hours after the surgery to reduce the risk of bleeding, but Tylenol is fine to use. A small number of men experience long-term pain (more than three months) in the area of the scrotum or testicles after a reversal.

    Hematoma (collection of blood): Bleeding under the skin that may cause scrotum area to look bruised, and bruise shows commonly in a few days after surgery, but pooled blood can be occasionally caused by bleeding in the surgery site inside the scrotum. The patients should report any unusual scrotal swelling and bruise to the surgeon.

    Infections: Infection after vasectomy reversal is not common, and it occurs more common when there is a hematoma beneath the skin. Infection occurs in the wound or inside scrotum, can be treated with hematoma evacuation (I&D drainage) and antibiotics.

    Hydrocele (Fluid Collection): Fluid can build up inside scrotum and cause swelling. This may resolve on its own, but may sometimes need to be drained with a needle. Check with a doctor if there is any unusual swelling.

    Sperm granuloma: If sperms leak into the scrotum, the immune system can react to the sperm. The local tissue gradually forms an inflamed mass. It is much more common with vasectomy than vasectomy reversal. If it happens, it indicates that the vasectomy reversal is probably not successful.

    Testicular atrophy: Testicular atrophy occurs when the blood supply of the testicle was injured, which results in permanent damage to that testicle. This can lead to scarring and dysfunction of testicle with diminished sperm and testosterone production. In general, the other testicle produces enough sperm and testosterone to compensate.

    Low sperm count: After a vasectomy reversal, the initial sperm count might be lower than that before vasectomy. This may be caused by many factors such as scar tissue blocking the sperm in the connecting sites, or the reaction of the body’s immune system to the presence of sperm, or epididymal dysfuction.

    Sexual difficulties: There is no physiological reason that a vasectomy or a vasectomy reversal should affect the patient’s sex drive, or their ability to have sex or an erection, but these procedures can occasionally cause significant psychological and emotional response in some men.

    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.

    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.

    • Sign Up for Our E-Newsletter
    blog icon facebook icon
    Click for the BBB Business Review of this Health & Medical - General in Edina MN   Click for the Patients' Choice award   ASLMS logo   American Board of Laser Surgery logo
    Click for the IMQ accreditation in Minneapolis, MN American Association for Primary Care Endoscopy logo