(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

I really appreciate my vasectomy reversal buddies online, they are the only ones who know what it is like to be in a relationship with someone you can only cross your fingers to have a child with. It is a big gamble and it takes a lot of emotional strength to get through it, especially when you are fighting with a strong biological desire to have children (that would periodically hit me and I couldn't talk to anyone about it). I even asked my atheist partner to pray for me (he does have a spiritual bent in spite of himself), I told him that he should do it because I wanted him to (while crying of course).

My pg symptoms have shifted this week, less of the car sick feeling and now onto vague nausea (there is a difference I swear). Yesterday I threw up in the morning, right before I had to head out the door to my chiropractic appt. I think my prenatal vitamin didn't agree with my stomach. Today has been better. I've been able to push through the fatigue more now, I think it has evened out a bit as well so I'm not quite so sluggish in the afternoon. I have my ultrasound tomorrow afternoon -- can you believe it will be July already?

I'm going on a picnic with a friend on Friday and skipping out on work for maybe the full day. I didn't get to go to NY so I'm due a little R&R. I'll probably be doing some catchup work for the office over the weekend anyway.

Just FYI, someone at my office is in a relationship with a man who already has teenagers, a divorce (of course) and a vasectomy. She's going to be 40 in October and struggles with the fact that her fertile window is closing but her boyfriend, however committed he may be, is not interested in having any more children. Everyone here is lucky enough to have a partner/spouse who was willing to undergo an extremely uncomfortable procedure to restore their fertility. Count your blessings.

A woman I met on the chat yesterday told me to eat sour things like lemonade and sour candy; she said it helped her through her pregnancy. I've been drinking a lot of limeade and grapefruit juice and it seems to go down easy enough. I read that anemia can make m/s worse and that taking b-vitamins can help (although taking vitamins is tough when you are feeling already) I tried candied ginger the other day as well, it helps with seasickness so I thought it might help. It was difficult to think of it as appetizing but it did seem to alleviate some of the stomach discomfort.

We had doctors tell us along the way that SSRI meds for panic-anxiety that my partner took didn't affect fertility but when I read the fine print their tests on rats left a question mark. He got off of Paxil and his count increased.

Then they told us that morphology was something that you are born with and there is nothing to be done about it but he had a vasectomy and reversal and I found it hard to believe that might not contribute.

They also said there was nothing you could take, or do to improve MFI but we didn't give up. My partner saw a naturopath and was Dx as being hypoglycemic so he changed his diet and eating habits and he's felt a lot better since.

They told us IVF/ICSI was the only way but they would take us through a progression -- abdominal surgery for me with 3 months recovery (and 3-4 weeks missed work) before we could try again, then try naturally for 3 months, then try IUI/Clomid for 3 months and then move on to ICSI. We were devastated.

We watched and read the stories of the other couples online who succeeded in spite of similar low morphology and had hope. I noted every instance of slight improvement and finally looked up all of the anti-oxidents and nutritional supplements that people were trying. He's been taking those for 6 months and coincidently hasn't had any problems with panic-anxiety. He started walking to work each day as he was able and he's feeling great.

Then we just tried to maximize the odds (plus I did a bunch myself to improve my fertility since my fibroid was an issue as well) and kept our fingers crossed but I thought for sure it wouldn't work, we were hopeless and intervention might be the only way. But then my period was late and my breasts were large, my body was hot and I took the test and we got our first positive pg test.

So today is full of all kinds of good news for me and my partner. We
just got our first pregnancy test positive, confirmed by the doctor's office just a little while ago (my pregnancy hormone level is very good). We've been trying, actively trying, for over 2 years. My partner had a vasectomy reversal in 1998 and we had a sperm morphology issue as well. This happened though completely naturally, the old fashioned way.

I already had an appointment scheduled with the RE (reproductive
endocrinologist) today to check on the size of my fibroid since I've
been going for acupuncture treatment since January. I was worried
because the ultrasound wouldn't be accurate since my period hadn't
arrived yet (with its corresponding drop in the estrogen level). The
fibroid in February measured 6 x 6.5 x 9 cm, today it measured about
6x7. Who knows what's up with it but at least it didn't get larger!!

We are really excited that the "equipment" works and have our fingers crossed.

I don't feel pregnant at all and honestly, I even told the doctor,
when you have a heavy period and it doesn't arrive when you expect it you feel like you are walking on eggshells until it does. I guess the biggest thing is that my PMS symptoms are backing off and I don't feel hormonal or yucky. So far my impression is that this is all a good thing hormonally.