(Vasectomy and) Vasectomy Reversal Information

I'm surprised that I haven't really posted about it before but I guess since my partner's reversal was so long ago (1998) that I haven't really gone into it in much detail over the past three years. I'll try to remedy that so that others can learn from what I've learned.

My partner thought that he was going to help out the overpopulation problem and in a fit of idealism and with encouragement from his wife at the time, underwent a vasectomy. That was several years before we met, and as it would happen, on the cusp of the end of his marriage. I can't really speak too much as to how his post-op recovery was though I know that he went in for the procedure alone and was hurt that she didn't even come to see him home afterwards. (Lesson #1 -- it is an emotional thing and the female partner should be there to provide support).

I've had a few sexual partners in my past and so I was a little familiar with what ejaculate looks like. What was weird about my partner's prior to his reversal was that it was thicker than the intact guys I engaged with. I guess this is due to the ejaculate just containing the portions from the prostate and seminal vesicals. After his reversal it returned to a normal looking consistency.

The final product of semen that you see when you come contains only 5% sperm; the other 95% is made-up of secretions from the seminal vesicles (considered an extension of the prostate) and prostate fluid (about 80% of the final mix), which gives ejaculate its whitish color.
From Premature Ejaculation


From when we first started dating he told me he intended to have a reversal, he had already worked through his regrets about having the procedure and so we knew it was on the horizon. From what we learned online at the time, having a reversal within 4-5 years of the initial vasectomy supposedly would help to ensure a greater likelihood of success.

The first step was to locate a doctor who specialized in vas reversals as we wanted this done right the first time. I searched online and at the time, Columbia University had and still has some great vasectomy reversal info and doctors who looked pretty good but through a friend's father who is a urologist in Washington, we learned about Dr. Dale McClure , a urologist specializing in fertility at Virginia Mason Hospital. My partner, since we were still just dating at the time, went for his appointments without me. I remember feeling embarrassed when he came back and told me that Dr. McClure asked about the fertility of his partner (me) and he provided some answer about my having regular cycles -- ack! things were going really fast for me and we'd only been together for a couple years.

The surgery was scheduled to be done through a facility at Group Health Hospital on Capitol Hill; there was some reason it was done there which if I recall correctly might have had to do with both insurance and the technology available. I insisted on being at the hospital the day of the operation, knowing how hurt he had been by the lack of support when he had his vas.

On the Internet prior, we had learned that the medical term for a vasectomy reversal is vasovasostomy and that there was a microsurgical technique used to sew the tiny vas deferens back together again using a fancy sewing technique under intense magnification -- this techique was supposed to have a higher success rates than older techniques.

Prior to the procedure my partner was sedated in a pre-op are and I was able to spend time with him and massaged his feet and kept him relaxed and calm (it was from this experience that he learned how to take care of me surrounding my first d&c and then my fibroid surgery which was really nice for me). The nurses told him that he better be really nice to me and that I was a "keeper". When he was good and loopy on the meds I stepped out into the waiting room and he went into the operatory. I told him that I would be there the entire time he was being operated on so he should know that he wasn't alone ever.

[Graphic detail]
From what he's told me, in the operatory he was awake but sedated during the operation. There was a camera pointed at his testes throughout the procedure, with a screen within his view which was fairly intense for him to watch. The doctor made two incisions into the front of he scrotum and lifted out his testicles to have access to the surgical site (in contrast, vasectomies are done through very small incisions through the back of the scrotum). When it would get too intense for my partner he would tell the nurse to dose him more. It took about two hours to do the operation and then he was moved out into post-op where I was able to come in and see him and rub his feet some more.
[end graphic detail]

We left the hospital that afternoon and went home to rest. He was instructed to not ejaculate/have sexual intercourse for four weeks after the operation to help with healing. Since then I've heard of other doctors wanting to have men begin ejaculating sooner (10 days post-op) to help keep the vas open. I don't know if there is a standard, I assume it is still going to be based on your doctor's own experience and preference. While he was healing the most noticible thing was that his scrotum was HUGE. His balls were swollen to the size of large oranges at least and it took weeks for the swelling to go down.

