User Submitted Questions and Answers, Part 1.

Are you getting a vasectomy?
Plan ahead and get some cold packs on Amazon and a 3 pack of jock straps for a comfortable post-surgery recovery!

We’ve compiled a very extensive list of user submitted questions and answers that Dr Karpman has so graciously provided Vasectomy-information.com. You can browse at your leisure or use the table of contents to jump to content. We have divided the questions in to multiple pages as there are just so many to provide.

 

Table of Contents

Question about samples post vasectomy

From Rob:-
I had my vasectomy done in April 2010, the procedure went very well. I took my first ‘sample’ back to the doctor after 25 ejaculations in mid May. This sample came back negative. I took my second ‘sample’ back to the doctor after 37 ejaculations in mid June. This sample also came back negative. My question is this: since both samples were negative, does this mean that I was sterile between the 25th and 37th ejaculations (mid May to mid June)?

There is no guarantee that the samples between the first and second post vasectomy sample demonstrating no sperm are devoid of sperm but we can only assume that they were. I have seen men with semen samples showing no sperm on the first analysis, sperm on the second analysis, and subsequent azoospermia on the following 2 samples. All of these semen analyses demonstrated only a few non-motile sperm on the second analysis which most experts would agree is not capable of causing a pregnancy. Previous studies have shown that all men in one study demonstrated azoospermia after 24 ejaculates. Other surgeons have advocated only a single semen analysis 3 months after the vasectomy.

 

Pregnant after a vasectomy

From Jennifer:-
I am a 26 year old female who is dating a 42 year old male. He told me after we had unprotected sex that I couldn’t get pregnant because hes “fixed”. After 2 months of not using any form of protection, I recently found out I’m pregnant. There is no way on this green earth that anyone else could be the father. If vasectomies are 99.7 percent effective, why are there so many post about after vasectomy pregnancies?

Vasectomy is a very effective form of contraception and the success of the procedure is over 99%. Most of the vasectomy failures occur in the early post-operative period and are usually related to incomplete clearance of sperm from the reproductive tract prior to having unprotected intercourse. Late vasectomy failure after documented clearance of sperm from the ejaculate is extremely rare, especially if a repeat semen analysis after initiating the pregnancy still shows the absence of sperm. A certain type of vasectomy procedure, the ligation band technique (Vasclip) has recently been shown to have an unacceptably high rate (25%) of failure. Every male patient who has undergone this type of vasectomy procedure should have a semen analysis performed and consider conversion of the vasectomy to one of the more standard procedures.

Vasectomy and erectile problems

From Nick:-

As I am one of first generation to have had a vasectomy and am now 62. Are there any indications that show any cause for lack of erections? At the time when I had mine there were no studies to show what would happen in later life. I am a non drinker and non smoker (although did in earlier years) and not on any form of medication accept half a disprin a day (just for precautions for strokes). Have used cailis but not to any advantage (minor erection ). Any thoughs on the subject?

There are no studies to date implicating vasectomy with erectile dysfunction (E.D.). Erectile dysfunction is a common condition and becomes more prevalent in men as they become older. Smoking, atherosclerosis, diabetes mellitus and certain medications are the most common causes of E.D. and most of these conditions will continue to increase a man’s risk of E.D. long after the problem has resolved. In fact, many of these conditions never completely resolve, but may stabilize or not continue to progress. Many men are affected by E.D. and the prevalence of this condition in our society is approximately 1 in 5 men.

 

Can vasectomy cause thrush?

From Tray:-
My girlfriend complains that I give her thrush after every time we have sex. I had a vasectomy 7 years ago. As soon as I was able to have sex again she would say the fluid would make her sting and she would have to wash almost immediately for relief. This went on for a few months afterwards and eventually over time subsided. But she is of the firm belief that because of the vasectomy it causes her to have thrush. She has had thrush over the counter treatments and via GP. Can this be proven? Is it possible? What can be done?

The vasectomy procedure does not add any fluid to the ejaculate, but instead eliminates the sperm component that makes up 5% of the fluid by volume that is ejaculated. Sperm, in and of itself, has never been shown to have any anti-infective properties. The vast majority (95%) of fluid in a man’s ejaculate comes from the prostate and seminal vesicles. This fluid has been shown to have anti-infective properties and is not affected by a vasectomy procedure. However, the prostate can become infected (prostatitis) and this is more common as men get older. Prostatitis can lead to changes in the consistency, color and smell of semen. Prostatitis can lead to irritative symptoms in the man and, theoretically, can cause irritation for the female partner if the ejaculate is infected. The relationship between thrush and vasectomy, or oral intercourse for that matter, has never been shown to exist. Evaluation by an urologist with evaluation for and treatment of prostatitis can resolve these problems.

 

Follow on from an earlier question

From Marty:-
In an earlier post you said that “The reason most vasectomy reversal patients are asked to refrain from sexual intercourse or ejaculation for a period of time after the vasectomy reversal is because it is important for the tubes to seal and heal prior to having forceful contractions of the vas deferens as is common during ejaculation. The only thing holding everything together after surgery are some fine microsurgical sutures that can tear if force is applied to them. Additionally, a water tight seal at the anastomotic site prevents sperm from leaking out which can cause obstruction of the vas deferens. There is no right answer for the duration of abstinence that is required after a vasectomy reversal and can vary anywhere from two to six weeks. Oftentimes this period of time is determined by the surgeon’s experience with performing the surgery. Whether or not something could have been damaged by prematurely having intercourse is really difficult to say. The first semen analysis will demonstrate if any potential things could have been damaged.”

My question is this. *if* the microsurgical sutures were to break (for any reason) – what happens with the “loose ends” of the vas deferens in the scrotum? Would the loose ends simply “hang there” or would semen/sperm begin to fill the scrotum over time?

Disruption of the sutures prior to healing would cause leakage of sperm outside of the vas deferens. A partial disruption would cause sperm to leak out of the vas deferens and this would ultimately be sealed off by the body similar to when an open-ended vasectomy is performed. Oftentimes, a sperm granuloma forms which can vary in size from a pea sized lump to anything larger. The process is self limited and we don’t see huge sperm granulomas filling the entire scrotum even in the extreme case of open-ended vasectomy. Complete disruption of the anastomotic sutures would result in a similar situation, but probably to a greater degree. The ends of the vas deferens are not “free-floating” and would not be dangling in the scrotum. Usually, the ends of the vas deferens are surrounded by some degree of scar tissue and are fixed in the scrotum after a vasectomy reversal.

 

How long before I can pick up my daughter without damaging the reversal?

From Amy:-
Thank you in advance for answering this question. My husband recently had a vasectomy reversal and the procedure went well. He is currently recovering. He has a 4yr. old daughter who is ~50lbs. She frequently wants him to pick her up and carry her around. How long should he wait in order to safely pick her up without running the risk of injury and damaging the reversal?

