Approximately 500,000 men request vasectomies each year, and it is recognized that 5% of them will change their minds, usually due to remarriage or improved circumstances allowing for more children. Microscopic vasectomy reversal, when performed by an experienced male reproductive microsurgeon, offers your patients improved surgical success rates and, with few exceptions, the highest pregnancy rate in couples wishing to restore their fertility following vasectomies.
Numerous cost-benefit analyses have repeatedly confirmed the fact that vasectomy reversal is at least as effective as IVF while costing only half as much. Furthermore, in couples with favorable prognostic factors, reversal may achieve pregnancy rates much higher than IVF – again, at half the cost.
Dr. Yuan reverses the vasectomy in vasovasostomy (VV) and bypasses the blockage in epididymovasostomy (EV). In VV, the vasectomy site and the two ends of the vas deferens are identified and excised back to healthy tissue. The testicular side of the vas is now unblocked and typically oozes fluid of various consistency depending on the obstructive interval; this in turn dictates the procedure to be performed. With VV, the ends are then brought together and reconnected using microsurgical sutures with the aid of an operative microscope.
Either a two-layer or a modified one-layer technique may be used depending on the surgeon’s preference and the degree of vas lumen disparity. In EV, the vasectomy site is similarly approached and excised. Thick fluid consistency and the lack of sperm will mandate the performance of EV. The epididymis is examined and a single tubule is then selected for the bypass.
Various techniques have been used to connect the vas to the epididymis. The current approach relies on invaginating the epididymal tubule into the lumen of the vas. The approach and its variations have the distinct advantages of being easier to perform and having higher success rates when compared with the traditional end-to-side technique.
For those patients who are experiencing infertility due to a vasectomy, there are the alternatives of therapeutic donor insemination, in vitro fertilization or reversal of a vasectomy, the latter of which provides couples with the optimal and least expensive option for biological parenthood.