Dr. Larish performs vasectomy reversal micro-surgery at Gramercy Surgery Center. This state of the art facility utilizes the most modern and advanced high quality surgical microscope, micro-instruments and the most highly trained nurses and support staff.
Dr. Larish has helped many men successfully reverse their vasectomies.
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After Vasectomy Reversal FailureVasectomy reversal is one of the most technically challenging surgeries in all of medicine. The skill and experience of the microsurgeon is critical. If no sperm are present in the semen by six months after vasovasostomy or by 12 to 18 months after vasoepididymostomy, then the reversal surgery is considered a failure. Often, the cause of reversal failure is that a vasovasostomy was performed when a vasoepididymostomy was indicated. Or, there was inaccurate approximation of the vas due to poor surgical technique. Or, blockage occurred from scarring as a result of disruption of the vas blood supply. Scientific studies support re-operation in cases of failed vasectomy reversals.
In the hands of a skilled and experienced microsurgeon such as Dr. Larish , the exact cause of a vasectomy reversal failure can be identified and addressed. In the event of epididymal blockage, a vasoepididymostomy can be performed. In cases of poor approximation of the severed ends of the vas deferens or scarring of the vas deferens, a repeat vasovasostomy may do just the trick. Dr. Larish has “redone” many failed vasectomy reversals and corrected “redo” failures by other physicians. Given his advanced expertise, an additional vasectomy reversal procedure may be more cost-effective than in vitro fertilization.
IVF involves incubation of human eggs and sperm in a culture dish. For fertilization to occur, the egg must have optimal maturity and the sperm must function normally. Once a fertilized egg develops into an embryo, it is transferred back into the female. In a man with a vasectomy, sperm must be retrieved from the testicle or epididymis. It involves insertion of a needle under local anesthesia. The cost of one cycle of IVF can range from $8,000 to $15,000.
Because of the expense, lower pregnancy rates, and potential side effects from hormonal therapy for the female partner, reversal surgery, and in most cases, repeat reversal surgery are options of first choice for vasectomized men. IVF is an option to consider if vasectomy reversal is unsuccessful, rather than as an alternative to surgery. Dr. Larish works together with fertility clinics in New York to perform sperm retrieval techniques in combination with IVF treatment.
If you are interested in learning more about vasectomy reversal microsurgery, call Dr. Larish, the most experienced micro-surgeon for vasectomy reversal in NYC.
The 2008 report of the American Society for Reproductive Medicine cites current research indicating that microsurgical vasovasostomy results in sperm return to the semen in 85% to 90% of men and successful pregnancy in 50 to 70% of their partners. In men treated with microsurgical end-to-side vasoepididymostomy, sperm returns to the semen in 84% of men evaluated for 6 months or more, and 42% of men achieve pregnancy when evaluated for 12 months or more. When sperm do not return to the semen by 6 months after vasovasostomy or by 18 months after vasoepididymostomy, the reversal procedure has failed.
Vasectomies which are performed closer to the testicle are more difficult to reverse and may require a vasoepididymostomy. A vas deferens that is disconnected further away from the testicle permits a reversal using the vasovasotomy technique which is known to have a higher success rate.
The more recent the vasectomy, the better is the prognosis for success in vasectomy reversal. Nevertheless, Dr. Larish has successfully reversed vasectomies in patients up to 40 years following a vasectomy with pregnancy occurring in as little as a few months after reversal.
A prior history of good fertility especially with the same partner, overall good health, and the presence of a “sperm granuloma” all increase the likelihood of success. A sperm granuloma acts as a pressure relief valve for the epididymis and keeps epididymal pressure low which decreases the risk of epididymal rupture. Epididymal rupture (“blowout”) would necessitate the vasoepididymostomy procedure known to be the less successful of the two types of reversal surgeries. The longer the vas deferens on physical exam, the lower is the risk of obstruction and the greater is the chance for a regular, more successful vasovasostomy procedure. However, the absence of epididymal blockage or vas deferens obstruction on exam cannot guarantee that a vasoepididymostomy will not be necessary.
