Factors That Determine Success
What is a successful vasectomy reversal?
It is very important to understand how success is defined after a vasectomy reversal. The only honest and fair definition of success is really quite simple: adequate numbers of sperm in the semen. A reversal is designed to restore the flow of sperm back into the semen. Pregnancy - the ultimate goal of most vasectomy reversals - involves a multitude of other health and fertility-related factors with both the man and especially his female partner. Some like to quote amazing pregnancy rates, often higher than physically possible. Talking about pregnancy is not really helpful, as doctors have no control over the many factors that influence whether or not a couple can become pregnant. Sadly, many self-proclaimed experts use extremely low numbers of sperm to declare success, making their own numbers look artificially impressive. It may be good on paper but if it is not enough to make a baby, then the doctor is not being honest. Some self-proclaimed experts quote published numbers, rather than their own. Just as bad are the doctors that make up high vasectomy reversal success rates to look impressive. As Dr. Marks often says, "we are not God. We simply focus all our attention on restoring flow of sperm so that a baby can be conceived the way it was designed."
Though we can often predict who is likely to have a successful vasectomy reversal, there will always be factors that we cannot control and that may have an impact on future fertility. Dr. Marks and Dr. Burrows have performed many reversals on many men 25 to 42 years out from their vasectomy, and found ideal findings including whole and even swimming sperm! Yet, their histories and exams would not have suggested such favorable findings. In fact, many were told that based on the number of years since vasectomy, a reversal is simply physically impossible with no chance for success. So even in the best of hands, predictions are simply educated guesses and sadly often uneducated guesses. There are no blood or ultrasound tests or exams that can accurately predict the results of a microsurgical reversal. One key factor is the age and health of the female partner. This is the one area where you really can't make a choice.
The one controllable factor that best predicts success is simple and completely up to you - the microsurgical skill and expertise of the surgeon you choose. It is not about what they charge, how many papers they published, their university affiliation or the location of their office. This high level of skill that can only be achieved and maintained when the surgeon is performing vasectomy reversals on a frequent and regular basis. At the International Center for Vasectomy Reversal, P.C., we perform an average of 6 to 8 reversals each week and have done so for many years. We are proud to say that we have deliberately decided to control our volume by limiting each microsurgeon to only one reversal a day, so that each patient can be assured that each and every reversal we do receives our complete and undivided attention. No rushing off to do a second case nor are we fatigued from an earlier case. ICVR is a full-time, reversal only practice.
Years since the vasectomy
For many years doctors thought that the farther out you are from the vasectomy, the lower your chances for success. Many of the world's experts still think this is true. A study of our own patient's success rates shows that here at ICVR time actually plays no role in the outcome of a vasectomy reversal. Therefore it is wrong to impose an arbitrary time limit on when a reversal will work or when it will not. At our Center, you can expect a minimum of 90% and as high as 99% success, whether you are 2 or 42 years out from your vasectomy. Statistics are great at predicting the success for a large population of men, but not very accurate at telling an individual what his specific chances of success will be. No one can accurately predict the future for an individual. Yes, it is true that the longer the system is blocked, the odds gradually increase that damage may occur in the delicate tubules of the epididymis. Even with this, you can still expect a 90% to 99% success at ICVR; successes in men we see weekly who were told very bluntly by very good urologists that it was impossible for them to have a successful reversal. Their children tell a different story. These amazing success rates come from Dr. Marks and Dr. Burrows ability to accurately interpret the vasal fluid during the reversal and to use these findings to direct which procedure is best for you. And of course, this with our skill and expertise to do the right procedure is the why we have achieved such a high rate of success or men from all over the world.
The technique used in a patient's original vasectomy can potentially have an impact on success as well. If a small segment of vas was removed with minimal damage to the adjacent vas or surrounding tissues, then the reversal is much easier than if a large segment is removed or the vas has extensive damage. Whenever possible, we try to obtain the procedure notes from your original vasectomy. This may offer additional information to help with your reversal. The good news is that whatever the technique used for your vasectomy, even if it makes the reversal more challenging, it does not impact on your success rates at ICVR. We have seen many thousands of vasectomies and feel confident we can reverse almost any vasectomy. Ask us for more information about our special packages.