I believe he was meant to have a semen analysis within a few months of the procedure but we weren't ready to start a family yet and the doctor said that he had found sperm during the procedure from the testical side of the vas. I think it was fear of it not working more than anything that made my partner delay his semen analysis. Finally over a year later he went in and had it done and the results were pretty poor by WHO standards. He was instructed to come back for another test in a few months if I recall correctly. He asked the doctor at the time about some ongoing pain that he had in his scrotum/testes and the doctor thought it might just be part of the healing process. We felt a bit discouraged but only time would tell.

Specific things we learned along the way from our experience:

There might be pain for a while

Sperm counts might be low for a while and continue to improve over time without intervention (we saw significant improvement after 2 years)

Ejaculate consistency will change after the reversal, to a more normal consistency

You should be sure to have a semen analysis based on Kruger morphology standards and not just WHO standards, and also make sure you are tested for anti-sperm antibodies as well

MFI supplement cocktails can actually improve morphology

The our doctor felt that our chances of conception would be better with a repeat reversal (though it wasn't required ultimately because things improved on their own) than with trying TESE/IVF

General post vas reversal fertility info:

There is a greater chance of having ROS damage to the sperm

That the success rates post procedure have more to do with the health and age of the female partner than just on the time between vasectomy and reversal

That there is about a 50% chance of conceiving on your own post reversal

Vasectomy and Vasectomy Reversal Links:

FIND A SURGEON

Society for Male Reproduction and Urology (SMRU) - Member Search

INFORMATION ABOUT THE PROCEDURE

The Patient's Guide to Vasectomy Reversal

Microscopic Vasovasostomy

Vasectomy Reversal - Introduction

Microsurgical Vasectomy Reversal

What's New in Male Infertility Treatment at Cornell
Vasectomy Reversal: The Microdot Method for Precision Suture Placement

Google Groups: alt.support.vasectomy

International Center for Vasectomy Reversal

Vasectomy Reversal - Johns Hopkins

Building Bridges to Conception - Vasectomy Reversal

Vasectomy Reversal Questions &s; Answers

Microscopic Vasectomy Reversal

Vasovasostomy

The Infertility Center - FAQs - vas reveral Qs and As link

Cary Urology Vasectomy Reversal

Vasectomy.com

ARTICLES ON VARIOUS RELATED TOPICS

Warning over vasectomy reversals

Vasectomy - Can it be reversed?

Morphological changes of spermatozoa in proximal vas deferens after vasectomy

Microsurgical Vasovasostomy versus Microsurgical Epididymal Sperm Aspiration/Testicular Extraction of Sperm Combined with Intracytoplasmic Sperm Injection

Some vasovasostomized men are characterized by low levels of P34H, an epididymal sperm protein.

Vasectomy Myth Debunked: NewYork-Presbyterian/Weill Cornell Study Finds Vasectomy Reversal Highly Effective, Even After 15 Years

Vasectomy Reversal & Sperm Antibodies

VASECTOMY

Vasectomy Blog

Vasectomy Information

For Someone Going in for Her First Infertility Appointment

If you are going in to see an RE (reproductive endocrinologist) it is good to have an idea about what will happen, know more about things that will be tested and also understand the range of things that could contribute to your fertility non-performance.

Usually the plan is to start with the least invasive testing and analysis and then progress into more invasive as required. Here are the usual steps:

1. Blood work
2. Semen analysis
3. HSG (before trying IUI or Clomid)

Here are some links to sites and article that I've found over the past couple of years that have been the most helpful about the general infertility workup (I've got loads of links on specific conditions and hormones as well, but I'll have to publish those in other posts.)

I like this section quite a bit for getting a handle on what you want to get out of your fertility treatment. It's very thorough.

