have

Vasectomy Reversal: Fertility Options After Vasectomy | Jesse Mills, MD | UCLAMDChat



Sharing buttons:

good afternoon and thanks for joining me

today this is another webinar series in

UCLA Health's medical webinar series i

am dr. jessie nelson Mills a associate

professor a clinical professor of

Urology and the director of the UCLA

health men's clinic today my subject I'm

very very excited about this is

something that brings me great joy and

gratification as a physician and that's

because we're going to be talking today

about second chances

and what I mean by that is we're going

to be talking about vasectomy reversals

and what I can do as a physician to help

couples achieve pregnancy after the man

is had a vasectomy so before I begin in

earnest

remember to hashtag any questions

through twitter at hashtag UCLA md chat

and for that at the end of the episode

here we will have some time for question

and answers from the audience so before

I get into vasectomy reversals we have

to figure out how we got there in the

first place and so we're going to talk a

little bit about vasectomy and a little

background on that is it a vasectomy is

the easiest probably most cost-effective

way for couples to achieve permanent

sterility or permanent inability to

achieve pregnancy after after a

vasectomy and so because it's so common

we have a lot of literature about this

and we have a lot of facts that I want

to go over essentially this is a very

very common procedure it's also probably

unless it is definitely less invasive

but also more cost effective than female

sterilization as well as if a man is

able to get a vasectomy and he's with

the same partner then the females don't

have to go on oral contraceptives and we

don't have to worry about barrier

protection for for pregnancy prevention

so so it's a very quick easy operation

upwards of 15 to 20 minutes outpatient

procedure so it makes sense for a lot of

couples to to elect for a vasectomy for

their their reproductive needs

having said that guys have a lot of

questions surrounding vasectomy and I'm

happy to answer any of these at the end

of the seminar as well but one of the

things that I get all the time is what

happens to the sperm after a vasectomy

so the man continues to make sperm as if

nothing changes after the after the

vasectomy in other words a vasectomy all

it does is it closes that road so that

roadblock is in place and every time a

man ejaculates the same amount of semen

comes out same amount of fluid in other

words but he still does have a that

roadblock in in his in his vasectomy

now the sperm get stored inside the

testicle and they don't go anywhere

which is fine what happens after about

four or five days is the sperm involute

in other words the cells are made the

sperm are ready to go and once they're

ready to go if they have no place to go

they just sort of shrivel up and die and

get remodeled and and come back to fight

another day so once that happens if the

secta me is so common upwards of 500

thousand a year and not all marriages

end in happily ever after so we have

somewhere around a thirty percent

divorce rate in this country we used to

think it was much higher it's actually

been on the decline over the last decade

or so but there are a lot of men that

get vasectomies and then decide for

whatever reason to have a reversal so

let's go over who that guy looks like

and what that couple looks like so

change in female partner as I alluded to

so a man and a woman marry have children

they decide on vasectomy and then

something happens to the relationship

and now the man is with somebody else

who would still like to have kids so

that's very common scenario but not

exclusive by any means and not

necessarily the most common scenario

there are also men and women that decide

on vasectomy for sterilization they have

two children and they decide they're

done and that little kid is so cute that

they decide that they need to make a

middle child and have yet another have

another child so therefore I do plenty

of the second reversals on couples that

have just decided to add to their roster

what about changes in religious status

or some religions as we know

prohibit vasectomy is a

birth control and there are people and

men that decide to convert later in life

to those religions and so certainly

vasectomy reversal for religious

preferences is also something I

performed over the years now one of the

things that we don't hear a lot about in

vasectomy but is a very important part

of my practice is there are there's a

very small number of men that after

their their vasectomy end up with

significant and often debilitating pain

after the vasectomy we're not exactly

sure why that happens it is probably

something to do with obstruction of that

the the sperm fluid that causes this

back pressure in pain and why that

doesn't happen to most men we don't know

and why it happens to a very small

percentage of men somewhere around one

in a thousand to one in 3,000 men after

