blog

New home semen analysis test about to hit stores - but watch out!

Mon, 13 Feb 2012 20:31:30 -0700

At first glance you would think this is a good thing - being able to know more about yourself, specifically your sperm count. And many tens of thousands of men, I am sure, will buy and use this home sperm count test. Unfortunately they, like so many others, will be making a huge mistake by incorrectly assuming that normal numbers mean all is well and low numbers suggest poor fertility. The truth is that a semen analysis is NOT a test of male fertility. It is a test of only 2 things - sperm production and sperm delivery. A semen analysis is a good way to make an educated guess about a male's fertility status, but it is not precise and many men with low counts have no problems fathering children. Likewise, we see men with great numbers who are simply unable to make a baby. There is so much more to fertility and conception that sperm counts.

In fact, sperm counts and motility (the ability to swim up to find and fertilize the egg) vary widely in the same person from hour to hour, day to day, week to week. That's just the way we are. In our vasectomy reversal only practice, a semen analysis is a normal part of our follow-up care. In the male fertility world, because of so much variability in semen analysis from test to test, a single semen analysis result is not considered adequate to offer an opinion about what it means or doesn't mean. It is like looking at one frame of a movie and trying to guess all the details of the plot, characters, etc. It's just not enough information.

We usually ask for 2 or even 3 separate sperm counts, each at least several weeks apart, before we can get an idea of what is really going on. Plus, there are many, many factors that can impact sperm numbers or motility. Some of these hurt sperm counts for a few hours, others for a few days, others still can reduce numbers for almost 3 months, the time it takes to make a sperm from start to finish. These factors that can hurt sperm include heat (a fever, hot tubs, hot baths, Jacuzzis or hot saunas which can drop counts for up to 3 months), tobacco, marijuana (hurts sperm quality and lowers testosterone), many health problems, many medications (prescription and over-the-counter), the presence of a varicocele, prior surgery down there, your frequency of ejaculation (you should wait for 3 days without ejaculating before checking a count to allow sperm numbers to build up), nutritional status, and level of hydration or dehydration, to name a few.

So yes, go use the test if you want to know but if your sperm numbers are good and you are not able to get pregnant within 6 months of actively trying, go see your OB. If your sperm numbers are not normal or are zero, then you should see your urologist first for an exam and a more detailed semen analysis by an experienced andrologist to see if the pharmacy home test was accurate or not.

Can we just have one child?

Mon, 30 Jan 2012 17:28:14 -0700

This is common question raised by many couples considering vasectomy reversal. The answer -yes, of course you can. It is important to remember that a well performed vasectomy reversal by a true expert is about 1/3 the cost of in-vitro fertilization with ICSI and more effective. If, after having you single child you are no longer interested in fathering any more children, then you can easily have a vasectomy without any additional problems or risks. In fact, vasectomies are commonly performed on men who, after their reversal, are done and ready to move back to the “no more children” phase of life.

Interestingly, there are also times when after one more child the couple decides that they wish to have a second or more children. This is when a vasectomy reversal is also the best first choice. With your restored fertility after reversal, it costs you nothing to have additional children. What’s great about a reversal is that it allows you to decide how many children you want over time, and provides for the healthiest of children in the most cost effective manner.

The other options to have just one child, other than vasectomy reversal, include:

Adoption- average cost about $20,000 to $30,000. Yes, you make the world a better place by taking in a homeless, parentless child but there are other issues as well.

IVF with ICSI after sperm retrieval, at cost of about $12,000 to $45,000, depending on the doctor, the facility, your location, your egg and sperm health and more.

Donor insemination - cost about $1000 to $2500 per attempt or more for IUI (Intra-Uterine Insemination), where sperm from a healthy male that resembles the father has his sperm instilled, with about 15% effectiveness per attempt, per cycle so this takes on average about 6 to 7 cycles.

"It's not in my head - this pain is real!"

Wed, 14 Sep 2011 20:58:18 -0600

Pain after vasectomy is a rare and devastating side effect from a vasectomy. Almost without exception, every single vasectomy pain patient whom I talk with tells me how their doctors repeatedly told them that their pain was "not real", was really "psychosomatic" or was from an emotional need for attention or a "drug-seeking behavior." In essence, they were being told that their pain was not really there and that in fact they were crazy as there were no physical causes of pain after vasectomy. There are many post-vasectomy pain patients that are even told that Post Vasectomy Pain Syndrome (PVPS) doesn't exist, and so go far as to tell the patient that they have never heard of such a syndrome. Yet this syndrome of severe or chronic pain after vasectomy is well known and clearly described in the medical literature, and has been so for many years. The problem is that the doctor you are seeing may not be aware or educated on this rare complication of vasectomy. When I counsel patients about vasectomy, I am always certain to explain in my review of potential complications that PVPS does exist. I explain further to this patient considering a vasectomy than when this pain after vasectomy occurs, it can be severe, unrelenting and life-destroying.