Making Your Fertility Treatment Plan:
How to Avoid Hit-or-Miss Fertility Treatment

Here's a good link about testing:
A Comprehensive Infertility Work-Up

Here are hormones levels to reference:
Hormone Levels & Fertility Bloodwork



Another page about infertility tests

This article (Infertility Care and the Role of the Compounding Pharmacist - PDF format) has some info about how your chart can indicate different issues with follicular development and hormones

This page is for a group in Britain that does pre-conception consultations. They are after healthy mothers and babies, it might give more insight into nutritional issues for you:
FORESIGHT PREPARATION FOR PREGNANCY PROGRAMME


Remember at your appointment that your treatment plan needs to match up to your social, financial, spiritual and ideological beliefs. Be sure to communicate if you are not comfortable with anything they recommend. I've known couples that wouldn't have a semen analysis due to religious beliefs so don't be shy about standing up for yourself.

Semen Analysis -- Helpful Details

Tapered refers to the head of the sperm, I found several references that mention testicular heat as a possible contributor to this defect:
Men with an elevated testicular temperature frequently due to a varicocele or exposure to excessive heat often have tapered sperm quality and may be missing the acrosome, the packet of enzymes at the tip of the sperm head that allow the sperm to bore through the coating of the egg.
From: An in-depth look at fertility

I also found this article: Deterioration Of Sperm Morphology In Men Exposed To High Temperature

Forward progression has to do with how well the sperm are at swimming forward. I don't know much about it but Vitamin E and Selenium are supposed to help with motility

Hypoosmolarity has to do with too much water being in the sperm cell I believe, remember osmosis from biology class in high school? I couldn't find anything that directly spoke to directly this but this quote points out some possible things to research more on:
In mammalian cells, hydration may change dynamically in response to hormones, ethanol, aniso-osmotic environments, oxidative stress or by cumulative substrate uptake.
from: Hepatocellular hydration: signal transduction and functional implications.

Here's a comprehensive guide to refer to: Semen Analysis in the Clinical Evaluation of Infertility

Semen Analysis

Here are some comprehensive guides to refer to: Semen Analysis in the Clinical Evaluation of Infertility

Semen analysis

The Fertility Guide: The Male Factor

Normal Ranges for a Semen Analysis from INCIID

Helpful Details

Morphology refers to the shape and structure of an object. Morphology may be even more important than count or motility in determining potential fertility. Abnormally shaped sperm cannot fertilize an egg. About 60% of the sperm should be normal in size and shape for adequate fertility.

The perfect structure is an oval head and long tail. Abnormally shaped sperm may include a number of variations:

A very large round head. (In one study, if 14% or more of sperm had round enlarged heads, the chances for pregnancy fell to about 20%. Such an abnormality indicates early unraveling of genetic material.)
An extremely small pinpoint head.
A tapered head.
A crooked head.
Two heads.
A tail with kinks and curls.
From Infertility in Men

Tapered refers to the head of the sperm, I found several references that mention testicular heat as a possible contributor to this defect:
Men with an elevated testicular temperature frequently due to a varicocele or exposure to excessive heat often have tapered sperm quality and may be missing the acrosome, the packet of enzymes at the tip of the sperm head that allow the sperm to bore through the coating of the egg.
From: An in-depth look at fertility

I also found this article: Deterioration Of Sperm Morphology In Men Exposed To High Temperature

Forward progression has to do with how well the sperm are at swimming forward (aka motility). I don't know much about it but Vitamin E and Selenium are supposed to help with motility

Hypoosmolarity has to do with too much water being in the sperm cell I believe, remember osmosis from biology class in high school? I couldn't find anything that directly spoke to directly this but this quote points out some possible things to research more on:
In mammalian cells, hydration may change dynamically in response to hormones, ethanol, aniso-osmotic environments, oxidative stress or by cumulative substrate uptake.
from: Hepatocellular hydration: signal transduction and functional implications.

A Shot at Improving Your Semen Analysis

(to a woman who's husband was just diagnosed with 2% morphology)

I wouldn't give up hope just yet, since your husband has been away there is a good chance that things got a bit sluggish and studies have shown that ejaculatory frequency can improve sperm quality. You guys should get busy and that's one step in the right direction.

