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Vasectomy and Vasectomy Reversal
What are vasectomy and vasectomy reversal?
Vasectomy is a minor surgical procedure to block the delivery of a man's sperm to his semen, thereby making him sterile, or incapable of fathering children. Briefly, it involves two small incisions in the man's scrotum to gain access to the vas deferens (thin, coiled tubes that transport sperm), cutting them to create an interruption and sealing the two separated ends.
Vasectomy is a simple, fast procedure performed on an outpatient or day-surgery basis with a success rate of more than 99 percent and very low rates of complications.
The outstanding advantage of vasectomy as a technique of contraception is that it is permanent. With more than 500,000 vasectomies performed in the United States each year, this technique of male sterilization is the third most popular method of contraception (or preventing pregnancy) for married couples, after female sterilization and birth control pills.
On the other hand, if vasectomy's major advantage is its permanance, its major disadvantage may be its permanance, as well. Approximately five percent of men who have undergone vasectomy later seek to have it reversed, often because of a desire to have children in a second marriage.
But while vasectomy is a simple, inexpensive procedure involving only mild local sedatives, vasectomy reversal — a surgical procedure also called vasovasectomy — is a complex, more expensive operation requiring a hospital setting, general anesthesia and microsurgery. If performed within a few years of the original vasectomy, vasovasectomy's success rate is high. But the longer the period since the vasectomy, the lower the chances of resuming previous sperm levels or of achieving pregnancy.
The urologists of Connecticut Surgical Group have extensive experience in vasectomy and vasovasectomy, and have been leaders in the development of techniques for it.
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How is sperm produced and delivered?
A man's sperm cells are produced by his testicles, located in the scrotum at the base of his penis and transported into narrow, elongated storage vessels called the epididymides (often described as thin, coiled tubes).
The sperm cells are held in the epididymides until ejaculation, at which time they are conveyed through the vas deferens, the seminal vesicles and the ejaculatory duct to join with other semen fluids and be propelled through spermatic cords and the urethra into the partner's vagina.
The vas deferens are relatively long, muscular tubes that loop up from the epididymides in the scrotum through the inguinal canal toward the bladder, and then to the spermatic cords and ejaculatory duct leading to the urethra.
When a vasectomy is performed — that is, the anatomy of your vas deferens is changed — the result is that your sperm is redirected harmlessly into your bladder, where it is eliminated along with urine.
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How common are vasectomy and vasovasectomy?
Vasectomy is a simple contraceptive procedure performed around the world, and it's estimated by the National Institutes of Health that some 50 million men have had vasectomies, representing about five percent of all married couples of reproductive age (The comparable figure for couples who have chosen female sterilization, the NIH notes, is about 15 percent).
In the United States, some 500,000 men have undergone vasectomies. For men over 35, this represents about one in six.
A study published in the Journal of Urology found that between two and six percent of men who have undergone vasectomies seek to have it reversed.
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How is vasectomy performed?
Vasectomy is a brief, simple surgical procedure that begins with one or two small incisions — each about one-quarter inch in length — in the skin of the patient's scrotum. The urologist locates each of the vas deferens tubes through an incision, gently pulling it out to create a loop extending from the incision.
A segment about one-half inch in length is excised from the vas deferens. The two newly created ends, closed off either by cauterization, stitches or surgical clips, are placed back in the scrotum. The procedure is repeated on each side and the incisions are closed with stitches.
A slightly different technique called "no-scalpel" vasectomy was developed in China in the 1970s and is used in the United States today for about one-third of all vasectomies. With this approach, the urologist locates the vas deferens under the skin by feel and secures it with a clamp. Then, he or she uses a tiny, sharp hook to puncture the skin and pull the vas deferens tube out for separation. Again, the newly created ends are sealed and placed back within the scrotum. The incisions created in the skin with this technique are so tiny that stitches are rarely required.
Either process takes only 15 to 30 minutes and usually involves only a mild local sedative. You'll likely be asked to rest for about half an hour before being allow to go home.
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What should I expect after my vasectomy?
Following your vasectomy you may experience some pain or swelling in your scrotum. This can be alleviated with aspirin, ibuprofen or acetaminophen, an ice pack on your scrotum and perhaps some kind of support, such as an athletic supporter.
You should plan on resting for a day following your procedure and should expect to be completely recovered in about a week. You can probably plan on returning to a non-strenuous job after a day or so. Complications such as bruising, swelling and infection are rare and should be reported to your doctor. You should be able to resume sexual activity after a few days.
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How quickly will my vasectomy become effective?
It is important to emphasize that while the effects of vasectomy are intended to be permanent, they are not immediate. You will still have some sperm in your system, and cannot count on being sperm-free until you've had some 10 to 20 ejaculations. To assure this, your doctor will need to check your semen for sperm, beginning after about a dozen ejaculations or two months.
Until it's conclusively demonstrated that you are sterile, you should continue to use other contraceptive techniques (and, since vasectomy doesn't protect you from sexually transmitted diseases, you should be aware of the need for protective measures anyway, when appropriate).
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Will vasectomy change my sexual capabilities?