the second we'll have this pain it's

very very significant and so about I'd

say 8 to 10 to 12 times a year I perform

a vasectomy reversal purely because that

man after his vasectomy is having pain

so the goals are different obviously I'm

not these couples are not trying to

initiate pregnancies again but what

we're trying to do is relieve that

blockage and we'll get into how I do

have a second.we reversal in a few

slides and have a little better

understanding of that anatomy to

understand why this could occur and then

what I do to fix it what about the men

that have gone somewhere else for

vasectomy reversal and it didn't work

are they still candidates for a redo

vasectomy reversal and the answer is

absolutely

once I evaluate them and and we go into

some of the evaluations necessary on the

female side as well prior to electing

vasectomy reversal as a way to establish

fertility again

so here is the anatomy at least of the

vas deferens and of the epididymis and

again I'm going to turn towards my

drawing here a little bit to show

exactly where a vasectomy is done and

then also where vasectomy reversals are

performed so the vas deferens itself

starts really as this little tube that

comes off the backside of the testicle

and goes all the way up into the scrotum

and eventually up into the urethra so

the actual vas deferens in a human is

about this long where most

vasectomies is the scrotum is somewhere

from about here all the way down to here

so somewhere in here is the common site

for a actual of the second amine so when

I'm planning my surgical case I'm always

visualizing exactly where that vasectomy

site is and that's the place I'm going

to target first to find a way to put

this man's vas deferens back together

and so basal tube here the other

important gland I want to point out has

this gland that looks like a little sea

called the epididymis and the vas

deferens is really merely a continuation

of the epididymis the other way to look

at it is the epididymis is a very very

finely coiled tube the diameter of the

tubules of the epididymis is somewhere

around a third of a millimeter as the

epididymis stretches out into the vas

deferens the diameter of the inside of

the vas deferens is somewhere around in

millimeters so you know that we're going

to be discussing operating under a

surgical microscope to even consider

putting things these structures back

together appropriately and adequately so

epididymis is then attached to the

testicle and the sperm essentially made

in the testicle and then through a

series of ducts these little very very

very small tubes is what is how the

sperm get from the testicle into the

epididymis and eventually along that

tube all the way up into the the urethra

and the ejaculatory duct do they meet

somebody who knocks them off their feet

and she in fact what skids and so they

come see me

so prior paternity is important if he

hasn't had children my workup and

evaluation is slightly different I want

to know how healthy the man is not only

from what I think I might find

impairments in sperm production but also

just as general health and if there's

any way I can intervene to make him

healthier that's probably going to make

his sperm healthier as well and

ultimately that's what I'm doing I'm

doctoring both the man and his sperm I

want to know what medications he's

taking because there are a few that have

a significant impact on sperm production

so if you tuned in for my last webinar

in male fertility we had a little

discussion about testosterone therapy

which is becoming increasingly more

common and sperm production and it

essentially completely shuts down sperm

production the tricky thing about

testosterone is in this country it's not

a pill it's most often put on as a sad

or gel and a lot of men don't consider

testosterone therapy medication it's

just something they put on in the

morning

and that's it critical for me because if

I don't ask that question and I go in to

do his surgery and I put him back

together and I don't find sperm I don't

know if he's not making sperm because

he's got a genetic abnormality or

whether he's on some medication that

suppresses it but the bottom line is

finding it out in the operating room is

not the right time to find it out other

critical factor and this is something

we'll touch on a little bit later as

well is how far out is the man from his

vasectomy anybody that's done any

research and reading about vasectomy

reversals that's the first thing that

comes up in terms of predicting success

rates and we'll get into how important

that is but we'll also get into some of

the reasons that that's relatively

important as well and that comes down to

some of the surgical aspects that we're

going to discuss later but it is a

general rule of importance that the

longer man is out from his vasectomy

potentially the chances of a successful

reversal go down but more important than

that it changes the surgical complexity

and that again speaks to the fact that

if you're going to go through this