The length of the lower vas on the testicular side may be important. The longer this segment, the lower the pressure within the obstructed system. Therefore, it is less likely that there will be damage in the delicate epididymis, thereby increasing the likelihood of an easier vas-to-vas connection. The longer segment allows for pressure to be spread out over a larger area, rather than backing up into the epididymis. It is this high pressure in the epididymis that can result in blowout of one of the tiny tubules with subsequent scarring and blockage, requiring a more intricate and difficult vas-to-epididymal bypass to attach the vas to a single epididymal tubule. This longer testicular segment works like a pressure release system. Therefore, the higher the vasectomy is in the scrotum the better. Often, you can feel the site of the vasectomy, either by feeling a gap or perhaps a clip or scar.
The presence of a sperm granuloma has been shown to be associated with higher chance for a vas-to-vas connection. This small, pea-sized to blueberry-sized knot, if present, can be felt on the testicular side of the vas. It can be on either or both sides, or neither side. Though its presence is considered a favorable sign, not having a sperm granuloma can be fine as well. The granuloma allows for release of fluid from the end of the vas, which protects and results in less damage to the delicate tubules of the epididymis.
Throughout the reversal, Dr. Marks and Dr. Burrows remain focused on performing your microsurgical reversal while minimizing trauma to the surrounding tissues, preserving adjacent nerves and blood vessels.
During the vasectomy reversal procedure, the scarred ends are microsurgically removed and the fluid from the testicular side of the vas is analyzed. We look at the color, the consistency, the volume of the fluid, presence or absence of sperm and whether the sperm are normal, intact and moving. This information is the most important in directing which technique is best. The qualities of the vasal fluid unfortunately cannot be accurately determined prior to the reversal.
Your general health plays a role as well. Certain medications can affect sperm function and fertility. Smoking has been clearly shown to reduce sperm function in some men because toxic chemicals in cigarette smoke are concentrated in the testicles, damaging the sperm. Exposure to high heat may also reduce fertility. Your partner's age can also affect future fertility. We often recommend that the female partners get a exam by their Obstetrician/Gynecologist for clearance to get pregnant before you undergo a reversal.
In summary, the best predictor of success of a reversal is directly related to the surgical skill and expertise of the surgeon. Your doctor's volume of procedures and experience remains an important factor in your success. It is simply impossible for someone who does an occasional reversal to maintain the necessary microsurgical skills and experience of someone like Dr. Marks or Dr. Burrows.
We are performing a highly demanding and technically challenging operation on a human, not changing spark plugs or selling light bulbs. Once you understand the techniques and challenges of a reversal, and all the factors that can play into success, you can see that there is no way anyone can really "guarantee" a particular result. In fact, in the fertility field, money back "guarantees" of results have been labeled as clearly unethical by the American Medical Association (AMA). It is felt by many ethicists that guarantees and money-back promises really can't do anything to improve your chances for success. Rather, these marketing gimmicks shift the financial burden from the vast majority of men who will have successful reversals to the infrequent patient whose reversal may fail. In other words, most men end up paying more money than they should to subsidize the occasional failures. Those that do offer "outcome-based financing" (a fancy way of saying money-back guarantees) must charge more to everyone to cover the losses of a few failures. Sometimes these guarantees have hidden fees or hard to achieve requirements making it very difficult for patients to actually get any money back or qualify for a discounted redo.
We have seen patients for re-do reversals following these guaranteed reversals - all with a single sperm or two "seen" so no refund is given, yet clearly not enough sperm to achieve pregnancy. We have seen men for a redo reversal by other surgeons who pass on the "free" or reduced price redo by the original doctor in order to come to ICVR to get the best chances or success. Despite the potential marketing advantages to offering a guarantee, the doctors of ICVR are proud of their high success rates and let our care, experience and results speak for itself.
Get a no-cost pre-surgical consult to help answer your questions about the vasectomy reversal procedure.