Undergoing vasectomy should not in any way change your ability to achieve an erection, experience orgasm, or affect the masculine traits of deep voice, facial hair and body shape associated with testosterone and other male hormones. Male hormones are not in any way involved in the procedure.
Note that vasectomy won't improve your ability to have an erection if your were having problems before. Any problems you may encounter with erections will most likely be psychological. Conversely, your vasectomy may improve your situation psychologically by relieving a concern about the risk of pregnancy.
Even the quanity of the semen you produce will not be apparently different. Sperm accounts for only a very small percentage of semen.
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What are the potential complications of vasectomy?
There are small risks of complications such as bleeding into the scrotum immediately after your procedure. If you find your scrotum swelling or becoming painful, reddened or tender, or if you develop a fever, you should contact your doctor. If one end of your sealed-off vas deferens leaks sperm into your scrotum, a rare but possible complication could be the formation of a small lump of sperm called a granuloma. A granuloma rarely causes pain, but if it does it may need to be removed.
A very rare risk is recanalization — the possibility that the two severed ends of a vas deferens might reconnect or somehow create a new channel, restoring your fertility. This occurs in less that one percent of all cases. However, just to be on the safe side, you may want to consider having your semen tested for sperm one year after your procedure.
In the past, some researchers have occasionally tried to link vasectomy to long-term risk of prostate cancer. The safety of vasectomy has been intensely studied — the Health Status of American Men study by the National Institute of Child Health and Human Development tracked some 182,000 person-years of follow-up and found only a slight risk of an easily treatable inflammation of the epididymis and testes. No link to prostate cancer or arteriosclerosis has been proven.
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How is vasovasectomy performed?
Vasovasectomy, or vasectomy reversal, is intended to restore a man's ability to produce sperm and father children. Somewhere between two and six percent of men who have undergone vasectomy eventually seek to have their vasectomy reversed, usually with the desire of producing children in a new marriage.
Unfortunately, while severing the vas deferens is a simple procedure, reconnecting the severed ends requires a much more complex operation, an operating room, anesthesia and most likely the use of an operating microscope. It is usually performed on an outpatient or day-surgery basis. A typical procedure takes one to two hours.
Vasovasectomy involves the surgeon's accessing the sections of vas deferens, removing the scarred ends, testing the fluid inside the section closest to the testicle to detect evidence of sperm and — if sperm is present — carefully working to stitch them together end-to-end. In some cases the procedure can be done without a microscope, but many surgeons prefer the use of a microscope that can magnify fine structures by as much as 20 times.
Confirming the presence of sperm is important, since the original vasectomy may have caused fluid to back up in the channel, leading to pressure and a break — and a blockage — in the epididymis. If this is the case, there would be no sperm to channel through the reconnected vas deferens. Fixing it will require a more complicated procedure called a vasoepididymostomy, connecting the upper end of the vas deferens to the epididymis to bypass the blockage.
It's possible that a patient might require a vasovasostomy on one side and a vasoepididymostomy on the other. Also, it should be noted that a vasectomy performed in connection with a hernia repair may be more difficult to reverse since a longer section of the vas deferens may have been removed.
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What are the success rates for vasovasectomy?
Vasovasectomy performed with the use of a surgical microscope shows an average success rate of 5 to 97 percent in terms of reestablishment of sperm, and 30 to 75 percent in terms of pregnancies achieved.
Comparable figures for vasoepididymostomy 60 to 80 percent in terms of return of sperm and 20 to 40 percent in terms of pregnancies.
The most important factor in successful restoration of fertility is the length of time since the vasectomy. Men who seek vasovasectomy less than three years after their vasectomy generally achieve restoration of sperm to their semen about 97 percent of the time. For cases three to eight years out, the figure is 88 percent. For those nine to 14 years out, its 79 percent, and for those 15 years or more, it's 71 percent.
In terms of success in achieving pregnancies, the figures are 76 percent after less than three years, 53 percent after three to eight years, 44 percent after nine to 14 years, and 30 percent after 15 years or more.
While some pregnancies may occur within months of vasovasectomy, others may take several years. On average, it takes a year to conceive. However, once fertility is reestablished, it should continue for a number of years.
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What can I expect after undergoing vasovasectomy?
About half of men who undergo vasovasectomy say they experience about the same level of discomfort as with the original vasectomy. By and large, any noticeable pain — which can be treated with medication — disappears in a matter of a few days to a week.
Following your vasovasectomy, you should be able to return to light work in about a week. You will likely be advised to avoid strenuous work for about four weeks, and to refrain from sexual activity for about two weeks.
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Are vasectomy and vasovasectomy covered by health insurance?
Both vasectomy and vasovasectomy tend to be regarded as elective, lifestyle-related operations and are unlikely to be covered by your health insurance. You should check with your insurer first, however, to make sure.
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What do vasectomy and vasovasectomy cost to be performed?
Costs vary but vasectomy performed by Connecticut Surgical Group usually costs between $500 and $650. Most HMOs cover this procedure. A vasovasectomy may cost about $7,100.
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For additional information
You can find additional information about benign vasectomy and vasovasectomy at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations.
Likely sources include:
American Urological Association Health Guide
www.urologyhealth.org
American Foundation for Urological Disease
www.afud.org
National Institutes of Health
www.nih.org
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