Seeking microscopic vasectomy reversal following change of family circumstances

HISTORY

Mr M is a 43-year-old accountant who has recently re-married. He has two sons from his previous marriage who are now 6 and 12 years old and underwent vasectomy five years ago. His new partner is a 32 year-old fit and healthy midwife. They wish to have two and possibly even three children.

Mr M and his partner both live a very active lifestyle and have no relevant medical history. They have had in-depth conversations about their future family plans. They have a very good understanding of Assisted Reproduction Techniques (ART) and Invitro Fertilisation (IVF) however enjoy their intimacy and wish to have a more natural form of conception. They are prepared to explore that option if vasectomy reversal is not successful.

A close friend had a successful microscopic vasectomy reversal at Melbourne Urology Centre hence the decision to make the appointment. Their research of our website: melbourneurologycentre.com.au also highlighted the importance of choosing a centre that offers a microscopic approach with a dedicated Urologist and micro-surgeon team. They were also reassured that Melbourne Urology Centre has a close affiliation with fertility/IVF centres if required.

PHYSICAL EXAMINATION

On examination Mr M was mildly overweight. On careful palpation of the scrotum there was around one centimetre gap between the two ends of the vas deferens.

INVESTIGATION FINDINGS

No preoperative investigations were required as Mr M had no previous fertility concerns.

TREATMENT

Following in-depth discussions over a long consultation Mr M and his wife opted to proceed with microscopic vasectomy reversal. Consideration was given to Assisted Reproductive Techniques and IVF. They were aware that sperm could be extracted through various other techniques if required. They chose microscopic vasectomy reversal as they wished to have more than one child. They considered this a more natural method and overall more cost-effective. The chance of success was estimated to be high as the time since vasectomy was not too long.

Mr M underwent microscopic vasectomy reversal on a Friday afternoon and was discharged the same day. The procedure was performed under general anaesthesia and took around two hours to complete. There was mild scrotal discomfort which slightly increased over the 12 hours after surgery as the local anaesthetic wore off. His pain was well controlled with a combination of Paracetamol and Ibuprofen. He had a scrotal pad and wore tight supportive sport underwear. There was no bleeding. Mr M was instructed to keep the wound dry for 48 hours and keep the supportive dressing intact. He was asked to avoid any strenuous activity including sexual activity for a minimum of four weeks. He was allowed to return to his desk work after a week.

FOLLOW UP

Our nurse contacted Mr M five days following his procedure. He was feeling much better and had minimal pain. He returned to work after one week. He was also once again reminded to avoid any strenuous activity for four weeks.

At a 12 week follow-up Mr M’s semen analysis showed 5×106 viable sperm per ml; the procedure was deemed successful. He was aware that this result does not guarantee successful conception, but it does indicate successful reversal of vasectomy. Achieving pregnancy takes on average 12 months after successful vasectomy reversal.

Take Home Messages:

• Microscopic Vasectomy Reversal is a cost-effective and viable alternative to ART or IVF
• The success depends on the technique, fertility of couple, age of female partner and time since vasectomy was performed
• Use of a high powered surgical microscope and a dedicated team comprising a Urologist and Microsurgeon is likely to maximise success rate
• Even following a successful procedure, it may take up to a year to achieve successful pregnancy
• ART and IVF is a viable alternative with its own set of advantages

 
Written by Dr. Shekib Shahbaz and Dr. Tony de Sousa