Vasectomy Reversal
The most common reason to perform sperm duct microsurgery is to reverse
a vasectomy. Dr. Buch has performed numerous successful vasectomy
reversals since 1985 using the most up-to-date microsurgical techniques.
He has reported his success rates in medical journal articles and seminars,
and he has been a pioneer in the use of frozen sperm from the site of the
vasectomy reversal. The frozen sperm provides a "back-up plan" for
future attempts at pregnancy should sperm fail to return to the ejaculate in
spite of a technically excellent microsurgical vasectomy reversal.
Currently, 98% of our clients who have a straight-forward vasectomy reversal (vasovasostomy) will have successful return of sperm to the ejaculate, and 65% will achieve pregnancy by natural means. This compares favorably with the 85% pregnancy rates of couples trying to get pregnant naturally (those who are not associated with a vasectomy reversal). These numbers are why so many people come to Dr. Buch for vasectomy reversal . When sperm returns after a successful vasectomy reversal , the natural pregnancy rates can be enhanced by use of medication for persistent sperm antibodies, and through the use of sperm processing (washing) in combination with insemination of the female partner.
In cases where the time from the vasectomy to the attempt at vasectomy reversal has been more than 10 years, there is an increased chance of a secondary blockage in the ducts closer to the testicle, which are called the epididymis. Even in these technically more demanding cases called epididymovasostomy (EV or VE), our success rate for return of sperm is 85% and our natural pregnancy rate is 50%. Currently, our patient with the longest duration from vasectomy to successful vasectomy reversal with return of sperm in the ejaculate is 27 years!
MICROSCOPIC VASOVASOSTOMY AND EPIDIDYMOVASOSTOMY
(a few quotes from Dr. Buch below are included)
Increasingly more men are presenting to the urologist for vasectomy reversals or to correct acquired blockages of the sperm duct system. Fortunately, microsurgery has advanced significantly in the past several years so that reversing a once thought of as permanent sterilization (vasectomy) is now highly possible. "My career has been dedicated to men’s fertility issues since 1985, and I specializes in microsurgery, having previously directed the men’s infertility program at two universities."
It should be remembered that much of the success of a vasectomy reversal depends on two factors: (1) the skill of the surgeon and (2) the findings at the time of the surgery. Although a microscopic vasovasostomy is not always necessary to produce an effective outcome, it does result in higher success rates. "I perform a two layer repair using microscopic sutures and the latest microsurgical equipment including the operating microscope. I prefer to have my patients operated on as an outpatient. This affords them the opportunity of returning to their home or a nearby motel, saving them considerable expense and making the overall experience much more pleasant. I perform procedures at the Legacy Surgery Center of Frisco. It is a superb outpatient surgical facility fully staffed by anesthesiologists and nurses trained in the care of patients who are having outpatient procedures."Operating time for a vasovasostomy or epididymovasostomy is approximately 4 hours. A local anesthetic is usually used in conjunction with a light general anesthetic, so that our patients wake up quickly and have no immediate discomfort. Postoperative care should include an evaluation of wound healing at 1-2 weeks, and a first semen analysis at 4 weeks. Semen analyses are then obtained at 2 month intervals until the semen analysis stabilizes or pregnancy is achieved. Routine follow up semen testing and visits will provide the best success rates.
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