Re–operations after a failed VasovasostomyIf pregnancy fails, in some cases, a repeat operation may be effective. Success rates depend on several factors, including the doctor's skill, complications from the original operation, the effects of anti–sperm antibodies, and the time elapsed since vasectomy. Even though tubes are open and sperm is restored in as many as 85% of men, pregnancy rates only average about 30%.
Damage to the epididymis occurs in about 75% of men who request a repeat operation after vasovasostomy failure. This requires an operation called vasoepididymostomy, which creates a bypass around the obstruction. To appreciate the difficulty, one should realize that the epididymis is 1/300 of an inch wide with a wall thickness of 1/1000 of an inch. Microscopic techniques are critical for the success of this procedure and require a surgeon who specializes in them. Success rates are higher for repairing obstructions closer to the testicles because the epididymis is wider in this area.
Assisted reproductive technologies (ART) or intrauterine insemination are available for men who want to conceive children after a vasectomy. For men who have failed vasovasostomy, however, a repeat procedure appears to be less expensive than embarking on fertility treatments at that time. One very effective fertilization technique for men who have had vasectomies or failed reversal surgery is called intracytoplasmic sperm injection (ICSI). In this procedure, sperm are usually taken from the epididymis using a technique called epididymal sperm aspiration (ESA). The procedure injects a single sperm into an egg with the aid of a powerful microscopic and robotic instruments. The fertilized egg is then implanted in the woman. In general, Pregnancy rates are round 20%. Damage in other ducts and small tubes are a major reason for vasoepididymostomy failure. Ultrasound before the operation may be valuable to determine if these abnormalities exist, which would make it unlikely that the procedure would be successful.
Fertility TreatmentsAssisted reproductive technologies are the best approach at this time for men with evidence of anti sperm auto antibodies due to vasectomy or other causes. High doses of corticosteroids may be useful in conjunction with intrauterine insemination for infertile men who show antibodies to their own sperm, although their effectiveness is not proven. It should be noted that these drugs have potentially serious side effects with prolonged use.
Stability in their RelationshipIdeally, the couple should view the operation as a mutual commitment to an already successful marriage or relationship. Good candidates are those men who are part of a couple that considers their family complete and permanent birth control as one method of maintaining the family’s stability. Vasectomy generally is not a good idea if the couple’s relationship is under great stress, it is not a cure for emotional or sexual problems between a man and woman.
What are after–effects?
Postoperative ComplicationsVasectomy is a low–risk procedure and the complications, which occur in about 10% of patients, are usually easy to control.
Immediately Postoperative Pain. All men experience some acute pain in the scrotum after the operation. Acetaminophen (tylenol) with or without codeine is the primary choice for postoperative pain. Aspirin, ibuprofen (advil, Medipren, Motrin, Nuprin) or nap oxen (aleve) or other so–called NSAIDs can cause bleeding and should be avoided. This pain generally disappears within two days, although the patient may feel sore for a few more days.