procedure you want to go with a

physician that's very capable of

performing whatever physician whatever

procedure you need in order to get the

out outcome that you'd like on the

female side the age of a female is very

very important obviously I want to know

not only how old she is but what her

fertility potential is in other words

does she have any medical conditions

that may prohibit her from being able to

achieve the pregnancy because as great

of a surgery as I can do to restore

restore spur into a man's ejaculate if

I'm not at least addressing the female

side of this I've done that couple no

good so I want to know her fertility

potential and I also want to know her

patients level and I don't mean this

tongue-in-cheek it's true that there is

a difference in how I counsel couples

based on when they want to get pregnant

and you'd be surprised but not every

couple that comes to see me says that

they need to be pregnant in two months

one month six months twelve months most

of my couples plan out their vasectomy

reversal

based on when they actually want to

achieve pregnancy but if a couple comes

to me and they say that they really

really need to be pregnant in the next

two or three months we're gonna have a

very different different conversation

than if they are a little more patient

with with when they want to achieve

pregnancy and again that circles back to

the age of the female because if a

female is approaching the end of her

childbearing potential years then

perhaps a vasectomy reversal is not the

right procedure and we'll talk about

that in our alternative section coming

up so how do I counsel on success rates

and that's going to be the first

question I'll guarantee probably because

I wrote it but I'm sure it'll come

through on the web as well through our

Twitter feed what is that what are your

success rates and and how do I know if

this is going to be successful so one of

the things that I say is time from

vasectomy as we discussed earlier very

important but I will tell you that the

reason that's important is because when

I do the reversal the first thing I do

once I make my incision and I find where

the vas was cut at the time of the

vasectomy and I open up that tube I look

at the fluid coming out and that fluid

is going to teach me and tell me what

operation I need to do and where I need

to put that man's vas deferens back

together because we grade our fluid

based on the presence of sperm and the

consistency of the fluid and that's

critical because what can happen and a

man's sperm fluid over time is it can

develop what we call inspirations which

is essentially where the fluid gets very

very thick up to sometimes the

consistency of and I don't gross people

out but we do use the word toothpaste

and it looks just like you're squeezing

a tube of toothpaste when that fluid

comes out that's not even fluid anymore

and the reason that's important is that

if I saw that and I put that man's vas

deferens back together perfectly and I

would come out and say it was a great

operation I'm very happy with not only

my surgical technique but how things

went I have done nothing I've done

nothing to make that couple any more

fertile than they were before their

vasectomy because that fluid is so thick

that that body the vas deferens will

never be able to

push that out to get back to where the

sperm really are so if I see thick fluid

that is there that I know is unable to

be ejaculated when I actually put this

man back together then that operation

can't be done and I have to go to a

slightly different procedure which we'll

talk about but when I do that slightly

different procedure success rates go

down so for me a great day in the

operating room an easier day in the

operating room is when I open up that

vas deferens and I still see sperm and

if they're swimming that's the best

possible outcome so if I see motile

swimming happy sperm in the vas deferens

at the time of the reversal and most of

the time essentially a hundred percent

of the time that man is going to have a

good return of spurn to his ejaculate

and therefore the chances of pregnancy

are gonna skyrocket if I get in and the

fluid is clear or thin and at least I'm

seeing non motile sperm so they're there

they're just not swimming that goes back

to what we talked about a few slides

back in that the just the time from the

vasectomy is going to dictate often

whether or not there's swimming sperm at

the time of reversal but I know that

that man is going to be able to

ejaculate out those non motile sperm to

get were the good swimmers are and again

we'll be able to restore fertility if I

get in and I find sperm fragments mean

and I see heads of sperm and tails of

sperm this is just a timeline so in

other words that just means that those

fragments used to be sperm and they're

on that pathway to complete reabsorption

by the body and again it just changes

how easily and how quickly sperm is

going to return to that man's ejaculate

so quality of fluid is critical so if I

