A presentation on vasectomy reversal and how to have a child after undergoing a vasectomy. Includes success rates and myths.

1. You CAN have
a baby after a
vasectomy
Aaron Spitz MD
Assistant Professor, Department of Urology UC Irvine
Director, Center for Reproductive Medicine, Orange
County Urology

2. Welcome!
• SO, you want to have a baby?
• you CAN have a baby
• UNDERSTAND your options and and GET
GOING!

3. Overview
• Welcome
• Options
• Myths
• Techniques

4. what are my options?
• Reverse the vasectomy and have a child
naturally
• Reverse the vasectomy and have a child
with advanced reproductive technology
• Maintain the vasectomy and extract sperm
for in-vitro fertility, ICSI
• Reverse the vasectomy and extract sperm

5. Choosing
• For most couples, reversing the vasectomy
allows the greatest success at the lowest
cost and with the least risk
• For a small percent of couples, vasectomy
reversal will not work and sperm retrieval
for IVF-ICSI is appropriate and neccessary
• In most cases, a couple can choose either

6. Myths
• a vasectomy reversal is impossible after 10
years or so
• FACT : there is no amount of time after
which a vasectomy reversal is impossible.
Men make sperm their whole life. I have
successfully reversed a man almost 30 years
out. Success rates decline over time but do
not go to zero.

7. VR Success rates

8. Myths
• IF I want only one child I should do IVF
• FACT: IVF results in a 32% chance of twins
a 1.2% chance of triplets. Twins only occur
if they run in families with vasectomy
reversal.

9. Myths
• If a woman is over 35 she needs to do IVF
because a vasectomy reversal wont work
• FACT: the success rates for live birth
following vasectomy reversal versus IVF are
almost identical in women above age 35
who are ovulating and don’t have an
underlying fertility disorder

10. Comparison:VR vs IVF
Female
age
<35 35-37 38-40 41-42
vasectomy
reversal <
15 years
65 42
(age 36-40)
42
(age 36-40)
38
vasectomy
reversal >
15 years
56 32
(age 36-40)
32
(age 36-40)
28
IVF-ICSI 47.7 38.8 29.9 20.1
SART 2010

11. Sperm is
made in the
testiscle
Sperm is
stored in the
epididymis
Sperm is
mixed with
fluid from the
seminal
vesicle and
prostate
Sperm is
propelled up
the vas
deferens
semen is
deposited in
the urethra
where it is
ejaculated out

12. sperm is
made in tiny
tubules
Sperm is
stored in the
epididymis
sperm is
propelled up
the vas
deferens

13. Technique of
vasectomy reversal
• Vaso-vasostomy: two layer microsurgical
connection
• Vaso-epididymostomy: 4 point
intususcepted microsurgical connection

14. Incisions for vasectomy reversal

15. vasectomy scar

16. Choosing the correct
connection
sperm
no sperm
Vaso-vasostomy
Epididymovasostomy

19. Three 10.0 nylon microsutures are placed through one
half of the inner layer of the vas deferens passage

20. The three sutures are tied down bringing the first half
of the inner layer of the vas deferens close together

21. The ends are rotated 180 degrees and three more
microsutures are placed into the other half of the
inner layer of the vas deferens

22. The three sutures are tied down bringing the second
half of the inner layer of the vas deferens close together
Several more sutures are then placed to join the
outer layer of the vas deferens

23. the outer sutures are tied down completing the two
layer microsurgical connection

26. epididymis

27. epididymis

28. Microsutures are placed to
snug the opening of the
epididymal tubule up into the
opening of the vas deferens

29. Once the sutures are tied down the
epididymal tubule is snugly secured to the
opening of the vas-deferens

30. Recovery
• 48 hours of rest and ice
• back to work in 3 to 4 days “office level”
• No heavy exertion or sex for 4 weeks
• patients report soreness is similar to a
vasectomy

31. Sperm retrieval
• requires IVF-ICSI
• shorter procedure
• maintains the vasectomy
• similar risks

32. IVF-ICSI
In vitro fertility and intracytoplasmic
sperm injection
In vitro fertility and intracytoplasmic
sperm injection

33. Types of sperm extraction
• PESA
• MESA
• TESA
• Needle core biopsy
• TESE

34. PESA

35. MESA

36. TESA

37. needle core biopsy

38. TESE

41. Freeze tissue for later IVF-ICSI

42. Tissue is divided up into several batches

43. Advantages of TESE
• Greater yield for multiple chances at IVF
• No “blind stick” so less bleeding risk
• Testicular sperm is higher quality than
epididymal sperm. Better IVF outcomes
• Can be performed quickly with a local
anesthesia

44. Recovery
• Similar to a vasectomy
• 48 hours of ice and rest
• 5 days of “office level” activity
• Unrestricted activity after 1 week

45. Risks
• Vasectomy reversal
• bleeding, infection (1-2%)
• Sperm retrieval
• bleeding infection, injury to the testicle
(1-2%)

46. IVF-ICSI
In vitro fertility and intracytoplasmic
sperm injection
In vitro fertility and intracytoplasmic
sperm injection

47. Risks of IVF
• Ovarian Hyperstimulation Syndrome : fluid
accumulation in the abdomen after
ovulation or egg retrieval
• The mild form occurs in 10% to 20% of cycles and results in some
discomfort but almost always resolves without complications.
• The severe form occurs approximately 1% of the time.
• blood clots, kidney dysfunction, twisting of an ovary (torsion),
fluid collections in the chest and abdomen, and rarely even
death.
• In severe cases, hospitalization is required for monitoring but
the condition is transient, usually lasting only a week or two.
Occasionally, draining the excess fluid is needed to decrease
symptoms.

48. Risks of IVF
• Hormone injection side effects: Breast
tenderness, swelling or rash at injection
site, abdominal bloating, mood swings, and
slight twinges of abdominal pain

49. Risks of IVF
• Multiple gestation (twins, triplets): increased
risk of miscarriage, premature delivery,
infant abnormalities, handicap, pregnancy
induced hypertension, hemorrhage, ad
other significant maternal complications

50. Risks of IVF
• Ectopic pregnancies: slightly more than with
natural conception
• Ovarian twisting: (<1%) requires surgery to
save ovary

51. Conclusions
• Having a baby IS possible after a vasectomy
• Vasectomy reversal is usually possible and
offers good success with minimal risk
• Sperm retrieval and IVF-ICSI is a good
alternative for some couples

52. Feedback
• We value your opinion and want to serve
more effectively.
• Please take 2 minutes on-screen
immediately after this webinar and help us
improve.

53. Q & A
• Please type your questions into the
GoToWebinar Questions area.
• Questions we cannot get to on-air will be
answered offline by Dr. Spitz.

54. ThankYou
• Thank you for your time and engagement.