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Male Fertility

Vasectomy Reversal – Things to Consider

Men get vasectomies for a variety of reasons.  Many of them want to keep enjoying a healthy sex life without the worry of having “unwanted” children.  But we all know circumstances can change.  Many men will get divorced and re-marry, and may regret having an earlier vasectomy.  For men in this situation, there is hope vacectomy reversal.

Most surgeries for vasectomy reversal are outpatient procedures, and do not require an overnight stay in the hospital.  Most of the time, local anesthesia is used, or is some cases spinal anesthesia is used.  One of the main factors in the success rate in this operation is how much time has passed since the vasectomy.  As more time passes, additional blockages can form.  As strange as it may sound, some men will even develop antibodies to their own sperm.

This procedure normally takes anywhere from 2 to 4 hours.  The patient will also need a few hours to recover from the effects of anesthesia.  But the vast majority of patients will be able to go home that same day.  Pain levels can vary from mild to moderate, and most men are able to resume normal activities, including sexual intercourse, in about 2-3 weeks.

 

Chances of Success and the Risks

The best chance for this surgery to work is within 10 years of the original vasectomy.  The longer the time goes by, the less chance of success in a reversal.  The best odds for success are those who have the reversal within 3 years of the vasectomy.  If a man is looking to father more children, studies have shown that pregnancy of a mate is achieved about 30% of the time for those who had the reversal within 10 years.

There are some risks in a reversal surgery.  It is possible for infection to set in at the site of the surgery, and that is something that all men need to think about.  There can be fluid build-up in the scrotum, and that will require draining.  There can also be injury to the nerves or the arteries in the scrotum area.

 

Other Things to Consider

Before you undergo this procedure, you will want to check with your doctor to ensure that you were fertile before the vasectomy was done.  There are tests that can be carried out to determine if there are antibodies in your sperm both before and after the reversal procedure.  If by chance sperm antibodies are indeed present after a reversal procedure, the odds are very slim that a partner will be able to become pregnant.  In cases such as these, there are a number of remedies that can be undertaken, including in-vitro fertilization.

Do keep in mind that there is an inherent risk with any surgery, even a simple outpatient procedure.  So keep this in mind before you make a decision.  There are a number of skilled surgeons who perform this operation, so shop around before you make a choice.

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Erectile Dysfunction

Dr. David Nudell – Male Infertility

Contact Dr. David Nudell today!

Infertility affects 15% of couples attempting pregnancy in the United States. Roughly speaking, about half of these couples will have a male factor involved, and a male factor will be the sole cause of infertility in about 25% of cases. Thus, all men should have at least a basic evaluation by a urologist early in the course of the female’s evaluation to avoid expensive and unnecessary female treatments. Infertility is defined as the inability to achieve pregnancy after 1 year of unprotected intercourse. Many couples seek medical attention prior to waiting a year, especially if the female partner is over 35 years old. Most couples who seek medical assistance for fertility do not require high technology, expensive treatments.

Male factor abnormalities are diverse, but generally include hormonal problems (pre- testicular), intrinsic testicular problems (testicular), and problems with ducts leading from the testes (post-testicular).

When a vasectomy is performed, sperm production does not stop but it blocks the entry of sperm into the urethra. Unlike women, men produce sperm their entire lives.  The body eventually breaks down the blocked sperm, it is reabsorbed and new sperm continues to be produced.  There are instances when pressure can build up in the tubes behind the vasectomy scar and in some cases, the pressure can build and cause a tiny tubule of the epididymis to rupture.  This is generally referred to as an epididymal “blow out.”   If an epididymal blow out occurs, scar tissue develops and this becomes a new level of sperm blockage.  This is neither painful nor dangerous, but it is significant in that for a vasectomy reversal to be successful, it must be performed in such a way that bypasses this new level of blockage at the epididymal blow out site.

 

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Micro Surgery and Vasectomy Reversal

Statistics reveal that 500,000 men in the United States have vasectomies each year and 5% of those men seek a reversal five years after their vasectomies.  Vasectomy Reversal using Micro Surgery is a multifaceted operation that calls for a high degree of expertise and experience to be effective.  When performed by an urologist who is a fellowship-trained male infertility specialist, the success of a vasectomy reversal is increased.

When a vasectomy is performed, sperm production does not stop but it blocks the entry of sperm into the urethra. Unlike women, men produce sperm their entire lives.  The body eventually breaks down the blocked sperm, it is reabsorbed and new sperm continues to be produced.  There are instances when pressure can build up in the tubes behind the vasectomy scar and in some cases, the pressure can build and cause a tiny tubule of the epididymis to rupture.  This is generally referred to as an epididymal “blow out.”   If an epididymal blow out occurs, scar tissue develops and this becomes a new level of sperm blockage.  This is neither painful nor dangerous, but it is significant in that for a vasectomy reversal to be successful, it must be performed in such a way that bypasses this new level of blockage at the epididymal blow out site.

Sperm that is found at the testis end of a vas deferens indicates that an epididymal “blow out” has not occurred in which case a vasovasostomy is planned.  If sperm is not found, a vasoepididymostomy, which is an epididymis to vas deferens connection, is needed in order for sperm to flow.

