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Vasectomy Reversal: What is it and what you need to know
Dr. Kevin Ostrowski explains what a vasectomy reversal is, why someone would consider this, and any side effects.
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Learn more about Kevin Ostrowski, MD
Kevin Ostrowski, MD
Kevin Ostrowski, MD is a Physician at EvergreenHealth Urology & Urogynecology Care.Learn more about Kevin Ostrowski, MD
Transcription:
Melanie Cole: Welcome to Checkup Chat with EvergreenHealth. I'm Melanie Cole and today we're discussing vasectomy reversal. Joining me is Dr. Kevin Ostrowski. He's a Physician at EvergreenHealth, Urology and Euro gynecology Care. Dr. Ostrowski, it's a pleasure to have you join us today. We've done a previous podcast, you and I on vasectomy. Now I'd like to ask you about vasectomy reversal. What is that and who might be a candidate for it?
Dr. Ostrowski: Yeah, thanks so much. I'm excited to kind of talk about this topic. A vasectomy reversal is for patients and their partners who have made the decision to have additional children after a vasectomy. And that could be in lots of different scenarios where life changes and people decide that they want more children after they've had a permanent form of birth control, which is a vasectomy. A vasectomy reversal is a surgical procedure where we basically undo the vasectomy. What I mean by that is that we identify the kind of ends that your vasectomy happened at, which is the tube, the Vas is a to which curious sperm out from the testicle. We identify where that happened and go through the process of reconnecting those tubes together. Anyone who's had a vasectomy is a candidate at least for a discussion about it. And there are kind of pros and cons to Vasectomy reversal versus in vitro fertilization. And going to a person who does a bunch of these and kind of really understands the nuances of those two options is a very important kind of part of that. But from a patient perspective, anyone who has a vasectomy and is looking to kind of learn more or to undergo a procedure to undo what happened is a candidate.
Host: So you've given us a great explanation in a previous podcast of the procedure of a vasectomy. Now tell us a little bit about what happens during reversal procedure and what that's like for the man.
Dr. Ostrowski: Yeah. So just to kind of briefly go back to that other podcast at the time of a vasectomy. The tube, which is the Vas, which carries sperm out from the testicle is basically cut and a small portion of it is removed and cauterize. And at the time of the vasectomy reversal, what happens is you go to sleep, we identify that area where that cut happened. We freshen up or clean up the edges and identify the tube, and identify the hole or the Lumia on the inside. What we do is we kind of flush some fluid to make sure that it goes out through the ejaculatory ducks and then we look at the fluid coming from the testicle side. If that fluid looks really good, by that I mean that it has sperm or sperm parts in it. We connect those two tubes together using very tiny suture under a high powered surgical microscope. That suture smaller than your hair on your head and we connect those two tubes together and that's called a vas to vas connection or a vasa vasectomy.
If that tube shows that there isn't sperm, when we kind of push it out from the testicle, and shows that there isn't sperm in that fluid, then what we do is we take the Vas and we connect it down to it area on the backside of the testicle called the epididymis. That's called vas to epididymis connection or vas epididymocity. We look at both sides and both testicles and do the procedure on each side. That's the right procedure. What I mean by that is that you can get a vas to vas connection on one side or on both sides. You can get a vas epididymis connection on one side or on both sides. It just all depends upon how you've healed from your vasectomy and how long it's taken. Or how long has it been since your vasectomy?
Host: Is there an age limit Dr. Ostrowski, is there a time when you say to a man that they are too old for this type of reversal?
Dr. Ostrowski: Yeah. So there isn't an age limit, but the time from your vasectomy will determine how likely it is for you to need that vas epididymis connection procedure, does have a little bit lower success rate and a lower likelihood of pregnancy. And really what my goal is to cause a pregnancy and help couples kind of end their decision to have more kids. And so they need to understand kind of the chances of that happening and the impact of that and then make the decision that's the right decision for them. Whether that's to go forward with a vasectomy reversal, knowing that it may not be as successful as they get farther out from their vasectomy or go forward for another option, which is invitro fertilization. And that timeline does change for each couple, but typically when you start getting over 10 or 15 years since your vasectomy, we kind of start having the discussion about what's the right or best option for each couple.
Host: Well, let's talk about some of those other options. What other options are there besides a vasectomy reversal to help couples get pregnant?
Dr. Ostrowski: Besides a vasectomy reversal, which we talked about a little bit. The other option is invitro fertilization. What that is basically the process where the male partner is stimulated with some hormones and then she undergoes a procedure or eggs are taken outside of her body. That is combined with a procedure where we take sperm from the testicle we cause her fertilization outside the body, embryos are then grown and then embryos are transferred kind of back into the female partner. From a male perspective, the procedure is similar to the vasectomy where we basically numb up the testicle and take some tissue out for use with invitro fertilization.