The recommendations for post-operative restrictions on activity vary from surgeon to surgeon and are dependent on how the operation was done and the surgeons own experience. I usually tell my patients to restrain from any strenuous or physical activity including picking up objects or persons over 10 pounds for 2 weeks after their operation. This recommendation might be conservative or liberal based on other surgeons experience.

 

Reliability of Vasclip type procedure?

From Edie:-
I have a friends with benefits situation, I am a 47 yr. woman and my BF is 35. We have been together 2 1/2 months and he INSISTS on using condoms even though he had a vasectomy at 23 and I have missed 2 periods since Sep 09. He said when he had the vasectomy done the Dr. told him since he had the clamp procedure done there was a slight possibilty that he could get someone pregnant. I told him they have to say that for legal reasons and he is worring way too much. My ex of 17 yrs had a vasectomy after the first year of marriage and so did another boyfriend I had at 19. I told him if I was going to get pregnant it would have been with these 2 guys as we used no protection. He doesn’t even let me play with his penis on my vulva for fear I will get pregnant! Who is right?

The real question in this situation is “Has the man had his sperm count checked after the vasectomy or recently?” Vasectomies have been know to fail on rare occasions. The Vasclip procedure was a procedure done for vasectomy in the past and is no longer available. A recent study done on the Vasclip has shown that 25% of men will still have little channels through which sperm can travel even after the procedure. Recently, a new company caleed Pro-Vas is trying to market a similar type of occlussive device for perfoming vasectomies. The company does NOT have any clinical data to support their claim that the procedure is any more effective than the Vasclip and only received FDA approval because of its similarity to the VasClip procedure. I would caution men about this procedure until there is clinical data available to review that shows this device to be effective as a sterilization procedure.

The statistical probability of getting a 47 year old woman pregnant is extremely low, but not zero so we can never tell a man or woman that they do not need to use protection while having sexual intercourse. The best recommendation to any man who is concerned about his fertility potential after a vasectomy is to get his semen analyzed with a pelleted sample to determine his ability to get someone pregnant. This test is not expensive, is available at any laboratory and results are known within 24 hours.

 

Vasectomy Reversal Question (Keloids)

From Susannah:-
My husband is 36 and had a Vasectomy, via regular micro surgery, not laser surgery, 6 years ago while married to his ex-wife. He has four children and I do not think fertility has ever been a problem for him. I am 37 and have two children and I also have had no trouble in the past conceiving or carrying to term. My questions are: My husband tends to scar and gets keloids from surface cuts, not horrible thickened, raised, dark scarring, but enough to notice. Is Vasectomy reversal an option for us? Would it be better to go with laser surgery this time vs. tradition surgery? He also says that since his procedure, his ejactulations seem to ooze out like a lava flow rather than spurt out (sorry for the graphic details). Is this a factor to consider? Does this indicate that more internal scarring has occurred than normally expected? Will this contribute to vasectomy reversal failure?

The type of vasectomy performed rarely limits our options at the time of vasectomy reversal. The only limitation to vasectomy reversal surgery is when large segments of the vas deferens are removed at the time of vasectomy by aggressive vasectomy surgeons. Laser vasectomy is still performed by only a few surgeons around the country. There is no proven benefit for using a laser during the vasectomy procedure and some surgeons use it as a marketing gimmick to attract men to get their vasectomy done at their center.

Keloids and hypertrophic scars do occur in some men and are more commonly seen in men with darker skin. I am not aware of any relationship between keloid type scarring of the skin and worse outcomes during vasectomy reversal. Men who form keloids and hypertrophic scars do need to be aware of the fact that their skin incision might show some scarring greater than a man that doesn’t form these types of scars. I would probably recommend that men who are prone to scarring be given a course of strong anti-inflammatory medications in the early postoperative period.

 

Should the stitches look like this?

From Brian:-
I am really angry about the way my stitches look post vasectomy. Is it normal for them to look like this? Although it is somewhere that can’t be seen, it still bothers me. Is this something that could have been prevented? The photo was taken 6 days post op.

Vasectomy incisions 6 days

The attached photograph appears to be that of a relatively normal healing process for a vasectomy procedure. The size of the incision is a little generous, but otherwise looks normal for 6 days after surgery. The nice thing about operating on the scrotum is that it is a very forgiving area of skin and most scars will not be apparent after a period of time.

 

Is there a risk of infection if face masks aren’t worn?

From Doug:-

Hello. I think the website is an excellent source of information, but had 2 quick questions.

I had my vas two days ago. The whole procedure was pretty easy and painless (despite being ‘tight’ from nervousness, which soon went away halfway through the first side). Anyway, I was surprised that neither the surgeon nor accompanying nurse wore a face mask. Is the risk of infection so low during the procedure that wearing a mask is unnecessary?

I had to ditch my jock strap too. the thing was strangling me and creating more pain and discomfort than it is supposed to be helping! What exactly is the point to wearing the jock? Is it to allow the scrotum to heal or do the vas cuts heal better with everything compressed?

I also had a question on the titanium clips. It seems odd that they place them on the vas, then just let everything slide back in. isn’t there a risk that those clips might bump up against a teste or something?

The purpose of wearing masks during any surgical procedure is as much for the protection of the surgeon from bodily fluids as it is for the patient. That said, I don’t know of any studies that have shown that when surgeons wear a mask during the vasectomy procedure that the risk of infection is lower than if they didn’t wear a mask. The infection rate during vasectomy procedures is incredibly low to begin with (1%) and, therefore, most surgeons wear a mask based on their own preferences.

Tight fitting underwear or a scrotal support are encouraged for use immediately after the vasectomy procedure for patient comfort and to minimize any hematoma formation. Minimizing the movement of the testes and scrotum after the procedure decreases patient discomfort. Compression of the scrotum and surgical site can help reduce swelling and/or hematoma formation after the procedure. The scrotum has a large potential space and any slight ooze can accumulate into a lot of fluid if left unopposed. A golden rule in medicine is that all bleeding stops with direct pressure to the bleeding site.

The vasectomy procedure is performed on the vas deferens in the spermatic cord located above the testicle. Theoretically, anything can happen, but practically we do not get any complaints from patients that they feel the clips rubbing or touching other structures in the scrotum. Patients have reported that they can palpated the clips through the scrotal wall if they poke around down there. Titanium clips have been used extensively by vasectomy surgeons for many years because of their effectiveness, reliability and lack of side effects.

 

How much of the vas deferens is cut?

When men opt for vasectomies, it is possible to ask the doctor to cut a 6-8 inch instead of a small inch during the procedure? I’m worried if I get one and it is cut small, it would recanalize. Is it possible to ask them cut it wider?

I do not recommend excising unnecessarily large portions of the vas deferens during the vasectomy procedure. There are no studies showing that the larger the segment excised makes for a more reliable procedure. In fact, the most efficacious way of performing a vasectomy is to cauterize the ends of the vas deferens. This has been shown to be even more effective than cutting or tying the ends of the vas deferens alone. Most vasectomy surgeons employ several of these techniques during the procedure to ensure a successful vasectomy. With the lack of any advantage in terms of vasectomy effectiveness and the increased difficulty it makes for elective vasectomy reversal, should the need arise, I do not recommend excising unnecessarily large segments of the vas deferens during the vasectomy procedure.

