The newest developments in vasectomy and vasectomy reversals
Vasectomy
No Scalpel/Non Surgical Approach
The best recent innovation in the world of vasectomies is the "no scalpel" or "non-surgical" approach. This was developed in China in 1979 when vasectomies became a mandatory form of birth control after one male child. It came to the US in 1992 or so and is currently used by about 1/3 of U.S. vasectomists.
Benefits:
- Using only one puncture to do both sides, it is faster (11 minutes!), less invasive and associated with less pain than a standard vasectomy.
- There is also a "no needle" approach to giving local anesthesia for vasectomy that uses a device similar to the older "vaccine air guns" to numb the scrotum before vasectomy. However, it is not clear whether the patient anxiety caused by the "popping" air gun offsets the quiet, mild sting of local anesthesia given by a small needle.
- Newer, experimental "reversible" vasectomies are also under research investigation. These involve placing small "corks" within the vas deferens tube that can be flushed out or removed later without requiring formal reversal surgery. So far, the true reversibility of such methods has not been demonstrated.
Vasectomy reversal innovations are constantly being reported. Many such innovations come from urologists borrowing technologies and techniques used in other surgical fields.
- The use of optical magnification in the form of a surgical microscope several decades back borrowed from ophthalmologists, allowed for smaller sutures to be used (much smaller than a hair) and greatly improved vasectomy reversal success rates.
- More recently, we borrowed opthalmalogic lubricants to help visualize the tiny tubes and improve the accuracy of suture placement during reversal surgery.
- A new approach to reattaching the tubes termed "invagination" was another recent technical innovation that has resulted in higher success rates in the most complex cases along with faster return of sperm to the ejaculate after vasectomy reversal.
- Importantly, the addition of aggressive medical care after the vasectomy reversal procedure, including medications to improve sperm production and function, is a recent trend in the field that has helped couples achieve higher pregnancy rates. Finally, although not a technical advance in itself but rather a consequence of such technical innovation, recent research shows that vasectomy reversals are cheaper and more cost-effective than the laboratory based assisted reproductive techniques,
MYTH: A vasectomy is a permanent procedure and vasectomy reversals don't work very well.
False: Although a vasectomy is a durable and effective (<1/600 fail) contraceptive method for men, in the vast majority of cases it is reversible. Most men undergo vasectomy reversal to have children in a new relationship or have more children in an established relationship. Less often, men want to "be whole" again or have pain after the vasectomy that may be relieved with reversal. The reversibility of the procedure depends mainly on the skill of the surgeon, the use of optical magnification during surgery and the age of the vasectomy.
Among these, the skill of the surgeon is the most important factor, so it makes sense to ask your doctor about their personal success rates with the procedure.
MYTH: A vasectomy older than 10 years is not worth reversing.
False: After vasectomy, sperm production continues to proceed normally for years. Although the chances of sperm in the ejaculate after reversing "older" vasectomies are lower (70-80% chance in the best hands) than that for younger vasectomies (95+% chance), they are still very respectable. What happens as vasectomies get older is that a second blockage can develop deeper in the reproductive tract that must also be surgically bypassed to insure a return of sperm to the ejaculate. Both finding and fixing this deeper, epididymal blockage are essential for reversal success and are the hallmarks of the experienced vasectomy reversalist.
MYTH: Antibodies after vasectomy reversal make pregnancy rates low.
False: Although all men develop proteins called antibodies to their sperm after vasectomy and again after vasectomy reversal, these antibodies usually do not prevent pregnancies from occurring. In essence, men get "inoculated" to their sperm after vasectomy and form antibodies to sperm, similar to receiving a vaccine for the flu. Antibody levels then fall with time after vasectomy and rise and fall again after vasectomy reversal. Despite having these proteins bound to sperm, natural pregnancy rates after vasectomy reversal can be very high (60-80%) and make this procedure far more cost-effective than the alternative (in vitro fertilization, intracytoplasmic sperm injection and sperm retrieval) which is easily twice as expensive.
About The Turek Clinic
The Turek Clinic is a next-generation men's healthcare medical practice specializing in issues facing reproductive age men, including male infertility, vasectomies, vasectomy reversal, varicocele repair, and other minimally invasive procedures. The practice was founded by Dr. Paul Turek, a leading surgeon and former endowed chair professor at the University of California San Francisco in May, 2008. Dr. Turek's work combines innovative and cutting edge techniques with the wisdom of old-world medicine to treat and solve the problems of men ages 21 to 55 years of age. For more information, visit http://www.TheTurekClinic.com.