do a vasectomy reversal on a man that's

one year out from his vasectomy and I

find that paste and I do have a second

reversal on a man that's 35 years out

from his vasectomy and I find motile

sperm who do you think is going to have

the best chance as a success it's the

guy with motile sperm it doesn't matter

whether he was a year out or 35 years

out so again that's why it's relative

the time to vasectomy and there's a

couple of things that we can do to

predict whether or not I'm going to find

that motile sperm on that

and the two things that I look for on my

physical exam when I see that man is I

want to know where in the scrotum is a

vasectomy was done we know that the

higher up in the scrotum the further

away from the testicle the better the

chances of finding good sperm at the

time of reversal that's number one and

number two is that there is a little

scar tissue that we call a sperm

granuloma and it feels sometimes like a

pea-sized nodule sometimes they can be

as big as golf balls but essentially the

presence of a granuloma in the in the

scrotum on the vas deferens is also not

quite a hundred percent but about as

close to a hundred percent predictive

that we're gonna find good sperm and

good fluid at the time of Evis acting we

reversal so I can do that at the time of

his initial consultation which is why

this is so important to get an

evaluation ahead of time from from your

your reversal surgeon it's that physical

exam is critical for he or she to give

you the best chances of a successful

prediction for outcomes of this

procedure so that's what the physical

exam findings tell me experience of the

surgeon a shameless self plug but really

you do want to go to somebody that has

done hundreds if not thousands of these

procedures and has done them well and

has a good national reputation and makes

a living doing this in other words the

people that do this the best are the

ones that are primarily dedicating their

practice to micro surgeries so that's

who you want to seek out the other

aspect to training for this is that it's

not just about the surgery it's also

about the follow-up and it's also about

managing a man's hormones and we'll talk

about that a little bit towards the end

as well but very critical that not only

am i doing a very my very best job

possible in the operating room I'm also

managing that man's overall health in

the post-op period as well as his

hormones to make sure we're optimizing

sperm production because we don't want

to convert a man from an obstruction

which is what a vasectomy is to a non

obstruction and not address any

production issues as well because the

goal of this is optimization we want to

make this man as fertile as we possibly

can make him and give that couple the

best chance

of achieving pregnancy follow-up is also

important so I like to see my couples

back every four to six weeks until they

achieve pregnancy because I want to

follow his sperm counts a lot of times

what happens is that initial sperm count

when I see them around six weeks I'll

see some sperm but they may not be

completely optimal and what I mean by

that is they may be there and they may

be there in good concentration but their

motility they may not be swimming really

well or I might find under the

microscope that their sperm are all

stuck together and that's something that

I can fix with medications and so we'll

get into that a little bit as well and

I'm sure during the question and answer

someone will have a question about anti

sperm antibodies so what does the

procedure actually like we're going to

talk about preparation and one of the

last slides so what we're going to focus

on is the duration a guy wants to know

exactly what I'm gonna do with him most

of the time some of my guys say doc I

don't care what you do to me

knock me out make me better and tell me

how it went so for those guys you may

want to go grab a coke and let your

wives and partners hear what I'm going

to say next because we all will talk

about the procedure itself so usually

the surgery takes anywhere from two to

three hours sometimes even a little bit

longer the goal of surgeries of course

is to do exactly as much as it takes to

give that man the best possible outcome

so so occasionally if everything is very

straightforward

I find sperm right away I'm able to put

his vas deferens back together vas to

vas and do what's called a vaso of a

system II which is this procedure on top

that's about a two hour procedure if I

get to that point in the procedure that

we talked about earlier where I don't

find sperm I find that thick pasty fluid

in the vas deferens then I have to do

something entirely different I have to

do something called a vaso epididymis to

me what a vaso epididymis to me is is

also referred to as a Veysel bypass

because essentially I am bypassing the

vas deferens where even though I I find

that the tissue looks good if that fluid

is so thick that I can't get around that

to get to where I find sperm I haven't

done that manatee good so if you

