The Need For Epididymal Repair (More Complex Cases)
Precise microsurgical alignment of the inner canal of the vas lining with ultra-fine monofilament surgical thread that is invisible to the naked eye performed under the microscope with high powered magnification usually results in a normal channel for sperm to travel through and gives the best chance for a pregnancy.
The above diagrams depict the very delicate microscopic technique that we use for connecting the healthy end of the inner canal of the vas directly to the opening we make in the incredibly delicate epididymis in order to bypass the epididymal blockage.
The epididymis is a coiled, 20-foot long, fragile, microscopic tubule that carries sperm from the testicle into the vas deferens. The delicate wall of this tubule is a thin, filmy membrane 1/1000 of an inch in thickness. The diameter of the tubule is 1/300 of an inch, or roughly 1/3 the size of a pinpoint. After vasectomy, the testicle continues to produce sperm and fluid normally. This causes a build-up of pressure within the vas going all the way back to the epididymis. In most individuals this pressure causes a "blow-out" in the epididymis, similar to a leak in the thinnest part of a tire that has more pressure than it can handle. Sperm then leaks into surrounding tissue and causes scarring and obstruction.
Thus the patient has obstruction not only at the original vasectomy site, but also closer to the testicle, at the epididymis' blow-out site. In this situation, reconnection of the vas deferens alone would not restore fertility. Such patients require a more precise reconnection of the vas deferens to this much more delicate epididymis.
The majority of vasectomized men have such epididymal blow-outs. The longer the duration of time since your vasectomy, the greater the chance that you will have epididymal obstruction. However, it is important to understand that epididymal blow-outs can occur anytime following your vasectomy. If this has happened to you, these blow-outs will need to be repaired at the time of your reversal to maximize your chance of regaining fertility.
Above, we see the final connection being made from the outer wall of the vas deferens to the epididymis.
Sperm Production And Sperm Quality After Vasectomy & After Reversal Of Vasectomy
For many years people had wondered what happens to the sperm after vasectomy. Our studies, reported at meetings of the American Fertility Society and the American Urological Association show the following:
- After vasectomy, sperm production continues normally, but sperm transport slows down dramatically in response to the build-up of pressure. This pressure build-up eventually leads to blow-outs in the delicate ductwork which drains sperm from the testicle to the vas deferens, causing blockage not only at the vasectomy site, but also much closer to the testicle. Both sites of blockage must be corrected for the vasectomy reversal to succeed.
- In order for sperm transport to recover properly, this high pressure must be reduced to normal by a technically accurate reconnection of the two ends of the vas. If there is a partial obstruction, or an inadequate channel, sperm transport will not return to normal. For maximum fertility an unobstructed channel must be reconstituted. A scarred-down, partially open channel will slow down the transport of sperm, and lead to only older sperm with poor motility eventually reaching the ejaculate.
- Sperm counts do not reach normal values until 3 to 8 months after the reversal operation. This is the time required for recovery of sperm transport mechanisms. Sometimes sperm recovery requires longer however, and the uncertainty surrounding such a wait is usually less emotionally traumatic when you know that a technically perfect repair has been performed.
- Some have speculated that "sperm antibodies" prevent a successful outcome. Our studies have clearly disproved that theory. Failure of vasectomy reversal is not due to antibodies, but rather to obstruction either at the site of the vas reconnection or at the site of blow-outs in the delicate ductwork of the epididymis.
Diagram of steps in the very delicate microscopic surgical process for bypassing epididymal blowouts, necessary for obtaining high pregnancy rates with vasectomy reversal.
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