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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Do Urologists perform vasectomy reversals? If men change their minds about a vasectomy after opting for the procedure, surgeons recommend vasectomy reversal. In this procedure, a surgeon reconnects all the tubes (vas deferens). These tubes are responsible for carrying sperm into the semen from testicles. Once a professional successfully performs the procedure, semen will start carrying sperms, and couples can opt to get pregnant.
Pregnancy rates will increase from 30 percent to 90 percent after you are done with vasectomy reversal. However, the pregnancy rate depends mainly on the procedure for the reversal. Moreover, there are other factors that affect the success of reversal and achieving pregnancy. These factors include the age of the partner, time since vasectomy, experience and training of a surgeon, and fertility issues before the vasectomy.
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Testes are located at the base of the penis inside the scrotum. A coiled tube called epididymis helps sperm to leave the testes. Epididymis connects with the prostate through a long tube known as vas or vas deferens. Vas leads to the inguinal canal starting from the lower region of the scrotum. Then it reaches behind the bladder into the pelvis. At this point, it forms an ejaculatory duct by joining with the seminal vesicle. When you are ejaculating, seminal vesicles and seminal fluids mix with the sperm and form semen. The semen then comes out of your penis, following through the urethra.
Reversals are mostly performed by a urologist on come and go basis. Surgeons may perform the reversals in the surgery center or the outpatient area of the hospital. If a urologist is using a surgical microscope, they will perform the surgery after giving you anesthesia. Before performing the surgery, an anesthesiologist and urologist will discuss with you about the choices.
Performing this surgery through microsurgery is the best method. A urologist can examine the small tubes by up to 40 times when using a high powered microscope performing the surgery.
Once you are asleep, the urologist will make tiny cuts on the sides of your scrotum. Then the urologist trims the vas deferens’ ends, which was closed during the process of vasectomy. The urologist will then take some vassal fluid near the testis from the vassal end. They will then test if it includes the sperms or not. After that, the urologist will take any of the two methods for reversal. Here are those two procedures:
If sperm is available in the vassal fluid, this means that the path is now clear between the area of the cut in the vas deferens and testis. Now the urologist can join the ends from the cuts. The term used for connecting the ends is called vasovasostomy. When a surgeon performs the procedure through microsurgery, almost 85 out of 100 male patients find it effective, and there are chances of pregnancy in almost 55 out of 100 couples.
If the surgeon cannot find the sperms in the fluid, there are chances that because of vasectomy, a blowout in the epididymal tube is formed. In this case, the urologist will go back to the vas and join them from the upper end to the tube. Vasoepididymostomy has the same purpose as vasovasostomy. However, vasoepididymostomy has more complexity than vasovasostomy, and the results are the same. In some cases, urologist my perform vasoepididymostomy on one side and vasovasostomy on the other.
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There are various factors that you need to consider before choosing a fertility male health care or urologist. These factors include technology they are using, their support staff, and surgical abilities. As vasectomy reversal is a specialized procedure, the experience and training of a surgeon will have the biggest effect on complete outcomes. Surgeons with training for treating infertility in male patients are urologists. They have received proper training for male fertility and microsurgery.
Even though most vasectomy reversals need surgery only in the scrotum, sometimes the patient requires reconstruction inside the abdomen. This happens when the vas experiences a blockage due to any reason other than that of vasectomy. For instance, after you have gone through a hernia repair. When this case occurs, the urologist will avoid repairing the vas. Instead, they will perform the most complex procedure: robot-assisted intra-abdominal repair. Very few surgeons can perform this and have experience of both robot assistance and traditional microscopic techniques for repairing the vas successfully.
When you are choosing a doctor, you should not hesitate to ask questions about the experience of the urologist and how many reversals they have done, what techniques they are experienced in, and what is the effectiveness rate of pregnancy after they perform vasectomy reversal.
To speak with professional and experienced NYC urologists that perform vasectomy reversals, you can contact us at (646) 862-5500.
Visit our website for information about how we can help you with your condition.