Host: I think a very interesting question, Dr. Ostrowski, is sperm quality affected with a vasectomy or with a vasectomy reversal, which is one of the reasons I asked you about the age limit. Is sperm quality, does that play a part in this?
Dr. Ostrowski: We know that as men age there is some impact on sperm, although it is significantly less of an impact to then the effect on age of female partners eggs. But ultimately the procedure either to do a vasectomy has no major impact on sperm or on the ability for you to have a normal pregnancy or have normal sperm production. So undergoing a vasectomy reversal or going through invitro fertilization, and a sperm aspiration or a sperm extraction, really has no impact on sperm or sperm production. And can result in a very normal, obviously pregnancy and normal childbirth and all those sorts of things.
Host: It's so interesting Doctor, wrap it up for us with your best advice for men that are considering of a vasectomy reversal, if they can have a vasectomy after the reversal, if they then have had children and then want to go back and have a vasectomy again, kind of give us your whole summary of this procedure and what men can expect.
Dr. Ostrowski: I think vasectomy reversal is a great option for men who are looking to get pregnant after a vasectomy. It allows them to get pregnant naturally, which is what a lot of patients like. Meaning that they get to try and get pregnant again, and go through that process as opposed to an invitro fertilization. It also has very few side effects or risks besides it not working. And for the vast majority of men who undergo vasectomy reversal, the chance of getting sperm in the ejaculate is well over 90%. And the chance of getting pregnant is in the 60 or 70%. So those success rates were really high. There are other options including in vitro fertilization. And so going to someone who really kind of understands all those options and can kind of look at everything that's happened, how long it's been since you're vasectomy, how old your partner is, the impacts that those situations may have all impact your chances of success. And that's ultimately what we're talking about. After you know, we are successful and cause a pregnancy or multiple pregnancies then it is totally possible to get a vasectomy after a vasectomy reversal, it is a little bit more tricky. And so going to someone who has experience, who's done a bunch of vasectomies is very important because it does have a little bit more scar tissue, but is totally reasonable and a very straightforward procedure to get a vasectomy after vasectomy reversal.
Host: Well, thank you so much for joining us, Dr. Ostrowski. Really interesting topic. Thank you for sharing your incredible expertise with us today. To learn more about these services at EvergreenHealth Urology and Euro gynecology Care, please visit evergreenhealth.com/urologist to get connected with one of our providers. That concludes this episode of Checkup Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. I'm Melanie Cole.
Melanie Cole: Welcome to Checkup Chat with EvergreenHealth. I'm Melanie Cole and today we're discussing vasectomy reversal. Joining me is Dr. Kevin Ostrowski. He's a Physician at EvergreenHealth, Urology and Euro gynecology Care. Dr. Ostrowski, it's a pleasure to have you join us today. We've done a previous podcast, you and I on vasectomy. Now I'd like to ask you about vasectomy reversal. What is that and who might be a candidate for it?
Dr. Ostrowski: Yeah, thanks so much. I'm excited to kind of talk about this topic. A vasectomy reversal is for patients and their partners who have made the decision to have additional children after a vasectomy. And that could be in lots of different scenarios where life changes and people decide that they want more children after they've had a permanent form of birth control, which is a vasectomy. A vasectomy reversal is a surgical procedure where we basically undo the vasectomy. What I mean by that is that we identify the kind of ends that your vasectomy happened at, which is the tube, the Vas is a to which curious sperm out from the testicle. We identify where that happened and go through the process of reconnecting those tubes together. Anyone who's had a vasectomy is a candidate at least for a discussion about it. And there are kind of pros and cons to Vasectomy reversal versus in vitro fertilization. And going to a person who does a bunch of these and kind of really understands the nuances of those two options is a very important kind of part of that. But from a patient perspective, anyone who has a vasectomy and is looking to kind of learn more or to undergo a procedure to undo what happened is a candidate.
Host: So you've given us a great explanation in a previous podcast of the procedure of a vasectomy. Now tell us a little bit about what happens during reversal procedure and what that's like for the man.
Dr. Ostrowski: Yeah. So just to kind of briefly go back to that other podcast at the time of a vasectomy. The tube, which is the Vas, which carries sperm out from the testicle is basically cut and a small portion of it is removed and cauterize. And at the time of the vasectomy reversal, what happens is you go to sleep, we identify that area where that cut happened. We freshen up or clean up the edges and identify the tube, and identify the hole or the Lumia on the inside. What we do is we kind of flush some fluid to make sure that it goes out through the ejaculatory ducks and then we look at the fluid coming from the testicle side. If that fluid looks really good, by that I mean that it has sperm or sperm parts in it. We connect those two tubes together using very tiny suture under a high powered surgical microscope. That suture smaller than your hair on your head and we connect those two tubes together and that's called a vas to vas connection or a vasa vasectomy.