A firm or enlarged epididymis on physical exam may represent epididymal blockage which mandates the more complicated, less successful vasoepididymostomy procedure. One or both testicles found to be small in size may indicate testicular failure and may negatively impact the success of reversal.
Dr. Larish distinguishes between “patency” success rates and “pregnancy” success rates. Patency rates quantitate the success of sperm in returning to the ejaculate. Because pregnancy is a “couples phenomenon” and depends on other factors such as female fertility issues, its measurement is always lower than the patency rate. Please view the success rate of our vasectomy reversals for both the vasovasotomy and vasoepididymostomy procedures:
It is imperative that the chief surgeon be highly skilled in all aspects of urologic reconstruction but, most importantly, in the microscopic vasoepididymostomy procedure. Dr. Larish currently employs a state-of-the-art vasoepididymostomy approach. Also referred to as the longitudinal intussusception technique, it requires the microscopic manipulation of two 10-0 or 11-0 sutures (finer than a human hair). Dr. Larish’s expertise in this highly demanding procedure has resulted in a remarkable 90% patency rate in his vasoepididymostomy patients. These inspiring videos and testimonials affirm Dr. Larish’s masterful understanding of male fertility surgery.
If you are interested in learning more about vasectomy reversal microsurgery, call Dr. Larish, the most experienced micro-surgeon for vasectomy reversal in NYC.
The vasovasostomy is the standard and most commonly performed vasectomy reversal surgery. The separated ends of the vas deferens are identified. A sample of the vas fluid is examined under a microscope and is considered to be of good quality if its’ consistency is clear and it contains healthy sperm. The finding of motile sperm is an even better sign. The cut ends of the vas deferens are then stitched together.
Dr. Larish uses a high-powered surgical microscope and six sutures of 10-0 or 11-0 diameter (finer than a human hair) to reconnect the inner lumen and the outer layer of the vas deferens. This is called the Multi-layer Microdot technique. This advanced technique has contributed to Dr. Larish’s high success rates and low rate of scarring. It has also minimized the patient’s recovery time. See Dr. Larish perform a vasovasectomy.
In about 30% of Dr. Larish’s vasectomy reversal cases, no fluid can be expressed from the vas deferens or there are no sperm in the fluid. It must then be concluded that there is a blockage in the epididymis closer to the testicle. The blockage will not allow sperm to pass through to the vas deferens. Blockage in the vas deferens may be due to inflammation, high pressure in the epididymis or scarring following the vasectomy. This blockage must be bypassed by connecting the other end of the vas deferens directly to the epididymis. This procedure is called a vasoepididymostomy.
Dr. Larish currently employs the state-of-the-art Microsurgical Longitudinal Intussusception Vasoepdidymostomy technique. This technique is also referred to as the “two-suture longitudinal intussusception” technique and requires two 10-0 or 11-0 sutures. The technique permits a larger opening between the extremely small epididymal tubule and the larger vas deferens tubule permitting the two to be connected.
This procedure is one of the most complex and demanding in all of microsurgery. Only physicians who perform vasoepididymostomies on a regular basis should attempt the surgery. For Dr. Larish , this procedure is routine. His success rates are equivalent to those of the world’s leading male fertility microsurgeons. He has achieved 87% patency rate in his vasoepididymostomy patients. See Dr. Larish perform a vasoepididymostomy.
Regarding Laser Vasectomy ReversalsThis technique was popularized in the 1990s. Laser surgery works well for select blood vessel surgeries in cardiovascular medicine. However, research shows that laser vasectomy reversals have lower success rates. Laser vasectomy reversals may, in fact, cause more complications and damage to the vasectomy reversal site. Dr. Larish does not use this method of reversal.
If you are interested in learning more about vasectomy reversal microsurgery, call Dr. Larish, the most experienced micro-surgeon for vasectomy reversal in NYC.
Vasectomy surgery entails cutting the vas deferens to prevent sperm from entering the ejaculate in order to produce long term sterility. (click to enlarge)
Vasectomy reversal micro-surgery entails reconnecting the two ends of the vas deferens utilizing a surgical microscope, micro-instruments and micro-sutures in order to allow the sperm to enter the ejaculate and regain fertility after vasectomy surgery.