 

Vasectomy and previous operation for testicular torsion

From Jim:-
My questions concerns the potential for complications for someone who had testicular torsion surgery some years prior to wanting a vasectomy. I am 30 years removed from torsion correction surgery (bilateral “tack”) I have two rather large scars on my scrotum and large tortuous vessels that end near both incision scars. I am extremely testicle shy and don’t like them handled by doctors or even my wife. I still feel some deep pulling type pain with the wrong type of movement in my scrotum. I am a veterinarian so I have some experience performing follow-up surgeries in a region previously worked on, and I can only imagine the scarring and adhesion formation would severely complicate a routine vasectomy, not to mention be much more painful. Am I misguided with my worries? Should I be looking at other options for birth control, or possibly electing a vasectomy under general anesthesia for less pain and anxiety in the exam room? The thought of a needle, however small, being directed into my scrotum is unimaginable.
Thanks for any help you can give.

Performing a vasectomy on a man with previous scrotal surgery, regardless of the type of scrotal surgery, is a more complicated procedure than in a man without previous surgery. I would definitely recommend having the procedure done with a surgeon who specializes in performing vasectomies. Most men can still undergo a traditional vasectomy in the office under local anesthesia even in the setting of previous scrotal surgery. Patient anxiety can be overwhelming and necessitate having the procedure done at a surgery center with deeper anesthesia. In men who have concerns about needles near the scrotum, thay can have a no-needle technique performed using a MadaJet instrument to deliver the local anesthesia. I have also given patients anxiety reducing medications prior to the operation when necessary. If all else fails, relying on some alternative form of contraception might be the only answer.

 

Is cauterization the best option?

From Jeff:-
Thank you for taking the time to answer questions. I have the following question that I did not see in the archives and hoped you could help with: I’m wondering if getting a vasectomy using cauterization is significantly safer than one where the vas are just tied. By safer, I mean is there a significantly less chance of the vas rejoining over time with cauterization compared to without? If I get one without cauterization, should I get yearly semen checks? Thank you.

Studies have shown that out of all the known techniques for performing vasectomy, cauterization has the lowest risk of failure. Combination techniques that excise a segment of the vas deferens, ligate the ends and cauterize the ends have the highest success rates.

 

Can my sperm be donated for IVF even though I’ve had a vasectomy?

I had vasectomy 15 years ago. I would like to donate my sperm to my sister in-law because her husband’s sperm count is too low. Can this be done and if so, what procedure must be done?

Using donated sperm from a family member is an option for any man who desires. Usually, it is done when no sperm are available from the husband and the couple would like to avoid an anonymous sperm donor or desires having some genetic component from the paternal side. In men who have had a vasectomy, sperm can be retrieved easily but it can only be used for IVF/ICSI.

 

High antibodies after vasectomy reversal

From Karl:-
I’m hoping you can help as my GP was quite unhelpful and suggested my results were to be expected after my reversal op. In 2002 a had a vasectomy and in Sept 2008 had it reversed. All appeared to go well, yet my wife and I have been TTC since the reversal with no luck. I tried a couple of Home Semen tests which tested count and motility which were both positive, then recently had a proper test at the local hospital. Most things look fine, apart from the Antibodies and the round cells.

My Dr. said that antibodies are commonly high in reversal cases, which I have validated on this blog, but the most serious thing on the results seems to be the ’round cells’ which comes in at 36, when it should be <5. Is this also to be expected in a reversal patient? or is it more likely that I have in infection or other complication.

Can high antibodies and/or round cells be treated??? Do my results suggest that I’m infertile??

Please reply as I’m struggling to get any solid answers from my GP, he has now had to contact a specialist to get advice, yet I’ve still heard nothing back.

Anti-sperm antibodies are a common finding after vasectomy and vasectomy reversal. Despite their presence we still see a 65% pregnancy rate after vasectomy reversal and their significance in impairing conception is uncertain. White blood cells (WBC’S), or round cells as they are commonly reported, can be a sign of infection or unwanted inflammation in the male reproductive tract. WBC’s can produce reactive oxygen species which are free radicals that can damage sperm membranes and the genetic integrity of the sperm causing fertility problems. These WBC’s can come from the epididymis, prostate or seminal vesicles. My practice is to obtain semen cultures and treat men with a combination of anti-biotics, anti-inflammatories and anti-oxidants.

 

Stent in vasectomy reversal

From Charles:-
After watching some of the videos of vasectomy reversals, I am wondering why a micro stent is not placed in the vas during the procedure. The video showing microdots emphasized the accuracy of attaching the two vas ends to insure the lumen is kept open. Why couldn’t a small, permanent stent be inserted in each end to align the lumen and prevent it from being intruded upon during suturing?

Stents have been utilized in the past for vasectomy reversal. Unfortunately, the results of stenting compared to traditional 2-layer vasovasostomy in the hands of an experienced surgeon have been disappointing. Randomized control trials have demonstrated lower patency and pregnancy rates in men undergoing stenting compared to the traditional 2-layer microsurgical vasovasostomy. I have included a link to one such trial. Perhaps in the future, with the development of new biomaterial and refinements in micro-technology, we will see new stents come to market that are more effective and have comparable or better results than the ones we have studied in the past.

 

Growth after vasectomy

From Mike:-
I had a vasectomy done around 1992. I have never had any pain or discomfort and no more children so I guess it worked.lol. My problem is this. I noticed a while after the procedure that I had what seemed like a third testicle had attached itself to one of my testicles. Over time it kept growing and I told my GP who said it was common because it was sperm that was caught in the tube that was cut (or some kind of explanation like that) and not to worry. He called it a sperma something but I can’t remember. I had ultrsounds done and was told again not to worry. Well it has grown to a rather large size (probably the size of two regular testicles at least if not more) but there is no discomfort. Can you explain to me what this is and if I should consider having it removed. Thank you for your time.

This sounds like a sperm granuloma, but I am always hesitant to give any reassurance about a growing mass in the scrotum on the testis as this also may represent something more serious such as a tumor. All men with new masses on the testes or in the scrotum should seek immediate evaluation by their physician. Physical exam and scrotal ultrasonography are the only ways to differentiate these processes. A sperm granuloma is a benign process resulting from sperm leaking out of the vas deferens after vasectomy. The fluid is encapsulated by the body and can grow in size. Usually, no treatment is required unless the size of the lesion becomes very large or causes discomfort.

 

Did the Doctor cut the wrong tube?

On Sept 25 I had a In office vasectomy. I am 35 years old and have two wonderful boys. My wife and I do not want to have any more kids.