A vasectomy is a simple procedure where the vas deferens is cut to prevent sperm from entering the ejaculate and serves as a method of male sterilization.
In a typical vasectomy reversal, the two cut ends of the vas deferens are rejoined to once again allow sperm to enter the ejaculate. It is a procedure used to restore male fertility.
Men are typically cautioned that a vasectomy procedure is permanent. The truth, however, is that most vasectomies can be reversed. Success rates are critically linked to the skill and experience of the surgeon. Macroscopic vasectomy reversals typically have low success rates. Vasectomy reversals performed by skilled and experienced urologists utilizing a high-powered surgical microscope have high success rates.
Most general urologists perform less than five vasectomy reversals per year. Obviously, their limited experience in this procedure will negatively affect their success rates. It is important to determine if the surgeon you select actually specializes in microscopic vasectomy reversals. Relevant questions to ask include whether the surgeon has had specialty training in microscopic vasectomy reversals and what the extent of his or her experience is in the complicated vasdoepididymostomy procedure. Ask for permission to speak to a few of their patients who have had the reversal performed. Dr. Larish has performed thousands of vasectomy reversals and, for him, even the more complex vasoepididymostomy is routine.
Evidence does suggest slightly better results with more recent vasectomy procedures, but the success rate with vasectomies performed over 15 years ago is at least 70% with a 30% pregnancy success rate. Dr. Larish has successfully reversed vasectomies performed up to 30 years ago with pregnancies occurring in as little as a few months. Regardless of the length of time since vasectomy, vasectomy reversal remains the most effective and least expensive means of restoring male fertility.
Vasectomy reversals typically fail for one of two reasons. At the time of the first surgery, a vasovasostomy may have been performed when, in actuality, a vasoepididymostomy procedure was indicated. The other reason for failure is poor surgical technique in reconnecting the two cut ends of the vas deferens leading to scarring. Success rates following repeat reversals are slightly lower than for first reversals but are not so low that a repeat reversal should be avoided. It remains the procedure of first choice for restoring male fertility. Dr. Larish has performed numerous revisions of failed vasectomy reversals and is justifiably proud of his rate of success.
A vasovasostomy is the standard vasectomy reversal procedure. It consists of simply reconnecting the two cut ends of the vas deferens and restoring sperm flow into the ejaculate. A vasoepididymostomy is where the vas deferens is connected directly to the epididymis on the testicles. This procedure is necessary when a “blockage” is identified in the vas deferens coming from the testicle. This blockage may be due to scarring or inflammation. The blockage prevents sperm from exiting the testicle through the epididymis to the vas deferens and must be bypassed. A vasoepididymostomy is a highly demanding and complex surgical procedure. Only a highly qualified urologic microsurgeon should attempt this procedure. Therein lies the importance of choosing an excellent surgeon.
What will the vasectomy reversal surgery be like?The surgery is performed on an outpatient basis at the Gramercy Surgery Center. You will be at the center anywhere from three to five hours. The surgery itself is performed under general anesthesia. You must be accompanied by a responsible adult in order to be released from the center. You cannot drive yourself home. The post-operative pain is not unlike the pain you experienced following your vasectomy. You may notice swelling, bruising or discoloration of the scrotum. Pain medication will be prescribed for the first two days after surgery. After that, over-the-counter analgesics such as Tylenol or Motrin should suffice in alleviating any discomfort. Ice packs applied to the scrotal area will also help relieve any soreness.
Severe complications following vasectomy reversal are rare. They include infection or hematoma. If your incision becomes warm, swollen or painful or you develop a fever, or if you notice excessive bleeding under the skin (black and blue swelling), you will need to contact Dr. Larish immediately.
After a simple vasovastomy procedure, sperm typically reappear within three months. The first semen analysis is usually performed six to eight weeks after surgery. It may take up to six months for the sperm count and motility to stabilize. A semen analysis is performed every three to four months thereafter. After a vasoepididymostomy, it normally takes at least six months for sperm to reappear in the semen but may take as long as 12 to 18 months.