remember that drawing we had a few

slides earlier

I'm essentially taking that by that vas

deferens going all the way around the

obstructed vas and finding the

epididymis where actually I can find

sperm and I'm plugging the vas deferens

a millimeter wide remember very tiny

into the vas re into the epididymis

which is about a third of a millimeter

wide and essentially that is the the one

of the most tricky things we do in micro

surgery and even if I do that perfectly

that's where we talk about discrepancies

and success rates is that vaso

epididymis to me because you're sewing

together tubes that are less than a

millimeter wide there's a chance that

those tubes will never heal without

scarring even if there's a couple cell

layers of scar that may be enough to

prevent a perfect outcome having said

that we still have good chances and if

we do if we do this surgery enough and

get good at it then you should have very

very good chances even with the

vasoepididymostomy key is again surgeon

selection make sure he or she is able to

do that procedure before you sign up so

at the time of the surgery it's done

with their general anaesthetic most men

I allow them to breathe on their own

during the surgery so in other words my

anesthesiologist is controlling their

airway they're comfortable on some

intravenous sedation as well as a little

bit of oxygen and an inhalational

anesthetic but they wake up very nicely

at the end they don't I typically don't

have to put them on a heavy heavy deep

deep anesthesia and again after 2 or 3

hours they wake up with two small

incisions my incisions are almost

exactly the length of the man's testicle

so if a guy has big testicles lucky him

but that incision is going to be larger

if his testicles are not as big the

incisions always are going to be a

little bit smaller so that's as big as I

need to make it to get in there and find

the window I need to put that man's vas

deferens back together

I usually have men abstain from

showering for the day of the procedure

the next morning they can get up take

all their dressings off which is just a

big fluffy lot of gauze they get in the

shower no special wound care typically

they have them wear nice tight

undergarments I love the the tight

compression shorts better than

the gym class jockstraps that most

people are comfortable with but they

work really well for keeping everything

where I want them and they do that for

about a week after about two weeks allow

them to get back to full activity

including he has sexual intercourse and

this is good homework but it's important

for couples to actually ejaculate very

frequently because that's what helps

wash out that sperm that is obstructed

and not quite as happy swimming and get

to the guys that are being newly

manufactured so so that frequent

ejaculation is important after about six

weeks I'll see them back in the office

unless I see them at that two-week visit

especially if they're if they're local

here but it's six weeks is where I

really want to see them make sure that

I'm happy with how the semen analysis

looks and make sure I don't have to do

anything special with them based on that

semen analysis finding so what if my

first vasectomy reversal failed this is

not infrequent success rates of

vasectomy reversals people will quote

anywhere from fifty to ninety eight

percent so that's a huge range and it

depends on the surgeon and depends on

the operation as we talked about but

there's a lot of men I see on an annual

basis that have gone elsewhere

and didn't work so we end up having to

actually redo the procedure can I do it

sure does it work sure the technical

considerations are different so it's not

always the same every time I do an

operation I'm prepared to do whatever

operation it takes but when a man has

already had a reversal I have to do two

things I have to find where that

reversal site was and unblock that and

usually bypass that and then I have to

get in and still look for where the the

fluid is and where the sperm are and so

the reason for that is if a guy had a

vasectomy and had his reversal and at

the time of his reversal that surgeon

did not evaluate that fluid quality and

just did a simple vas to vas that may be

why it failed as we talked about earlier

so I need to determine that before I

move on and figure out exactly how to

put this man back together so I never

quit the surgery I never know exactly

what I'm doing until I see sperm and

when I see that sperm and I know where

it is that's when I can plug that man

back in and give him the best chances of

a successful surgery so what if

vasectomy reversal isn't the right

operation and and why would that be and

there are a few reasons we alluded to

earlier now we're going to get into it

so a couple of things that I need to

clarify is the only way for couples to

achieve pregnancy after vasectomy is

either a successful vasectomy reversal

or a sperm extraction for in vitro

fertilization and that's the key a

question I get all the time is can't I