Three weeks after the vasectomy I had a doctors visit to see how things were going. He then informed me that the lab results on the vas deferens reported that the left sample was a thick walled vein and not a vas deferens. The right side was confirmed as a vas deferens. This was hard to hear since he spent over an hour on the left side trying to locate the vas deferens.

His recommendation is to continue with the sperm test after a few months. If any sperm (mobile or un-mobile) are present in the first two samples, then he would like me to have another vasectomy, but this time in the hospital and not the office. If all three test come back as no sperm then he feels the second vasectomy would not be needed. He has offered to waive his cost on the second, but would not be able to do anything about the hospital cost.

My questions are:

1) Should I trust the test if they say that there is no sperm?

2) Is there any harm done by cutting the vein?

3) Are there any additional test to determine if there is still a possible path? (Ultra sound maybe)

4) Have you ever heard of a Doctor mistaking a Thick Wall Vain as a Vas Deferens?

5) Is it possible that the Lab made an error on the tissue (dye) test?

6) Could it be that I did not have a vas deferens on that side to begin with?

My first sperm test will be around November 15th and the second and third to follow.

We are hoping to have the second procedure yet this year due to insurance cost.

Please let me know what you think.

Unless the patient is missing a vas deferens on the side in which the vein was cut, sperm will most likely be present in the semen analysis. I think that performing pathologic evaluations on the vas deferens sample is a good idea and helps identify a problem with the procedure immediately, if one exists. That said, I have never had a surprising result such as the one mentioned above. However, I have heard of other physicians encountering the same problem. It is difficult to confuse a vein for the vas deferens as the consistency of the two structures is quite different but can occur with less experienced surgeons. The only consequence of cutting the vein instead of the vas deferens should be that the vasectomy will not work and will need to be re-done. We routinely cut/ligate the spermatic cord veins during varicocelectomy procedures in order to improve testicular health. If the vasectomy works, then it is because you are missing a vas deferens on that side.

 

Staples appearing through skin after a vasectomy

I had my vasectomy two days ago and it seemed to go well. The pain was not and is not bad at all. However when I took the bandage off yesterday and took a look I discovered what appears to be a staple on my scrotum. I’ve heard of staples being used in surgery and my understanding is that there might be some small clips used internally on the vas deferens but the doctor who performed the surgery told me nothing about this and how I might deal with it for aftercare. Is this normal? What happens when I fully heal? Will the staple be there permanently? Please advise.

It appears that the metal object in the attached pictures is a titanium clip like the ones we use for occluding the ends of the vas deferens at the time of surgery. In this case, it almost appears that the surgeon used the clip to close the wound. Clip migration out of the wound is a rare occurrence and usually happens later after the surgical procedure than 2 days.

 

Pulling and pinching due to stitching

From Roy:-
Attached are pictures 8 days post vasectomy. One shows a picture of the scrotum with both incisions visible. A second picture shows the folding of skin around the incision due to the stitching. A third picture shows the fold pulled back on one side to show (somewhat) how deep the stitch pulls the skin under the fold.

I feel pulling and pinching from the stitching around the incisions from my vasectomy. The skin around the incisions is raised in a fold because the stitch drew the skin on both sides so close together. The tugging and pinching sensation made me wonder if one end of the vas deferens was stitched to the scrotum there. Is this a normal stitch? The right side felt similar and feels to have left quite a thick scar tissue, but the pinching has mostly subsided. The pinching and tugging is quite uncomfortable. Will it go away? If the stitch were removed, would the fold flatten out and possibly relieve the symptoms?

Thank you for your response.

LeftCutPullBackFoldsmall

FullBothIncisionssmall

LeftIncisionPinchFoldsmall

The pictures appear to represent the normal healing process 8 days after a bilateral vasectomy procedure. The puckering seen in the picture is normal this soon after the procedure and will likely resolve with some time. The associated symptoms may or may not be related to the scrotal skin findings. It is difficult to say if the underlying vas deferens is tethered to the skin without physical examination. It is difficult to make any long-term conclusions about the outcome of any procedure so soon after the surgery.

Two weeks after the surgery, the pinching and pulling has been substantially reduced. The vas deferens was not stitched to the scrotum. However, the scar tissue around the incision and stitching is fairly thick and still somewhat sensitive if squeezed. Would a steri-strip, rather than stitches, have likely reduced the pinching and scarring? Or is use of a steri-strip not a (good) option for this type of surgery? Thanks.

Theoretically, a good idea. We like to use Steri-strips whenever possible in surgery for closure of small wounds. However, in practice, a Steri-strip would not work. They require a flat surface for the adhesive to be effective. The surface of the scrotum is full of peaks and valleys and would not provide an adequate contact surface area for Steri-strips.

 

Are laser vasectomies reversable?

From Gabrielle:-

My boyfriend had a laser vasectomy in January of this year. Are laser vasectomies reversable?

Are there any other ways to become pregnant without having a reversal? I know your article/responses explain procedures for reversal, but I was not sure whether they are in reference to the older style of vasectomy (clamping?) or all? Thank you for your time in advance.

The type of vasectomy performed does not make any difference on reversal success rates. All vasectomies are based on the same concept that the vasal lumen should be permanently occluded. Laser vasectomies are no different. Likewise, vasectomy reversal success is independent on the technique used for occlusion of the vas deferens. There is no evidence supporting an advantage in the use of a laser for vasectomy procedures.

Fertility testing before Vasectomy

From Mike:-
I can’t find any information out there about the normalcy of fertility testing prior to getting a vasectomy. As I’m considering the procedure, I’m wondering if it would make sense to get a fertility test done first, to determine whether or not I’m even fertile (obviously, I don’t have any kids) before deciding to have more-or-less permanent elective surgery.

Is it ever standard practice to test sperm first to see whether a vasectomy would possibly be an unnecessary surgery? What if a patient requested it?

Any man that has an indication that there might be a sperm production problem should get tested for the presence of sperm prior to undergoing a vasectomy. However, the presence of any sperm regardless of how low the count is capable of impregnating a woman. Therefore, only men with complete absence of sperm on at least two centrifuged semen analyses should consider themselves naturally sterile.

 

Are annual post vasectomy checks necessary?

From Amy:-
I apologize if you’ve seen this question before. I did search the website and could not find an answer to it. My husband had a vasectomy in 2006. He was given the “all clear” in early 2007 and since then has visited the doctor for a semen check once a year. The checks are always clear so my question is, does he need to keep going every year to be checked, or can we assume he’s “safe” now? It is important that I do not get pregnant (for health reasons on my end), so we are not opposed to getting him checked once a year. Just want to know if it is unnecessary. Thank you very much for your time and help.

Repeated checks for the presence of sperm years after a vasectomy are not necessary. Vasectomies are very durable especially after several years of repeatedly negative test results.