We normally advise patients to wait four weeks before resuming sexual activity.
If your work is performed in an office setting, you will be able to return to work after three days. If your work involves strenuous labor, you will back on the job after four weeks. Patients are advised to avoid heavy lifting or strenuous exertion for four weeks after surgery.
Most medical insurances do not cover the cost of a vasectomy reversal. Dr. Larish has chosen to offer a fixed, all-inclusive price for the standard vasectomy reversal as well as for the more complicated vasoepididymostomy procedure. Patients can thus rely on clear, up front pricing with no surprising hidden costs.
If surgery is unsuccessful, you may consider reoperation or in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). In most cases, repeat vasectomy reversal offers the best chance of success. Assisted reproduction (IVF and ICSI) should not be considered as an alternative to vasectomy reversal, but rather, an option in the event of vasectomy reversal failure or when there is a female factor contributing to infertility. The cost of assisted reproduction (IVF and ICSI) is up to three times as high as vasectomy reversal surgery. For the female partner, it involves hormonal therapy. For the male, it involves “sperm harvesting” or extraction of sperm from the testicle by needle aspiration. With IVF, mature human eggs and sperm are incubated in a culture dish. ICSI involves injecting a single sperm into an egg. This procedure greatly enhances the success of IVF. Once the fertilized egg is develops into an embryo, it is implanted into the uterus.
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 Vasectomy Reversal Surgery:The vasectomy reversal procedure will take place in an outpatient surgery center. You can expect to be at the center for anywhere from three to five hours. Please follow the pre-operative instructions provided to you and be prepared to undergo general anesthesia. Dr. Larish will use microsurgical technique to reconnect the severed vas deferens. Upon awakening from anesthesia, you may notice ice packs placed on the scrotal area. These are intended to reduce swelling and pain. The pain is normally similar to the pain following vasectomy. You may notice bruising or discoloration of the scrotal area.
Pain medication will be prescribed for the first two post-operative days. Normally, after the second day, Tylenol, Motrin or Advil should suffice in alleviating any discomfort. The intermittent use of ice packs on the scrotum can also help soothe the pain. Above all, please remember: You cannot walk or drive yourself home after the surgery. Make arrangements for a friend or family member to meet you at the center upon discharge. You will not be released under other circumstances.
Try to minimize your activity level for the first few days and avoid any heavy lifting or strenuous exertion for the first month. If you work in an office setting, you will be able to return to work in approximately three days. If your work involves physically strenuous activity, you will be back on the job within four weeks. Sexual intercourse may be resumed as early as four weeks after surgery.
A routine follow-up examination will be necessary in approximately one week. This is intended to insure that the wound is healing properly. About three weeks later, you will be scheduled for a semen analysis. Sperm concentration and motility of the ejaculate will be analyzed. You will be asked to return for a semen analysis on a regular basis thereafter until the results of the analysis have stabilized. Once good sperm concentration and motility are achieved, Dr. Larish will recommend that several sperm samples be frozen and stored in a sperm bank in the unlikely event that the site of the vasectomy reversal scars down at some point in the future.
If you experience unusual pain, increasing swelling or bleeding after the vas reversal, please contact Dr. Larish immediately. If you call after normal clinic hours, ask the answering service to refer you to the doctor on call. Routine post-operative complications include infection, bleeding, and side-effects of general anesthesia such as headache or nausea.
There is a risk of delayed scar formation at the site of reconnection of the vas deferens. This is reported to occur at a rate of 2% per year for the first five years after surgery.
Vasectomy Reversal Measure of Success:The measure of success in vasectomy reversal is achievement of a pregnancy. Failure may be related any of several factors:
· Female fertility issues may play a role.
· Anywhere from 50 to 80% of men develop an immune reaction against their own sperm (anti-sperm antibodies) after vasectomy which can impair sperm motility.
· Scar tissue may form at the site of reconnection of the vas deferens.
· Long-term blockage of the vas deferens may adversely affect sperm motility.
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.
