Choosing to have a vasectomy is a big decision, and so is
deciding to have it reversed. Often, a man who has a vasectomy does
so because he is done having children or does not want to father children.
Later on, however, things may change—perhaps he has remarried, is restarting a
family after the loss of a child, or simply has had a change of heart. Whatever
the reason, a vasectomy reversal can be performed and, in most cases, end in
his fertility being restored.
During a vasectomy, the tubes that transport sperm from the testes and out of the urethra (vas deferens) are severed then obstructed via sutures or electrical cautery to prevent fertilization. In order to restore fertility through a vasectomy reversal, the cut ends of the vas deferens tubes are reconnected or are connected to the epididymis (the reproductive organ where sperm matures). If successful, sperm will return to the ejaculate and result in pregnancy.
Reversals are performed with general anesthesia and done in an ambulatory surgery center or outpatient area of a hospital. After the patient has been anesthetized, the surgeon (a urologist) will make a tiny incision on both sides of the scrotum in order to access the vas deferens. Once they have been pulled through the cuts and isolated from the scrotal sac, the scarred ends of the vas that are blocked are removed. To see if the fluid inside the end closest to the testicle contains sperm, the surgeon will take a fluid sample. If sperm is present in the fluid, this means there is no blockage between the testicle and the site in the vas from which the fluid was taken. This too means that there is no blockage in the epididymis. With this knowledge, the surgeon can perform a simpler type of vasectomy reversal, known as vasovasostomy, whereby the cut ends of the vas can be reconnected to reinstate a pathway for sperm. A microsurgical approach is considered best, as it may result in the restoration of sperm to the semen in up to 95 percent of patients and pregnancy in up to 75 percent of their partners.
If sperm is not found in the fluid sample, there may be a break in the epididymal tubule, which is often due to a backup of sperm caused by the original vasectomy. A break can result in a blockage, and this means the surgeon will need to do a more complicated technique called an epididymovasostomy, whereby the urologist must bypass the blockage by connecting the upper end of the vas directly to the epididymis, but above the obstruction. Success rates and pregnancy rates are lower with this technique than they are with a vasovasostomy.
With either technique, however, though the vasectomy reversal may be successful (meaning sperm has returned to the semen), pregnancy rates differ and largely depend on the skill of the surgeon as well as the length of time from the vasectomy until the reversal. For some who’ve had a reversal, it may take only a few months for pregnancy to occur, but for others it may take a year or more.
Following a reversal, your urologist will perform a semen analysis every couple of months until your sperm count becomes stable or pregnancy has been achieved. Sperm usually appears in the semen within a couple of months, but for some it may take up to 15 months. The latter typically occurs in men who’ve had an epididymovasostomy. Once sperm returns the semen, the man can be fertile for many years.
About Karen Boyle, MD
Dr. Karen Elizabeth Boyle graduated from Harvard with Honors and then attended Albany Medical College, where she graduated again with Honors and Distinction in Research. She completed her general surgery and urological surgery training at The Johns Hopkins Hospital, The Brady Urological Institute.
Dr. Boyle then completed the prestigious fellowship in reproductive medicine and microsurgery at Baylor College of Medicine, and then returned to The Johns Hopkins Hospital where she served as Assistant Professor of Urology, Obstetrics and Gynecology and Director of Reproductive Medicine and Surgery. While at Hopkins, Dr. Boyle was active in research and teaching, and established and grew a dominant practice of male infertility, sexuality and aesthetics.
Her commitment to providing personal, compassionate, comprehensive care to her patients combined with her diagnostic and surgical excellence has resulted in her being a much sought after solution for patients and practioners alike. It is this commitment to excellence in the patient care experience which prompted Dr. Boyle to establish her current practice as Director of Reproductive Medicine and Surgery, Sexuality and Aesthetics at Chesapeake Urology Associates.
Dr. Boyle specializes in male infertility, and offers state-of-the-art evaluation and treatment of the infertile male. Dr. Boyle works closely with all reproductive endocrinology practices located in the D.C./Baltimore metropolitan area as well as nationally, providing expert care for the male partner. She is the Director of Male Fertility at Shady Grove Fertility Reproductive Science Center, the nation's leading institution of reproductive medicine and boosts the top pregnancy outcomes nationally.
As an experienced microsurgeon, she specializes in vasectomy, microsurgical vasectomy reversal, microsurgical varicocele repair, and all sperm harvesting techniques including microdissection testicular sperm extraction, as well as electroejaculation and penile vibratory stimulation. Dr. Boyle is among a select few microsurgeons nationally who can perform the technically challenging epididymovasostomy and microdissection testicular sperm extraction.
As a leader in the area of reproductive and sexual health, Dr. Boyle recognizes how important it is to address all issues related to the well-being and happiness of her patients.
She is committed to surpassing patient expectations and providing exceptional patient care, achieving the results each patient desires and deserves. As an innovator in the evaluation and treatment of sexual health and aesthetics, Dr. Boyle provides a comprehensive approach to the care of each patient.
Dr. Boyle regularly lectures on male infertility, vasectomy reversal, and sexuality. She is extensively published in her areas of expertise and is actively involved in The American Urologic Association, The American Society of Reproductive Medicine, The Society of Male Reproduction and Urology, The Society for the Study of Male Reproduction, The Sexual Medicine Society of North America, The International Society for The Study of Women's Sexual Health and The American Academy of Cosmetic Surgery.
Her contributions to the field of fertility, microsurgery and sexual health have been featured in many media outlets such as Men's Health, Women's Health, Fertility Today, Radius, Playboy, ABC television documentary Hopkins,"The View" with Barbara Walters, "Healthy Life" with Dr. Tim Johnson and ABC News.
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