Due to an undescended testicle, my invasive vasectomy two years ago failed. I want to be sterile and keep my testicle. What are my options?
An in-office vasectomy was not possible, so I was placed under general anesthesia and my undescended testicle was temporarily removed from my scrotum so that the vas deferens could be cut. The doctor was uncertain if the correct tube was cut after the surgery, and my most recent sperm motility test showed 1 per HPF and 66% motility. I was told that the only real solution now is to remove the testicle completely, but it might lower my libido. Reattempting might cut an artery. Any advice?
Answers from doctors (5)
Based on the 1 sperm per high-powered field, it appears the vasectomy was performed but the sperm has not cleared. This, unfortunately, is not uncommon.
The usual advice is to ejaculate as much as possible and repeat the specimen until clear.
The internet is replete with articles about sperm not completely clearing after vasectomy. I'd advise reviewing those articles and speaking with your urologist.
Of note, some feel sterility is achieved with less than 100,000 per HPF, however, we all would prefer zero sperm prior to giving the go-ahead for unprotected sex. Another note, 20 million sperm seen on a semen analysis is felt to be the low range number to achieve pregnancy.
Published on Jul 11, 2012
A few issues here. Since you describe your undescended testicle is in the scrotum, I assume you had surgery in the past to put it the scrotum. If so, there likely is scar tissue in the spermatic cord, which contains the blood vessels and vas. This makes it quite difficult at times to locate the vas in the scar tissue, and hence the vas may have been misidentified at the time of vasectomy. Also, we don't know how long after the vasectomy your sperm sample check occurred. It may be that in time your sperm count will go to zero. It may be worthwhile to get a formal semen analysis since it is also possible that you have an extremely low sperm count and other adverse sperm health parameters to make all of this moot. If still potentially fertile, you might want to have another urologist assess your situation.
Published on Jul 11, 2012
The vasectomy should be done under the microscope so the artery and vas can be seen. Unless pathology was done showing a vas was missed, both sides should be redone. No reason to remove the testicle.
Published on Jul 11, 2012
If the pathology revealed that in fact a piece of vas was obtained from the undescended testicle, re-exploration of scrotum in attempt to locate vas on each side is the only option. Understand that undescended testes might need to be removed because of scarring and prior surgery. If the other testicle is normal, however, removal of the testes is unlikely to lower libido.
Published on Jul 11, 2012
It depends on where the other testis is, and you certainly need to be re-explored. Using a microscope can aid in distinction between vas and the remaining spermatic cord.
Published on Jul 11, 2012
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