The good news is that your life is not ruined, you can have resolution of the pain and be back to the normal way you were before the vasectomy. First and foremost you need to understand that this constellation of pain and symptoms can be tricky to treat. The biggest hurdle is to find a urologist that understands the syndrome and the pros and cons of each of the various options available to you, as explained in another article.

It is essential that you and your wife know, deep down in your heart, that no matter how bad the pain has been, no matter what you have been told, there is a light at the end of the tunnel, that this pain can and will go away, and that you can once again be the man you were before. You can be the husband and father, enjoy sex without severe pain and get back to work. Once again you can enjoy sports and hobbies such as bike riding, mountain biking, horseback riding, basketball, baseball, football, soccer, squash and running. Bottom line, you can enjoy life the way you did instead of being crippled by the unrelenting, severe pain of Post Vasectomy Pain Syndrome.

Vasectomy reversal experts or not

Mon, 22 Aug 2011 20:16:17 -0600

So often I hear or read about patients who are considering our full-time vasectomy reversal only program as well as looking at a number of other vasectomy reversal "experts". When they tell me their final list, I am usually surprised that several of the doctors they are considering are often not vasectomy reversal experts at all. In fact, they are often busy general practice urologists who also do an occasional vasectomy reversal. What these doctors have so smartly done is to create an impressive image of expertise, often with a fancy website that pronounces their expertise and fame.

When it comes to the challenges of a several hour technically demanding microsurgical vasectomy reversal, the skills required do not just come back to a doctor on an occasional basis a few times a year. To achieve the highest level of success, which all patients deserve, a surgeon must perform microsurgical vasectomy reversals frequently. Here at ICVR, we perform on average 5 to 7 vasectomy reversals each week.

So how do you identify which vasectomy experts are real and which are not? One clue is to look at their practice description. If they claim they also care for prostate cancer, BPH, kidney stones, kidney cancer, urinary tract infections, blood in the urine, male fertility and sexual health, vasectomy and vasectomy reversal, pelvic pain and more, then chances are good the doctor is not a top tier vasectomy reversal expert.

When it comes down to it, you rightfully can expect the highest chances for achieving your dream of fatherhood by taking the time to carefully select a true expert – one who has dedicated his practice to performing highest quality microsurgical vasectomy reversals!

Read more about Dr. Sheldon Marks and Dr. Peter Burrows. We offer a no-cost consultation to help you understand the vasectomy reversal procedure, process and cost. Talk to us today.

Hidden Costs of a Vasectomy Reversal

Fri, 17 Jun 2011 11:17:55 -0600

The out-of-pocket dollar costs for a vasectomy reversal are pretty straight-forward. That's a no-brainer. Assuming the doctor or facility is honest with you up-front, the price you are quoted is what you will pay. But costs for achieving fertility after a vasectomy through a microsurgical vasectomy reversal can be more than just money.

No one talks about these hidden non-dollar costs.

Yes, there may be significant costs that have nothing to do with money in your wallet. These costs can make the cash cost of your vasectomy reversal seem like nothing. I am talking about the cost to you if the reversal does not work. If you think about it, how much money have you saved if your reversal was a failure? If you opt for a non-expert or a wannabe vasectomy reversal doctor, it is more likely your vasectomy reversal will not work and you will still be sterile after your reversal. This means that you will have no chance for natural conception and getting your dream of a future family. What price can you put on the emotional nightmare of a failed vasectomy reversal? Plus, there are serious costs often seen with the wannabe surgeons to include significant pain and a slow recovery - problems the top-tier experts rarely have.

Lets not forget the added and higher costs of having a redo vasectomy reversal (yes, I do many of those and they are harder to do and cost more). Even more expensive is moving to IVF/ICSI, which often costs more than 3 times the fee of a redo vasectomy reversal.

So when considering costs to have your reversal, look at the big picture and choose wisely.

So what can you do?

Take the time and do your research.
Be skeptical of claims. Look at the "expert".
How long have they been an expert?
Just because someone has an impressive website or testimonials singing the doctor's praise does not mean he is skilled and experienced.
Ask the tough questions.

Realize that the local doctor or the cheaper surgeon really may not be the best for you. Convenience means nothing if the reversal is not a success. The few bucks you might save or the day of travel in the long run will be forgotten if you don’t get your dream child and family.