 

Vasectomy reversal question

From Alicia:-
Hello Dr. Karpman. I appreciate your time answering the questions submitted to you. I have looked through your archives and have not seen my issue addressed, and hope you may be able to help me. My husband is scheduled for a vasectomy reversal on Dec. 15 of this year. He has two children ages 8 and 10 from a previous marriage. His vasectomy was done 8 years ago. He said that he had been told by his doctor that he had a low sperm count at some point in the past, but he’s not really sure of what the numbers were (he’s not a real “detail” guy!). We have been told by the doctor’s office who will be performing the procedure that they will examine his sperm level before performing the reversal. This begs the question, for me anyway, what happens if they don’t see any sperm? Should they continue the procedure? I asked the woman who runs the office (maybe his nurse, not sure), and she said “obviously there will not be any sperm present because he has had a vasectomy”. It made me feel really stupid, so I was afraid, at that point, to ask for clarification. I had always assumed that men who had undergone vasectomies still produce sperm, it just doesn’t flow out the penis. Is this correct? Is there any way to check his sperm production levels before we spend all this money on a reversal? Or are sperm counts only “checkable” after the procedure is done, when it may be too late. I would just really hate to go through all this time and expense if it were for naught, especially if it could be determined by this doctor beforehand, and he still performed the procedure anyway to receive the payment. Any information you could give us would be most helpful. Thank you for your time.

The only way to confirm that a man’s fertility potential is present in the absence of sperm as is the case after a vasectomy is to perform a physical exam measuring the size of the testes and to obtain hormone tests such as FSH. These two tests are not 100% reliable but give us the best prediction of a man’s fertility potential, along with his previous history of paternity. Surgeon’s performing vasectomy reversals should always check for the presence of sperm in the vas deferens at the time of vasectomy reversal. However, the absence of sperm from the vas deferens does not signify poor production but merely that a secondary blockage may have developed and the “bypass” operation is required. Unfortunately, there is no better way to predict a man’s fertility potential until after the reversal. Couples in situations where there might be a spem production problem or problems with ovarian function should consider the alternative of sperm retrieval with IVF/ICSI.

 

Doctor unable to locate vas deferens

My husband just called me and was very upset. Last week he had an appointment to schedule a Vasectomy and the DR had a hard time locating his vas deferens, telling him he was too small in the private area and that’s why he (the DR) had a hard time finding the vas deferens. That of course made my husband very upset. He scheduled his vasectomy for a week later, which was today.

My husband took time off work and went in. Well the DR never did the vasectomy he told him he couldn’t locate his vas deferens (after prodding around) and that my husband would have to do it at a hospital and be put to sleep for the procedure. The Doctors reason this time was that my husband has to much fat in his private area to locate the vas deferens. Now my husband could lose a few, but is not that bad. The Doctor told him about 1 percent end up having to go through surgery in the hospital.

A simple procedure is turning into a huge hassle. Is this DR right in what he is saying to my husband? Is the vas deferens really that hard to locate?

The vas deferens can be difficult to palpate and the difficulty of palpation is related to the patient’s anatomy and the physician’s familiarity with anatomy in this region. In these difficult situations, you never want to force a physician to perform a surgery in a situation he/she is not comfortable in. My recommendation to any patient in this situation is to either go along with your surgeon’s preference for performing the vasectomy, or choose another surgeon.

 

Does the Vasclip procedure mean vasectomy reversal is easier or cheaper

From Meagan:-
My husband had a vasectomy clip done about 4 years ago. We are wanting to get that reversed but unfortunately cannot afford the more expensive, highly spoken of doctors. Is there a difference in pricing since it was the clip instead of the cutting procedure? Also, are the chances of getting pregnant greater since he wasn’t actually cut? Thank you for your time.

Regardless of the type of vasectomy procedure, the best chances for a successful vasectomy reversal is to have it done using a microsurgical approach by a fellowship trained and experienced surgeon. Vasclip used for the vasectomy does not change outcomes for vasectomy reversal success.

 

Can I get my wife pregnant with low motility?

From Victor:-
Thank you doctor so much for your time. I recently had a vasovasectomy in March 2009 and by April my first semen sample was 38 million with all else normal except for the motility was about 38%. My second sample taken in May indicated that my sperm count was 46 million with my motility going up to 42%. My doctor made a comment of “What a Guy” and indicated that with a sperm count that high I should not have any problems impregnating my wife. My wife and I have been trying to get pregnant, since then with no luck. We purchased a Clearblue ovulation monitor to help monitor her cycles and she is producing all the normal hormones (Follicle Stimulating Hormone and Luteinizing Hormone) that are required to have a normal pregnancy. She is 35 years old and I just turned 49 I am in exceptional health I have maintained my health and diet taking nutrients for almost 30 years of my life. With the exemption of the occasional pork rib attack that I get around the holidays at my age I must watch my cloistral. Since my reversal my wife, who normally is on time has been running about 5 to 6 days late with about day 16 (of her cycle) she complains of sharp pain in her right ovary area. I have a feeling that my sperm my not have what it takes to penetrate the egg or even make it there in the first place and we may be wasting valuable time as I am not getting any younger. I already have two grown children from a previous marriage 24 old boy and a 20 year old girl; although, I was extremely excited about having another child.

For future consideration and for other readers’ insert:

1) My vasectomy was performed in 1994 (15 years ago)
2) I work out at least three days a week (since 1990)
3) I take vitamins and one 81 aspirin 5 days a week
4) I am 49 years old and had my Vasovasostomy in March of 2009
5) Getting my Reversal was extremely painful and I did have complications by infection and had to be placed on steroids
6) Ice can be your friend, it was not that bad but I am sure my age played a roll
7) First semen sample was taken one month after surgery with motility at 38%
8) Second semen sample was taken two months after surgery with motility at 42%
9) I take ginseng on a regular basis

At motility of this level can it be possible to get my wife pregnant?

The short answer is, yes. A man should be able to get a woman pregnant with the stated semen parameters. However, pregnancy is dependent on multiple factors, one of which are the semen parameters. It can be possible that there is a female factor involved and this can be contributing to difficulty with getting pregnant. Irregularity in a woman’s menstrual cycles is a sign that further evaluation into her fertility capacity should be sought.

 

Should I get more testing done?

From Joel:-
Thanks for taking my email. I had a vasectomy in Dec of 2008 in a military hospital. I have been in for numerous tests and have had both clear and non motile sperm present. I’ve never had two consecutive tests come back clear. I went back into the Urology clinic this last week to see what was wrong. The Doctor had me submit another specimen and tested it immediately. I was informed it was clear. I stressed to the doctor that my wife and I really do not want any other children so I want to be sure that I don’t have any sperm present. The doctor also told me that non-motile sperm can’t get a woman pregnant and that I shouldn’t worry about it. I was also informed that they do a much more thorough test than a civilian Dr. would and that I would have been cleared a long time ago had I gone to a civilian Dr.

This is very frustrating because I can’t see to get anyone to give me a straight answer. What should I do? Should I keep going in for tests? Or should I trust that Non motile sperm pose no threat?