just aspirate sperm out and then use

that for insemination or intrauterine

insemination this IUI it doesn't work

and the reason it doesn't work is that

we need millions of sperm for a

successful IUI

if I'm doing a sperm aspiration I'm

happy if I get one million sperm

sometimes two sometimes more but the

bottom line is the minute I start

aspirating sperm I'm creating scar

tissue in that man's epididymis makes it

very difficult to go back to that same

spot or anywhere else and find sperm if

that IUI didn't work the first time so

it's purely a matter of quantity in

order for an IUI to be successful we

need ejaculated sperm so again has to be

done through either a vasectomy reversal

or sperm extraction for IVF that's the

only way or in vitro fertilization the

only way that we're gonna be able to

establish pregnancy after vasectomy and

again if you tuned into my last webinar

on fertility if you didn't welcome to go

back and see it it's still posted but

essentially we talked about these

different acronyms for sperm extraction

and after a vasectomy

the most common way most of us fertility

specialists will get sperm for in-vitro

fertilization is through what's called a

pacer or a percutaneous epididymal sperm

aspiration the reason for that is we

know what the guy's problem is we know

that he had a vasectomy so we should be

able to find sperm in the epididymis so

we take a small aspirating syringe and

then take out as much sperm as we can

from that epididymis and we use that for

IVF a Mesa is a little bit more involved

it's done

through an incision and a microsurgical

microscope and that's if we're not

finding a spot where we have adequate

sperm or for a surgeon's preference some

of us just prefer to do everything under

a microscope if I get in I'm doing a

peso or a Mesa and that sperm is not

motile it's too old then I end up having

to go back into the testicle same

operation again if I'm doing a sperm

extraction I don't leave the operating

room or procedure room until I find

sperm that's viable for in-vitro then

we'll do some of the testicular sperm

extractions either and again most of the

time at this point I've made it a tiny

little window incision and I'll be doing

what's called a testicular sperm

extraction but you can also do that

percutaneously or through a small

puncture puncture incision as well and

then lastly for I cannot see too many

reasons why after a vasectomy a man

would need a micro surgical testicular

sperm extraction we usually use that

procedure for men where we don't know

why they're not making sperm or their

sperm quantities are so low but again

that's the way we do sperm extraction

and so why would we do this why would I

take business out of my own practice and

say let's do sperm extraction instead it

goes to the age of the female partner so

again if that woman is towards the end

of her fertility potential years whether

that's thirty four whether that's forty

four again I would leave that evaluation

up to the females reproductive

endocrinologist or ob/gyn that

determines that they may have more of an

imperative to get pregnant sooner than

later and if you look at vasectomy

reversals and time to pregnancy most of

the time it takes about three months to

get good quality and good quantity of

sperm back into the ejaculation after

Evis ectomy reversal and it can take up

to 18 months before we actually see

pregnancies so this is a wide window and

if that female partner doesn't have 18

months before she has her ovarian

reserve depleted then we need to think

about something other than reversal

upfront so that's why we had the

discussion about about sperm extraction

& Veatch

fertilization at that first consultation

if a couple wants more than one child

and they don't want to go through the

IVF or in-vitro fertilization process

more than once due to expense or due to

stress on the female partner or for

whatever reason discectomy reversal if

successful should remain successful

should remain successful so that men can

have multiple children after their

reversal so that's critical there are

couples that just do not want to have in

vitro fertilization and want to do this

spontaneously and naturally as much as

possible so they're going to be the best

candidates for vasectomy reversal now

the expense and that'll be another

question I'm sure and it's hard to nail

down exactly where the second reversal

because this is a medical procedure and

every man is different and his needs may

be different and there may be different

tests that we have to do in order to

look at suitability but in general

globally you can think of in vitro

fertilization and sperm extraction to

have a price tag somewhere in the

$20,000 plus range whereas vasectomy

reversal you can think globally is

somewhere under $10,000 there's all

kinds of variabilities and it depends on

what part of the country and what and

what kind of surgeon you're going to but

remember those numbers then in general

vasectomy reversal is more cost

effective if it's the right operation