If that tube shows that there isn't sperm, when we kind of push it out from the testicle, and shows that there isn't sperm in that fluid, then what we do is we take the Vas and we connect it down to it area on the backside of the testicle called the epididymis. That's called vas to epididymis connection or vas epididymocity. We look at both sides and both testicles and do the procedure on each side. That's the right procedure. What I mean by that is that you can get a vas to vas connection on one side or on both sides. You can get a vas epididymis connection on one side or on both sides. It just all depends upon how you've healed from your vasectomy and how long it's taken. Or how long has it been since your vasectomy?
Host: Is there an age limit Dr. Ostrowski, is there a time when you say to a man that they are too old for this type of reversal?
Dr. Ostrowski: Yeah. So there isn't an age limit, but the time from your vasectomy will determine how likely it is for you to need that vas epididymis connection procedure, does have a little bit lower success rate and a lower likelihood of pregnancy. And really what my goal is to cause a pregnancy and help couples kind of end their decision to have more kids. And so they need to understand kind of the chances of that happening and the impact of that and then make the decision that's the right decision for them. Whether that's to go forward with a vasectomy reversal, knowing that it may not be as successful as they get farther out from their vasectomy or go forward for another option, which is invitro fertilization. And that timeline does change for each couple, but typically when you start getting over 10 or 15 years since your vasectomy, we kind of start having the discussion about what's the right or best option for each couple.
Host: Well, let's talk about some of those other options. What other options are there besides a vasectomy reversal to help couples get pregnant?
Dr. Ostrowski: Besides a vasectomy reversal, which we talked about a little bit. The other option is invitro fertilization. What that is basically the process where the male partner is stimulated with some hormones and then she undergoes a procedure or eggs are taken outside of her body. That is combined with a procedure where we take sperm from the testicle we cause her fertilization outside the body, embryos are then grown and then embryos are transferred kind of back into the female partner. From a male perspective, the procedure is similar to the vasectomy where we basically numb up the testicle and take some tissue out for use with invitro fertilization.
Host: I think a very interesting question, Dr. Ostrowski, is sperm quality affected with a vasectomy or with a vasectomy reversal, which is one of the reasons I asked you about the age limit. Is sperm quality, does that play a part in this?
Dr. Ostrowski: We know that as men age there is some impact on sperm, although it is significantly less of an impact to then the effect on age of female partners eggs. But ultimately the procedure either to do a vasectomy has no major impact on sperm or on the ability for you to have a normal pregnancy or have normal sperm production. So undergoing a vasectomy reversal or going through invitro fertilization, and a sperm aspiration or a sperm extraction, really has no impact on sperm or sperm production. And can result in a very normal, obviously pregnancy and normal childbirth and all those sorts of things.
Host: It's so interesting Doctor, wrap it up for us with your best advice for men that are considering of a vasectomy reversal, if they can have a vasectomy after the reversal, if they then have had children and then want to go back and have a vasectomy again, kind of give us your whole summary of this procedure and what men can expect.
Dr. Ostrowski: I think vasectomy reversal is a great option for men who are looking to get pregnant after a vasectomy. It allows them to get pregnant naturally, which is what a lot of patients like. Meaning that they get to try and get pregnant again, and go through that process as opposed to an invitro fertilization. It also has very few side effects or risks besides it not working. And for the vast majority of men who undergo vasectomy reversal, the chance of getting sperm in the ejaculate is well over 90%. And the chance of getting pregnant is in the 60 or 70%. So those success rates were really high. There are other options including in vitro fertilization. And so going to someone who really kind of understands all those options and can kind of look at everything that's happened, how long it's been since you're vasectomy, how old your partner is, the impacts that those situations may have all impact your chances of success. And that's ultimately what we're talking about. After you know, we are successful and cause a pregnancy or multiple pregnancies then it is totally possible to get a vasectomy after a vasectomy reversal, it is a little bit more tricky. And so going to someone who has experience, who's done a bunch of vasectomies is very important because it does have a little bit more scar tissue, but is totally reasonable and a very straightforward procedure to get a vasectomy after vasectomy reversal.
Host: Well, thank you so much for joining us, Dr. Ostrowski. Really interesting topic. Thank you for sharing your incredible expertise with us today. To learn more about these services at EvergreenHealth Urology and Euro gynecology Care, please visit evergreenhealth.com/urologist to get connected with one of our providers. That concludes this episode of Checkup Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. I'm Melanie Cole.