On this page Dr Vijayant G Gupta (MCh Urology) tries to answer in more detail frequently asked questions on Vasectomy Reversal.
To Read about Vasectomy and No Scalpel Vasectomy Click here
To read about Vasectomy Reversal in India and Vasectomy Reversal Cost in India Click here
Write to me at [email protected] for more details
1) Do I specialise in male infertility? What are my credentials to offer Vasectomy Reversal Surgery?
Answer – Yes I do. I am a Board Certified Urologist and surgeon practising for 8 years in India. Credentialed for 6 years post surgery fellowship, and 2 years post Urological Fellowship.
I have almost a decade of experience managing male infertility and vasectomy reversal. I offer vasectomy by the No Scalpel method since 2011 with more than 500 successful NSV performed. Besides vasectomy reversal I also offer surgeries like Spermatocele creation, scrotal exploration and Vaso Epidydmal Anastomosis.
2) How frequently do I perform the vasectomy reversal procedure?
No Scalpel Vasectomy or Vasectomy procedures I would perform approximate 50 cases a year.
Vasectomy reversal surgeries (vasal recanalizations) are approx 10 to 12 a year.
3) What are the methods of Vasectomy reversal performed in my practice? VEA vs VV? Vaso Epidydmis Anastomosis vs Vasovasostomy for Vasectomy reversal?
Vasectomy reversal is performed in standard two methods
a. Vasovasostomy – the previously cut ends of the vas are identified. After preservinf perivasal blood supply, all scarred and cut tissue is removed. The cut margins are freshened. Patency is checked on both ends and the cut ends are joint together.
b. Vaso epidydmostomy – in cases of very long lost vas length, absent testicular fluid or failed cases a VEA or Vaso Epidydmal anastomosis is performed. In this the vas is joined to the epidydmal tubule to allow sperm return tot he ejacualate.
4. What are the methods of access to the Vas site that I employ?
I access the vas for vasectomy reversal by one of the three incisions.
a. Standard 5 cm midline scrotum incision – Most convenient incision. Gives good access to do a good job.
b. Mini Incision Vasovasostomy – For more discerning patients a 2 cm incision on both testis – allows rapid healing, but only possible in cases a sperm granuloma is there and the incision site in not too high or low on the scrotum.
c. No Scalpel method – Access the vasectomy site with a NSV puncture – avoids stitches and does a quick job.
I offer all three but depends on every case individually.
5) What is the surgeon’s success rate in achieving sperm motility and pregnancy?
Return of sperm after reversal depends on many factors including but not limited to duration of vasectomy, amount of vas loss, patient comorbidities and age related testicular dysfunction.
Considering all variables if I audit all my cases across spectrum, I would say I have a 80 percent sperm return rate to the ejaculate, 50 percent viable motile sperm rate and a 50 percent spontaneous conception rate (with a fertile female partner).
6) If there is no sperm found in the vas deferens, is the surgeon able to perform the more advanced procedure to bypass a blockage?
In Vasal Recanalization surgery, on table I aspirate fluid from the testicular side of the vas and send it for analysis to document sperms. This fluid is usually graded on morphology on table and also analysed microscopically.
If the couple so chooses and is adequately worked up we can also use the aspirated sperms (if viable) to be cryo preserved or used for concurrent ICSI. We can also arrange for testicular tissue to be retrieved and used for sperm retrieval in the same sitting.
If the aspirated fluid is devoid of sperms, even then I would proceed with vasovasostomy since much research has shown return of sperms once the vasectomy is reversed. Especially in men who have fathered children before.
But, I do perform Vaso epidydmal anastomosis if required and discussed before hand. Though I prefer to proceed with a vasovasostomy even in negative aspiration and wait for 6 months to reexplore and do a VEA if required.
7) What is the time frame for scheduling a Vasectomy Reversal in India?
The time frame for a Vasectomy Reversal in India would be
Before visiting my practice (In your home country)
a. Online consultation
b. Basic Medical Workup – Blood tests
c. Schedule the date for surgery and Book the OR according to availibility
After landing in India
a. Day 0 – Visit my clinic for examination, medical workup, pending investigations, anaesthesia checkup, decision making and setting up plan of action
b. Night 0 – Sleep in hotel, prep for OT, Light dinner
c. Day 1 – Shift to Hospital, Shift to OR, Surgery (3 hours) , Recovery room till evening
d. Night 1 – Shift back to Hotel with your private nurse, sleep in Hotel
e. Day 2 – Visit in Hotel for dressing, removal of drains and urine bag if placed. Examination and rest in Hotel with your private nurse
f. Day 3 – Visit my clinic on way to airport, fly back
All sutures are self dissolving, do not require removal. All medicines are disbursed with valid signed prescriptions with SOS medicine kits.
Month 3 – Semen examination in Home country and review with reports online.
8) What is the cost?
Vasectomy reversal Cost in India is given here in details.