Persistent non-motile sperm in the ejaculate is a dilemma that every vasectomy surgeon must deal with in their practice. Whether this represents a micro-recannalization or just some residual sperm in the “tank” is difficult, if not impossible, to determine. This should become more apparent with some time. In theory and practice, rare non-motile sperm can not cause a pregnancy, if they are truly non-motile. However, because of legal concerns related to an unwanted pregnancy, most vasectomy surgeons are unwilling to give a man the “all clear” if any sperm are still present in the ejaculate after a vasectomy.

 

No sperm six months after vasectomy reversal

From Carla:-
My husband had a vasectomy reversal in March 2009 after having the original vasectomy about 9 years before. Doctor said there was not any fluid when he did the reversal but that didn’t mean it wouldn’t work. My husband had tremendous swelling and pain for 3-4 weeks after the procedure. He still has a swollen testicle now, 6 months later and the doctor says its normal. He has been tested 3 or 4 times and has not shown any signs of sperm returning. We have a son together that is 10 years old and he has a daughter from a previous marriage who is 13 years old. The doctor is now recommending a dosage of Clomid to try to kick start things for him. Would you agree this is the right step? What are your thoughts on the still existent swelling?

It is not clear which operation was done but it seems that a vasovasostomy was performed when an epididymovasostomy should have been done. The absence of fluid in the vas deferens at the time of surgery represents that a secondary obstruction has developed in the epididymis. Unfortunately, many general urologists perform vasectomy reversals and are not capable of performing an epididymovasostomy when it is required despite the recent practice guidelines from the American Society of Reproductive Medicine (ASRM) stating:

“Since it is seldom possible to determine pre-operatively if epididymovasostomy will be required in a man undergoing vasectomy reversal, only surgeons skilled in both epididymovasostomy and vasovasostomy should perform vasectomy reversal”

The lack of sperm in the ejaculate after a vasovasostomy six months after vasovasostomy represents a failed procedure. Clomid can improve the production of sperm but will not overcome the blockage that still exists. Persistent swelling in the scrotum 6 months after the procedure is equally concerning and should be evaluated by a physician.

 

Is this incision normal?

From Shawn:-
Attached is a picture of my vasectomy incision. Post procedure 2 days. This incision does not look normal to me at all. I’m not experiencing any unusual pain but I am concerned with the way this incision looks. Can you please let me know if this seems normal. Thank you.

 

The submitted picture represents an incision 2 days after a vasectomy procedure with a single midline incision. There is minimal bruising and swelling surrounding the wound. The dark areas represent some skin that has been strangulated by the sutures used to close the incision. There appear to be 4-5 temporary sutures. Everything appears to be healing as expected for a man after a vasectomy performed with a single midline incision two days after the procedure. The single midline incision sounds attractive to prospective patients, but the reality is that a single incision that requires 4-5 sutures to close is much more invasive than two separate incisions requiring zero to one suture to close. A comparison of photos from previous posts using the 2 incision technique will help with understanding the differences between the two approaches.

 

Question on MESA complications

From Susie:-
My husband had the MESA procedure (sperm aspiration) a year after his vasectomy so we could try to have a child. He had no issues with his vasectomy. The MESSA procedure was a very different experience. The doctor said there was a great deal of scar tissue from the vasectomy and she had trouble getting the testicle back into him after searching for sperm on the right side. The left side was fine and she retrieved sperm as planned. When he came out of the surgery he complained of tremendous pain (9 on a scale of 10). My husband has a high threshold for pain, so I was greatly concerned. He was diagnosed with a hematoma within 2 days with a great deal of swelling in his abdomen, groin and down his right leg. She said we would need to wait to see if it stopped bleeding on it’s own and the blood would absorb back into the body. Once the hematoma was diagnosed, he began to bleed through the stitches. We called the doctor and she said this was normal for a hematoma.

So we assumed it was bleeding out and doing fine. After a week, the stitches busted and there was blood and pus coming through the wound. He went back in to the doctor and she said this was normal and tried to stitch it back up again. “The old college try but it probably won’t stay.” It didn’t and busted again within a few days. We continued to put gauge on it each morning and night waiting for it to heal. A couple weeks later it began to smell really awful and pus even more. We got the on call doctor (we were also out of town on vacation) and he put him on antibiotics and said to pour alcohol on it each night if he could stand it. He couldn’t feel the alcohol other than cold but we assumed that was ok since the on call doctor said based on his experience alcohol kills everything.

We did this for 3 weeks. On his next scheduled checkup on the 4th week, it was supposed to be the size of a pin according to the doctor. My husband told the doctor the purple scab had peeled off a few days before and skin was flaking off. Also the smell had not gone away. She cut away some of the dead tissue and said she wanted to get him under to look open it up and look at the inside. He was back in surgery 2 days later. After 20 mins I was called into the consultation room. She said she’d never seen anything like it, the testicle looked and smelled dead but putting the ultrasound on it there was still blood flowing to it. I asked what we should do? I was worried about staff infection and long term risk to his life. She suggested it wasn’t a concern and she was waiting for tests back to see if the tissue was alive. She in the meantime cut everything dead she could see through the inflammation and probably got most of the testicle but really couldn’t be sure what she cut out. So now we’re trying to heal an open wound, there’s no open wound hospital care they can find over a holiday weekend. The doctor has been nice enough to offer to meet us at the ER tomorrow (Sunday) to change the dressing herself. We’re just wondering what we did wrong, why did he have to lose a testicle and what could we have done different when all we did was go in for a Mesa procedure that has gone horribly wrong and resulted in losing (maybe, but maybe not) his testicle. Our main concern is how can we understand for our own piece of mind what happened and how we can prevent anyone else from going through this horrible nightmare that was supposed to be a simple procedure?

Regards,

This case represents the worst consequence of a MESA procedure. MESA is the acronym for Microsurgical Epididymal Sperm Aspiration, a procedure used for retrieving sperm from an obstructed epididymis for the purposes of performing IVF/ICSI. It is considered a minimally invasive procedure with minimal side effects. Loss of a testicle is a devastating sequelae of this procedure and, fortunately, only occurs rarely. The reason why the severe infection developed can be a result of intra-operative contamination, lack of an adequate blood supply or due to co-morbid conditions of the patient. For example, diabetes mellitus can predispose patients to post-operative infections in situations where an infection would normally not have occurred. However, the decision to close the scrotum immediately after the first time the blood and pus came out was not the ideal decision. Once an infection has occurred, it is impossible to eradicate all of the bacteria and closing the wound only will trap the remaining bacteria in the scrotum, causing the infection to recur. Severe infections that are left untreated for several weeks can lead to the destruction of tissue.

 

Second vasectomy scheduled – got some questions.