Once a surgeon performs a thorough examination and the best course to proceed is determined, A Microsurgical Vasectomy can be performed to restore male fertility.  The technique allows for very precise placement of sutures which results in a much more accurate alignment of the vas lumen, which has the advantage of increasing the success rate of a vasectomy reversal.  Using microsurgery, eight or more sutures can be placed around the inside channel of the vas.  Once the surgical procedure is completed, couples may be able to conceive a baby naturally.

Some of the reasons men decide to reverse their vasectomies include wanting to have a child with a new partner, a couple deciding that they now want children after years in a long relationship or marriage, and the unexpected death of a child.  While vasectomies are considered a permanent form of contraception, they can be reversed and barring infertility issues, the chances of conceiving a child after a reverse vasectomy is possible.

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Male Fertility

Surgical Treatment of Male Infertility

Infertility is a condition that affects about 8% of men who are of reproductive age.  About 1/3 to ½ of these men have a condition that may be reversed with one of today’s modern surgical procedures.  In the past few years, there have been advances in medical technology that can help men to become fertile.  But, before any surgical procedure is performed on a man, their partner needs to be evaluated as to their reproductive potential.

But, keep in mind there is some debate that is ongoing in the medical community as to whether all of these surgical treatment of male infertility are indeed effective in helping a man to impregnate a partner.

 

Available Surgical Treatment for Male Infertility

Varicocele repair is an option in about 35% of infertile men.  Varicoceles are veins in the scrotum that have become enlarged, and this leads to a decrease in blood circulation,  and this in turn hurts sperm production.  This is a condition that affects about 15% of all men, and about 40% of men who are infertile.

This can be done as an outpatient procedure, and it will repair damaged scrotal veins.  When these are surgically repaired, studies have shown that sperm movement will improve, as well as sperm concentration and structure, all of which increase the odds of getting a partner pregnant.  Recent improvement in this procedure involved using a microscope to perform it, and this has led to better outcomes and reduces the risk of complications.

 

Microsurgery Reconstruction

These procedures are used in cases where there are obstructions causing infertility.  Vasectomy reversal is one of these procedures.  It is proven to be effective in situations where there is blockage of sperm caused by a vasectomy.

Another microsurgery procedure is epididymovasostomy.  It can be performed where there is a blockage locate in the epididymis.  This can be the case for those who have a history of injury or a previous infection in the groin area.

All of these procedures can be done with either local, general, or regional anesthesia.  Most all of these procedures will be done on an outpatient basis, with the vast majority of men going home the same day.

 

Reason for Caution

There is some disagreement in the medical community as to the effectiveness of varicocele repair surgery.  There have been studies done that show little improvement in the pregnancy rates of partners whose men had this procedure done.  Some studies have shown that improvement in men who had the procedure in getting their partner pregnant was only about 1% better than men who had no procedure done.

In short, you need to talk with your doctor to get more information about your case, and see where they stand on this issue.  The medical community is still gathering data on this, and the jury is still out.  But do keep in mind that all surgery is inherently dangerous, and that includes outpatient procedures including this one.  Explore all of your options before you make the decision to go under the knife, or in this case the knife and the microscope.

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Varicoceles

Varicoceles

What is Varicocele?

Varicoceles or varicose veins are a widening of the veins along the cord that holds up a man’s testicles.  It is a common condition that affects 15% of the male population and 40% to 50% of the infertile male population.

 

Symptoms

Varicocele usually does not have any symptoms and there is usually no need for treatment. A physician frequently discovers varicocele during a routine examination or a fertility check. When symptoms are present, they can include the following:

  • Pain ranging from dull to sharp and a feeling of heaviness and discomfort
  • Swelling
  • Infertility

 

Treatment

Varicocelectomy surgery is the primary treatment for Varicocele.  Anesthesia is used to numb the area.  The urologist will make a cut in the lower abdomen and tie off the abnormal veins allowing blood the area into the normal veins. The surgery is usually quick and efficient and the patient can leave the hospital the same day as surgery.  After the procedure, the patient is advised to leave an ice pack on the area for 24 hours.

Varicocele Embolization is an alternative surgery and does not require an overnight stay in the hospital.  This is an image-guided procedure where the cut is much smaller than a surgical cut allowing the patient to heal faster. A catheter is placed into a vein in the groin or neck area and using the patients x-rays as a guide, the doctor moves the catheter into the varicocele.  A tiny coil passes through the catheter into the varicocele allowing the coil to block blood flow to the bad vein and sends it to the normal veins.  After the procedure, the patient will need to place ice on the area and wear scrotal support for a short period.

Urologist Silicon Valley

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New health directives as of 3/17/2020

Be advised that with the new health directives as of 3/17/2020, we WILL remain open, as medical offices are exempt from forced closure. We will see anyone who wants or needs to be seen who is not sick with cough or with a fever. The office will likely not be crowded and we will practice all CDC guidelines requiring social distancing, hand washing, etc. If the situation changes we will update this site.

In certain cases we can offer telemedicine/phone consults depending on the condition.