for the right couple what about success

rates again those are all over the place

and it's very difficult to quote both

because each success rate has to be

determined by the viability of both the

male and the female partner and that

goes for either IVF or vasectomy

reversal

so in general we go back to that falling

on the fact that if we're doing a

vasovagal other words if I find that

good quality fluid at the time of the

SAC Daly reversal then the success rates

of getting sperm in the ejaculate are in

the high 90% range but again that's only

relative right because if I do a great

surgery and the man's got plenty of

sperm in the ejaculate and they're not

pregnant to me that's not a successful

outcome

and so the goal

is follow up with your surgeon follow up

to make sure that we're finding out how

to achieve your pregnancy goals outside

of what happened in the operating room

and again the recovery time reversal

versus sperm extraction if I'm doing it

that percutaneous sperm aspiration those

guys are usually able to get back to

work very quickly less than a week

before they can get back to normal

activity whereas a vasectomy reversal as

we talked about earlier is more of a

week long process of healing in two

weeks before they can resume completely

normal activity so how do you go about

choosing a surgeon who do you want to

see doing your vasectomy reversal if

you've made that decision so you want

somebody that is fellowship trained this

is critical the explosion of medical

knowledge in this country over the last

thirty years is so great as is the

explosion in surgical techniques that

you want somebody that truly specializes

in whatever procedure that you're doing

it's really difficult these days to be

somebody that has no post surgical post

residency training and doing such a

highly specialized operation so if you

go to someone that's fellowship trained

you know not only they have the academic

credentials to do the right work up the

appropriate workup but also the surgical

credentials to give you the best

possible outcome so ask it's an easy

question to ask to make sure they're

board-certified neurologists and get an

idea for your comfort level with that

that person you also want them to be

knowledgeable in endocrinology as we

talked about I can do a great operation

put a guy back together perfectly but if

I'm not managing his hormones that

they're responsible for sperm production

then he may not be getting the adequate

care he needs so you want somebody not

only comfortable in the operating room

but comfortable in the exam room and the

clinic to optimize your outcomes you got

to have somebody that's available and

willing to follow up and willing to make

sure they're gonna go the extra mile to

get you pregnant after that procedure

it's not just about the time in the

operating room very important to have

follow-up and obviously somebody that

has that does a lot of these and that

has a good reputation both in the

community and

essentially nationwide and then also

getting back to making sure that you're

not just going to a vasectomy reversal

factory where everybody that walks in

that has a vasectomy gets a reversal in

our good medicine not what you should do

you should go to somebody that can

counsel you and really give you the best

possible procedure and best possible

outcome Diagnostics to get what you

truly came into that office for which is

a pregnancy alright so now we're getting

into preparation what does a guy got to

do to get into the operating room and

have as best an outcome as possible

so if you smoke stop it's terrible it's

terrible for sperm is terrible for

babies it's terrible for everything and

that is your public service announcement

on quitting smoking don't do it if you

exercise keep doing it I love it I'm

going to get questions about is it okay

for my husband to keep riding his

bicycle for the most part bicycles and

fertility are fine unless you're riding

100 miles a day or 500 miles a week and

you're developing saddle numbness and

difficulties achieving directions from

penile numbness for the most part most

of us recreational cyclists can keep on

doing that keep exercising if you don't

start pretty easy it's good for us right

if you take any blood thinners it does

increase the complication rate so I like

to have my men stop about a week ahead

of time especially some of the newer

agents that are antiplatelet blood

thinners those are harder to test for it

does make the procedure a little bit

more conflict complex complicated and

increases your risk of post-operative

complications all right we actually got

to the end of this webinar I'd be

delighted to answer questions again

hashtag UCLA MD chat for questions and

for appointments to see one of the

specialists at the men's clinic the

phone number is down here below to call

and schedule your appointment it looks

like we already have some questions so

I'll grab the iPad and we'll start going

okay so here's a question I like this

question is it okay to get a vasectomy