From Bill:-
Dr. Karpman. Would love to have a few of these unanswered questions dealt with before my second vasectomy that is scheduled in less than two weeks. Long story short, had a Vasectomy in March this year. Found out about 1 month ago that I still have live sperm. It did not work as you can tell, and I have a second one right around the corner. Hopefully you can get back to me before that. Great Urologist did the first and it was very easy. He has done them for over 20 years and I am his first that did not work. He wanted to do the second one under general in the hospital to make sure this one works. Keep in mind that he sent in to pathology and got confirmation that he did cut the left and right vas…..so he did not make a mistake. Instead of a “free” in office procedure which I was looking for, the hospital has to be paid and would be pretty expensive. He recommended another Urologist at his practice that said he would do it and he feels very sure that a second would work just fine. So, do you have any data that shows how successful second procedures are? If so, are they done with general so that the Dr. can take a bigger piece of the vas to insure it will work. Or is the same 10 minute office procedure also as successful? With that answered, what does the new Dr. expect to find when he goes in? Will he know at that point if either or both vas had re-joined? Also, first procedure was 2 small incisions and this Dr. does it the other non scalp way? Any reason this is or should be a concern. I just really want to know going in for the second that I can expect it to work. Also worried that a second will be worse in some way regarding pain, recovery, added or more risks that I did not have from the first. It has been difficult to get these questions answered as for me to have an office visit first, I would have to pass on Sept. 8th. because he is so booked and I would be pushed back till Oct. My wife is due last month to have her 5 year IUD taken out and she is 42 and I do not want her to have to do that again. Looking forward to your response to these questions. Thanks so much for taking the time to read and answer this e-mail.

Regards,

The chances that a vasectomy will recanalize is extremely low and the chances of the same occurring with a second vasectomy is no different. The reasons why the first vasectomy did not work can be numerous and we can only guess at what is the reason. There is no reason why a repeat vasectomy after a failed vasectomy should be performed under a general anesthetic. Physician preference usually dictates the approach (scalpel vs no scalpel, one vs two incisions) and where the vasectomy will be performed (office or operating room). The findings at the time of repeat vasectomy are usually that of a joined vas deferens at the previous vasectomy site. Histologic evaluation can confirm which side recanalized.

 

Does it really take 50 ejaculations before being cleared?

From Ken:-
My doctor told me that he believes that it takes 50 or so ejaculations to clear out the sperm. He told me to work toward that number and come back in 2-1/2 months to get tested. It has been 3 weeks and I am up to 40 ejaculations. The question is what is more important, the number of ejaculations or the amount of elapsed time? Or are both important?

The number of ejaculates is the most important determinant for sperm clearance after a vasectomy. Simply waiting for the sperm to die and to disintegrate will take much longer than completing the required number of ejaculates. The studies have shown that all of the sperm can be cleared from the ejaculate in 24 ejaculations. Fifty ejaculations might be unnecessarily high.

 

When will semen return after a reversal?

From Sarah:-
My husband’s first semen sample was negative 4 months after the VR. Is there any chance that the sample will ever be positive? His vasectomy was about 4 years ago and he is 29 now.

The return of sperm to the ejaculate is highly dependent on which procedure was done to reverse the vasectomy. Vasovasostomy usually results in the return of sperm to the ejaculate in 2-3 weeks in 95% of patients. In contrast, epididymovasostomy takes 3-6 months to see the return of sperm. The absence of sperm in the ejaculte 4 months after the vasovasostomy procedure would be a bad sign that the procedure is not successful. Whereas, absence of sperm four months after an epididymovasostomy could only mean that the surgery has not yet matured.

 

Is vasectomy reversal likely to be associated with Downs syndrome?

I have just turned 44 and my husband and I would love to have another child. We have an 8 year old boy (delivered by emergency c section) and a 6 year old girl (delivered by elective c section). My husband is 37 and had a vasectomy 6 years ago, so we are currently contacting clinics to have a vasectomy reversal. We are both healthy, non smokers who do regular exercise and have no health issues.

I still have a regular 28 day cycle and for the past 6 years have had very definite signs of ovulation and feel as though I ovulate from both ovaries. My mother was 52 when she went through menopause and I have 2 sisters, 51 and 49, who still have regular cycles as well.

I understand there is an increased risk of Downs Syndrome at my age, and we would have all the relevant tests for this, but what I would like to know is whether having the vasectomy reversal combined with my age may pose too much of a risk in terms of problems or deformities for the baby? I have read somewhere that there is an increased risk of deformities after a vasectomy reversal, but how true this is I don’t know. If the risk is too high we would probably, sadly, decide against the idea.

I sincerely hope you can help to reassure me! Thank you in advance.

The fertility of a woman decreases as she ages and most fertility experts would advise a woman at the age of 44 that her fertility potential should be evaluated with tests prior to undergoing any costly procedures to achieve a pregnancy. A family history of late onset menopause is an encouraging sign but not conclusive evidence that a woman at the age of 44 can still conceive children. There is no evidence that there is any higher risk of congenital abnormalities in the offspring of men who have undergone vasectomy reversal. However, there is a higher risk of certain genetic mutations in the offspring of women who are of advanced reproductive age (>35 years old).

 

Scrotal Pain & Discomfort 6.5 Years Post-Vasectomy

From Paul:-
Brief history:

• Had traditional vasectomy (closed-ended, open incisions) in early 2003.
• General surgeon (did 2-3 per week) said left vas was difficult to find. Surgery seemed to take long but was eventually completed.
• Experienced substantial pain on left side for several months and frequent urge to urinate for several weeks. Eventually saw two urologists. First one prescribed Cipro & ibuprofen, and diagnosed epididymitis. Second one diagnosed continued infection and prescribed Doxycycline and waiting. I was told the scrotal ultrasound showed nothing. Both urologists advised against further intervention.
• I never experienced any change in sexual function or pleasure.
• Discomfort eventually subsided and was gone for several years before starting to return to the same left side.

Over the past couple of years I’ve experienced spontaneous (that is, with no “jostling”) pain in the scrotum with increasing frequency, always on that left side (but not as painful as the first several months post-vasectomy). Additionally, that side of the scrotum is constantly tender to the touch – I have to constantly watch where and how I sit, make sure my daughter or the dogs (very small) don’t bump me there, etc.

I mentioned this to my GP, who ordered an ultrasound. The results noted a 2cm hydrocele – a hydrocele also was noted during an earlier ultrasound but I don’t have any details on it. My GP says hydroceles don’t cause pain – there was nothing to be done for me and I would have to tolerate the pain. That was the end of the conversation.

I am also leery of GPs who say “there’s nothing to be done” as if they were specialists. This isn’t the first time I had a medical professional be cavalier about my scrotal pain issues, so I’m leery for that reason as well. But since my GP refuses to pursue this issue, I’m stuck unless I file a complaint and/or switch doctors. She’s otherwise provided good care, so I’m not ready to level any accusations yet.

I would like to clear this up soon; I’m unemployed but hope to find work in the next few months. I did wait-and-see until it was becoming unmistakably worse, and at 6.5 years post V it doesn’t seem like further waiting will help.

Any advice or suggestions would be greatly appreciated. Thank you!

