All About Vasectomy Reversal

Facts About Infertility Operations

Our regular microsurgical vasectomy reversal operation (VASO-VASOSTOMY) has an excellent chance of being successful and results are better the earlier the reversal is performed, but even pooling all our 4.300 cases up to 30 years after vasectomy, some 85% of all our couples obtain a pregnancy in the first twenty four months after the operation. That includes men of all ages with Vasectomies also of all ages (1 - 35 years). Our regular male infertility bypass operation (EPIDIDYMO-VASOSTOMY) for the rare cases of men who have total sterility from natural causes (which are called azoospermia), as well as those vasectomy reversal cases who need an E-V due to a damaged epididymis, have a 60% chance of producing sperms in the ejaculate, but only a 24% chance of a successful pregnancy within the first three years of operation.

Facts About Sperm Production

Human males produce about 20,000 sperms per minute from each testicle. These are about 1 micron or 1,000th mm in size. Well over 50 million sperms are therefore produced each day from each side. It takes two weeks from production for a single sperm to be pushed along out of the testicle. They collect at the top of the testicle and pass into the epididymis.

The epididymis is a soft, long, coiled, thin-walled and narrow maturation tube. It is approximately 70 microns thick (less than the thickness of a hair) and is surrounded by large thin-walled blood vessels which act as a heat exchange system in the many weeks it takes to mature the sperms. This requires a lower than body temperature, which is why these male organs are located outside the body cavities. Because the epididymal tubing is about 7 metres long if it could be measured out along a straight line, it is hardly surprising therefore that a micron-sized sperm will take over ONE MONTH to travel along its length. In this time, the sperm matures a strong body and grows a tail and a tough head. Only then can it function as a sperm. Sperm leaves the epididymis and enters the vas, which itself is quite a long tube being 25 cms as it goes from the epididymis, via the hernial orifice, into the pelvis and down to enter the prostatic gland at the base of the penis.

The vas is wider and more muscular than the epididymis, and is approximately 200 microns (0.2 mm) in internal diameter (about the thickness of two to three hairs). Usually sperm cells will take a few more weeks to travel down the vas prior to ejaculation which is done by the prostate gland. So total time from sperm production to ejaculation is two weeks (testicle) + four weeks (epididymis) + two weeks (vas) = eight weeks or more in total. If a man has had a VASECTOMY or if the epididymis is blocked, he can still ejaculate. However, his semen does not contain any sperms. Semen is produced by the glands called the "seminal vesicles" in the pelvis close to the prostate gland, and functions to carry the sperms along into the prostate gland in a normal ejaculate.

During VASECTOMY, the vas is tied off in the scrotum in order to prevent sperms passing that point. Until a sperm count proves all the sperms are now clear of the system following the operation of vasectomy, contraception must still be practised to prevent conception occurring from some normal sperms which could be still stored inside the vas beyond the scrotal ties or in the prostate gland.

Sperm production normally continues after vasectomy, and only some of the sperms are absorbed into the walls of the epididymis and into the bloodstream around that thin coiled tube, however millions of squashed sperm cells accumulate every day and can continue being made until death occurs.

When a blockage occurs in the epididymis or vas, there is pressure in the system and most sperms break down some being removed by the white blood cells. Most accumulate and the contents of the system slowly thicken. The production of sperms by the testicle is a very efficient system which will still work after a vasectomy. We have confirmed good sperm production in a man 30 years after his vasectomy, and he fathered a child after his reversal operation.

The Hospitals We Operate In.

They have an excellent modern microsurgical operating theatre with the best available microsurgery equipment, as designed by Professor Owen. The Hospitals have a quiet atmosphere in a garden suburb, excellent nursing staff, a good cuisine, and maximum visiting hours. The Hospitals are used only for elective non-urgent surgical cases by senior specialists. Professor Owen's operating team have been together for more than 24 years. Professor Owen does the operation himself and is assisted by his Assistant Microsurgeon, his regular anaesthetist and a specially trained nursing team.

The Operation

PROFESSOR OWEN PERSONALLY OPERATES ON EVERY CASE.

It requires a light general anaesthetic, and is NOT painful during or afterwards. It is performed by our very experienced team of specialists. The patency of the whole vas is first checked with dye, which will exit through the urethra. A check is always made to confirm the production of sperms, after which the tubes are joined together under the microscope with the finest sutures. If the vasectomy was originally performed in the right place, the vas, a VASO-VASOSTOMY will be performed, and takes about one hour on each side. However, if the vasectomy was performed quite low down in the scrotum, then it may have tied off the last part of the epididymis, and the only way to repair this is to perform an EPIDIDYMO-VASOSTOMY, where the operation joins the epididymis to the remaining vas.

Post Operatively

The operation is not painful for the patient following surgery.

The patient requires some rest to allow the commencement of proper healing. After that time he can move about normally provided he looks after himself sensibly for a few weeks until healing is complete. (No riding of bicycles, horses, high diving, jogging, sliding down banisters, etc! - and no sexual intercourse until after healing). It is necessary to wear an athletic support ("jock strap") at all times for the month following the operation in order to support the scrotum. This is to prevent the weight of the testicles pulling on the delicate vas join. It is also necessary to refrain from intercourse for a period of one month post-operatively, and during the following six weeks. CONDOM contraception by the male partner is essential. This is to prevent possible conception with sperms coming through which have been previously made under pressure, and which may cause abnormalities in the unborn child which has not happened yet, as these instructions have always been followed. Therefore unprotected intercourse must be avoided, for the first ten weeks post-operation, in our cases, to be safe.

At ten weeks post-operation we require you to have the first sperm count. That count request can be taken to any Pathologist Collection office in any country. The result will be forwarded (usually by Fax) to Professor Owen and you should phone him to discuss the result a week later (to allow sufficient time for the result to be delivered to him). If the count is not wholly satisfactory, Professor Owen will organise a further count several months later and in any case discuss the progress of the return of the number, motility, and appearance of the sperms.

Professor Owen is concerned to keep in touch with his patients and follow up their progress, so please contact this office if you have any concerns. And please do not forget to inform us of the subsequent pregnancies and births.