There are a bunch of people on the boards who have gotten pg with 2% morphology. We did it too, though we had a blighted ovum.

I would suggest that since it takes 120 days to grow new sperm, that you repeat the test but after a few months of supplementation, healthy eating, destressing and regular intercourse. Then you could also do as Sonnet mentioned, using a condom to collect the sample -- how you collect the sample can influence what comes out and a longer pre-ejaculatory arousal period is associated with a greater quantity of sperm in the sample (I can't find the reference but its out there).

The UR had us do the SPA (Sperm Penetration Assay) test to see how the sperm reacted with the egg membrane. We did that test in May, the test results came back positive and we coincidently conceived the same cycle. He felt that the SPA (sperm penetration assay -- aka hamster egg test -- poor hamster) was useful as a next step in our diagnosis. This might show how your guys swimmers are performing IRL.

Laboratory Section - Sperm Penetration Assay
Sperm Penetration Assay

Also, having more sex prior to ovulation when you have fertile quality mucus means that you are pooling the available sperm which can make up some for the paucity in a single sample (see POOLED SPERM COUNTS)

Dr Perloe (guest host for chats here on the boards sometimes) suggested to us that the sperm DNA fragmentation test (SCSA) would be worthwhile but we got a BFP and didn't need to -- maybe soon we will do it if we don't get a BFP (having my fibroid out might have improved our fertility).

Supplements can help, we've seen some good results on the MFI board from various regimes that are all fairly similar. I expect that your DH hasn't been eating a lot of fresh veggies while he's been away, so he probably could do with a little extra for now.
I wrote up what supplements and doses my partner has been taking for another board member recently so I'm posting that here, other ppl might have additional recommendations:

Grapeseed -- 120 mg, 1 each day
L-Carnitine -- 250 mg, 1 each day sometimes
Arginine -- 500mg, 1 each day sometimes
Multi-vitamin -- 1 each day
Zinc -- (with c) -- 23mg, 1 each day sometimes
Rhodiola Rosea -- 300 mg, 1 each day

The ones marked sometimes he doesn't take every day, but instead several days a week. He senses that his body doesn't need it, which if your DH is in tune with his body he might find with some of the supplements as well. For starts though, I would do take all of these (rhodiola is optional though it might help as well, it is a potent anti-oxident and adaptogen which can help DH feel better after the stress he's been under -- they gave it to Russian fighter pilots in the Soviet Union to deal with the G-force better) -- he should do the supplement routine for three months and you should be able to see a difference in a subsequent analysis.

More information to check out:

Sperm

Male Infertility

Male Fertility or Infertility

All About Sperm

These are some of the better links I've found about sperm generation and basic men's infertility.

MALE INFERTILITY

Male Infertility Overview ~ Assessment, Diagnosis, and Treatment

Male Reproductive Problems

Advanced Urology - FAQ's on Information pertaining to Male Infertility

Infertility in Men


SPERMATOGENESIS

Maturation of a sperm cell - diagram

Spermatogenesis Slides -- with details of various constituents involved in process

Spermatogenesis

MORPHOLOGY

Semen Characteristics: Advancement in Andrological Assessment - PDF
Indian Journal of Clinical Biochemistry, 2005, 20 (1)
173-183
R.S. Sharma** K.K.Gaur#, P.C.Pal*, Monika Manocha*, Deepak Tomar*, Arif Azam Khan*, Vinita Tripathi*, Vineeta
chattree* and A. Kriplani+

The Importance of Sperm Morphology in the Evaluation of Male Infertility

Poor Sperm Morphology

Sperm Abnormalities: Testicular Causes

Illustration showing nomal to abnomal sperm

More images showing sperm morphology (Google Image Search)

Differential production of reactive oxygen species by subsets of human spermatozoa at different stages of maturation

FOR MORE INFORMATION VISIT:

Vasectomy Reversal Information

Semen Analysis

Improving Your Semen Analysis