Buyer Beware or "The Big Lie"

Mon, 06 Jun 2011 11:11:25 -0600

At a recent meeting of most of the world's leading vasectomy reversal experts, there were a few moments of heated discussion about microsurgery courses offered to general urologists. The purpose of the course is to improve the level of care they provide. Makes sense. The question that was debated - does taking an introductory weekend course in microsurgery really qualify the doctor to be able to perform microsurgical vasectomy reversal procedures? Just as important, does it qualify the doctor to be able to advertise that he had formal microsurgery training and is therefore an expert?

If the doctor was being honest with you and himself, he would have to answer no. Yet the internet is filled with dozens of doctors who say yes, they can and will gladly do your reversal, promising the success rates of the experts. Just as scary, they proudly promote on their website that they have had "advanced training in microsurgery". Really? This is without a doubt a huge distortion of what they were taught and unprofessional abuse of what was intended. What these doctors fail to tell you is what the course really consisted of and just as important, what the real trained microsurgery doctors go through to be able to say they have advanced training. Being a top vasectomy reversal expert means many years and thousands of patients with the highest level of documented success.

Advanced training - this can mean anything, literally anything, from a half-day class on up. For those few who choose to do it the right way, advanced training in microsurgery in 2011 is a 6 to 24 month competitive, full-time fellowship program after residency in male fertility and microsurgery. These doctors are truly trained. Of course, being trained doesn't mean you are skilled at vasectomy reversals nor does it mean that you are using those skills daily. A quarter century ago these fellowships did not exist, so us senior guys earned our stripes in the trenches, performing many thousands of reversals. Mix this with skill and years under their belt and your will have a top vasectomy reversal expert.

Weekend course. Then there are those that take a short, one day or weekend course. I know what these courses consist of, as I have helped teach a few of these over the years. They are not designed or intended to be able to take a general urologist and make him a vasectomy reversal expert overnight. Likewise, they are definitely not intended to have him boldly advertise and portray himself to the world as a trained microsurgery expert. Rather, these are good, useful courses intended as a sort of a "booster shot" to help general urologists 1. do a better job when they choose to do a microsurgical vasectomy reversal, and 2. better understand their own skill and limitations to know when the patient would be best served by referring him to a top vasectomy reversal expert.

Dishonesty. Why would these doctors be dishonest? The answer is obvious. If they can convince you that they are in fact a highly trained expert (when they are far from it), then you are more likely to select them for your vasectomy reversal. It's all about the money. Sadly, there is no ethics oversight, and these guys know it. They realize they can claim anything, distorting the facts to create a false image to essentially trick prospective patients into believing that they are something they are not.

What to do? This is where the "buyer beware" concept is so important. Take the time to seriously look at any doctors you are considering. How long have they been performing vasectomy reversals? How many do they do a week? Has it been decades or just since the economy crashed? What else do they do? Do they really dedicate themselves to vasectomy reversals? If you seriously read between the lines, chances are good you will find that great reversal doctor who can give you the highest chances for success and your baby.

Exercise probably does not impact on sperm counts and function

Mon, 16 May 2011 13:49:38 -0600

A new study out today suggests that exercise probably does not have an impact on sperm counts and function, unless, and this is a big unless, the man rides a bike more than 5 hours a week. How is this relevant to my vasectomy reversal patients? Well, performing a vasectomy reversal is all about restoring fertility, so this is highly relevant. After all, many of my patients do exercise regularly and some aggressively.

If you had asked me, I would have said that probably men who have some moderate exercise have better counts and motility than couch potatoes. Obesity is bad for fertility. Fertility researchers have known for years that serious bike riders have all kinds of genital numbness, injury and fertility problems. It makes sense that having one's testicles forcibly crammed up against the body for prolonged periods of time hurts sperm counts. We know the reason the testicles are in the scrotum, outside and away form the body is to keep them several degrees cooler than deep core body temperature. So in effect, the testicles in distance bike riders are heated, and so sperm numbers may be lower.

This does not mean that if you ride a lot you will have lower fertility. In fact, I know many bike riders and triathletes that ride much more than 5 hours a week and have great sperm counts. If you do have low sperm counts or if fertility is an issue or concern, then extended time grinding your testicles on a bike seat is probably not the smartest thing to do.

There are smart bike seats that allow you to sit correctly and do not cause problems- these can be found at www.no-nose.com. Yes, they look like old fashioned tractor seats but they are designed to use your body parts correctly. After all, the delicate external genitals are not really built to hold up your body weight. Instead, the bones of the pelvis do that just fine with no injury or hazards. I tell all my vasectomy reversal patients to avoid bike riding for some time after their surgery to let the delicate tissues heal "down there" and then to limit the time on an old bike seat. Even better, get a new seat. Best yet, if you have just had a vasectomy reversal and you are trying to father children, consider other forms of exercise where there are no worries about hurting your fertility.