now and reverse it later sure so that

goes back into the if a guy is pretty

sure he doesn't want to have kids

anytime soon is it okay to get a

vasectomy

and then he can come back later to get

it reversed the answer is of course it's

okay is it 100% successful no and it

goes back to what we just discussed so

so if a man is comfortable with the fact

that he has a reasonable chance of

becoming a dad when he wants to become a

dad later in life then that's a

perfectly appropriate route to take

however I'm contstantly counseling my

men for vasectomy that they need to be

really sure because not only is it a

bigger procedure to get it reversed and

because the success rates aren't

anywhere near 100% for pregnancy

outcomes then he really needs to think

about that one of the other things that

I discussed with my men that I counseled

for vasectomies is consider banking

sperm before you've respected me if

you're not sure absolutely that you

never want to have children then

spending a few hundred bucks on sperm

banking before your vasectomy is

probably going to be the most cost

effective way to achieve fatherhood

after revert I'm sorry after vasectomy

now of course the downside to that is

that once you bank those sperm they can

only be used for insemination IUI or IVF

depending on how much you bank and so

that's going to be a discussion you're

going to have to have with your future

partner that you've had a vasectomy good

news you've got sperm at the bank bad

news is she's going to have to get

pregnant through assisted reproductive

technology enhanced his sperm banking an

option before vasectomy absolutely

highly recommend it if there's if

there's even a shred of doubt it's a

peace of mind and it will save you money

in the long run so another questions

come up recently and this actually went

to went to bed and then came back again

what is relationship between vasectomy

and cancer risk so there were some

papers that were put out a

long time ago that showed that there may

be an increased risk of prostate cancer

in men that have had vasectomy since

that time there's been a lot of research

that shows that that's probably not

that's a it's a statistical correlation

but not actually a causation meaning

that men that have had vasectomies tend

to be more enfranchised in the medical

community and therefore they're getting

screened on a higher percentage for

prostate cancer they most likely have

already been to a neurologist who did

their vasectomy and they're comfortable

going back for prostate cancer screening

and that's why we see that blip however

recently there have been some more

studies that show that there actually

may be a slight increased risk that is

independent of just that one correlation

so we really don't know yet there's

certainly a lot of different options out

there I'm sorry a lot of different

opinions out there and I don't think

we've got that complete answer but

there's nobody it in any governing board

or professional society that is

recommending against vasectomy at this

point because of a potential risk of

increased cancer so can I expand on

sperm antibodies post-surgery and how

does it reflect a cover recovery times

so as we were talking about the the way

that I get concerned about sperm

antibodies is if I do a reversal on

somebody and I'm looking at their semen

analysis postoperatively and I see under

the microscope that there are a few

sperm that are happily swimming and then

there is a bunch of sperm that are all

clumped together so that their sperm

counts look good but those sperms that

are clumped together they're clumped

because they're sticky and they're

sticky often because they've they've had

an antibody reaction from the man's

serum that has gotten into their semen

and sperm that has then made those sperm

essentially non viable so the way that

we treat anti sperm antibodies is by

looking for that first minimizing that

man's exposure to reactive oxygen

species and free radicals usually

through anti-inflammatories and then

often through steroids just like any any

antibody mediated

a response or an immune system mediated

response whether it's rheumatoid

arthritis or whether it's a kidney

transplant that we're trying to avoid

rejection of we use steroids I do a

short course and that usually clears it

up so that those antibodies go are

suppressed long enough for that couple

to achieve pregnancy so they're very

important but only in the context if

they are impeding actual sperm release

and and and sperm being able to do what

they need to do so important but again

treatable most of the time let me see if

we have any more questions coming in so

far it looks like we're okay so I think

at this point I really appreciate

everybody's attention to this webinar

and the second we reversal and fertility

options after vasectomy thanks again for

tuning in and again this will be up

later on the UCLA health website for

replace and appointment numbers down

below feel free to call with any

questions thanks very much

Oh