Post vasectomy pain (PVP) syndrome can manifest in varied presentations and intermittently over time after the vasectomy. PVP is thought to be due to congestion of the epididymis or damage to the peri-vasal nerves at the time of vasectomy. Physicians not familiar with this condition will oftentimes overlook this as a cause of pain. Scrotal ultrasounds are often obtained to rule out more serious conditions when a patient complains about testicular pain. Scrotal ultrasounds will find problems such as hydroceles, varicoceles and spermatoceles in 60-70% of men when performed randomly. Some of these pathologies found on ultrasound can be confused with PVP. Hydroceles and spermatoceles are rarely associated with testicular/epididymal pain. Varicoceles can be associated with this type of pain, but the predictive value of correcting a varicocele is only around 50% for men with testicular/epididymal pain. A detailed physical examination by a specialist can diagnose PVP and treatments for PVP such as cord denervation, epididymectomy and vasectomy reversal are successful in up to 90% of patients with this condition.

 

What do these semen analysis results mean?

From Jamielynn:-
Thank you so much for the information that you provided in my previous post for my husband and I. Like I stated to you before, I printed out a copy of the information and we took it to the surgeon. After a few weeks the surgeon called us back and said that he was able to talk to the chief of lab to perform this test for my husband. So this week my husband took in his sample at 3:45pm. At 5pm (1 hours and 15min later) my husband called the lab and talked with a lady. She said that his sample was next to be ran. When my husband asked ” well doesn’t it need to be ran within 30min,” She couldn’t respond. All she knew that it was next. So the next day my husband went to medical records and picked up a copy of the results. The results read
POST VAS SPERM PRESENCE- Present- non-motile H
POST VAS SPERM COUNT- 0-4/hpf H
POST VASECTOMY COMMENTS- 0-4/hpf
At that time we called the surgeon to go over the results. The surgeon stated that the results mean there are no live sperm. I has asked the surgeon if they were not alive due to when the test was ran? The surgeon said that he would need to talk with the chief of lab to see whats going on. I also asked the surgeon if after a year after the vasectomy shouldn’t there be “No Sperm, dead or alive” That he shouldn’t be producing any sperm after a year. The surgeon also stated to me that there has to be a extremely large amount of sperm to create a pregnancy. My husband and I feel that the surgeon is looking at us like we are crazy. We know that there is something there. We do not want to have to go through all the pain of taking a chance on getting pregnant again.

Now we are at the point where the surgeon wants to have a meeting with my husband and I to come up with a plan. (Whatever that means). I wanted to get your response as a second opinion on what to do from here. Without the information that you were kind enough to provided us with on the pelleted semen test we would not have come this far…. My husband I thank you for that. We greatly appreciate it.

The standard protocol in most general hospital labs is different from that of specialized fertility centers when it comes to evaluating semen analyses irrespective if it is a quantitative or post-vasectomy semen analysis. Most regular hospital labs do not incubate the semen at body temperature until it is ready for microscopic evaluation. The sample is left standing on the counter at room temperature until the technician is ready to evaluate the specimen, sometimes for hours. It is well known that sperm will die or lose motility after as little as 30 minutes when the sperm are kept outside of body temperature. In this case it is difficult to say if the sperm were alive or dead when they arrived in the lab since the specimen was not handled appropriately for evaluation of live sperm. Also, centrifuging sperm at high speeds can cause damage of the tail of the sperm resulting in loss of motility prior to microscopic evaluation. Please also refer to a previous questions regarding fertility at very low sperm counts from our previous posts.

 

Has my vasectomy failed?

From Tom:-
I had a vasectomy in September, 08 from a board certified urologist. Post semen analysis at 3 months was positive (no other specifics available on this test). Another test was done at 6 months and was positive with a count of 20,000. Yet another test done at 9 months and results showed “Rare, non-motile”. My doctor says this happens in rare cases and I shouldn’t be worried. He wants another test at 12 months. I conservatively estimate I’ve had 50-60 ejaculations (probably closer to 70). The first 6-8 ejaculations contained blood, but that cleared after 3 weeks or so. I am 44 years old in good health.

I’m concerned that my vasectomy has failed and I’m angry. How do you recommend I proceed? Is there anything I should be doing to determine if my doctor did something wrong?

Thank you very much.

Persistent motile sperm at very low counts 6 months after a vasectomy likely represents recanalization of the vas deferens. This is the typical quantity of sperm seen after this occurence and emphasizes the importance of demonstrating two ejaculates without any sperm prior to confirming sterility. Contrary to common perception, the sperm counts of men with recanalization are usually very low in number with a low percentage of motile sperm. This is because the entire vas deferens has not grown back to its original state but instead a single or a few microscopic canals have formed allowing a small amount of sperm to get through the vasectomy site. The sperm count can intermittently show sperm with rare non motile sperm at other times. These patients should be followed closely and told to continue to use a contraceptive until two consecutive semen analyses 6-8 weeks apart are completely absent of any sperm or opt for a re-do vasectomy. Recanalization can be temporary with successful azoospermia demonstrated over time. This case also emphasizes to those couples wanting to have more children after a vasectomy but trying to avoid vasectomy reversal or sperm retrieval with IVF/ICSI the reality of recanalization. Recanalization sperm counts are usually too low and of poor quality to initiate a natural pregnancy, but we can’t tell patients wanting sterility that they are fine to have unprotected intercourse. Recanalization should not be perceived as a fault of the surgeon. Instead, it is more a reflection of how potent the growth factors released are after the vas deferens is cut or injured.

 

Tethering of vas deferens

I am wondering how common it is to have the vas deferens tethered and what is done to usually prevent this from occuring?

Tethering of the vas deferens after a vasectomy can occur and results from the scarring to adjacent tissues after the vasectomy. The biggest problems I have seen with tethering of the vas deferens is in patients where the tethering occurs to the scrotal wall. Patients describe a pulling sensation or pain, especially with ejaculation and certain activities. Treatment for this condition is usually surgical and requires mobilizing the vas deferens from the surrounding structures, wrapping the spermatic cord around the vas deferens or, alternatively, cutting back the vas deferns. The exact incidence of this occurrence is unknown but it is not a common finding after a vasectomy.

 

Post vasectomy lumps

From Jim:-
I had a vasectomy done 13 months ago. A few months later I noticed a very small lump at the bottom left of my left testicle. Since then I’m sure it has grown slightly. It is not a smooth feeling lump, feels sort of sharp/pointy and if I put pressure on it then I feel a very dull pain. Appears to be on the edge of the left teste but not part of it. I’m obviously concerned and would appreciate some feedback. Thanx, Jim

Any new lumps, masses or lesions in the testes whether they are in the testicle or adjacent to the testicle should be evaluated by a physician. Any lesion that is demonstrating growth over a period of time is even more suspicious for a malignancy. Obviously, our biggest concern is some type of cancerous growth and this can only be evaluated by a physician. These recommendations are universal and irrespective of the time since a vasectomy was performed.

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