Vasectomy reversal is a surgical procedure which essentially allows a man with a vasectomy to change his mind. Although vasectomy itself is readily accomplished in an office setting in about twenty minutes to a half hour, a vasectomy reversal is far more difficult, takes more time and requires microsurgical techniques for the best chances of success. Still, no matter how good the surgeon, the patient plays a major role in the success of the surgery. The following are some suggestions as to how to maximize the chance of success of the surgery from the patient side.
1) General health
The body simply works better if it is healthy. High blood pressure, coronary artery disease, diabetes, and any systemic disease can work against efficient body function. If a man has any of these conditions, it is important that he get them maximally controlled prior to reversal. The fertility of some diabetics is exquisitely sensitive to their blood sugar levels. If it’s chronically elevated, their sperm production and quality of ejaculate will simply be worse. Although being a tri-athlete is unnecessary, good physical conditioning can count, so, if you are able, stay in shape. Finally, age can impact as well. No one grows younger and, on average, men’s sperm production will decrease as age advances; interestingly, up to about age 45, sperm count will stay relatively constant for most men, but there can still be some deterioration in motility and morphology as time passes. That is not to say men over 45 should not have reversals. I have reversed men in their fifties and a few in their sixties who subsequently conceived children, but a younger age tends to go with a better prognosis.
Weight counts. Elevated body mass index is associated with metabolic syndrome, sleep apnea and low testosterone levels, all of which can be contributory to poor testicular function. Try to stay a healthy weight.
Finally, mental health is a part of overall health. Depression, anxiety, and other mental illness can affect results. Although not a mental illness, grief can have an impact. I reversed a patient who lost a loved one shortly after his procedure. His first analysis showed no sperm. Months later, after he was coping better, his semen parameters became normal and he and his wife conceived.
2) Recreational substance use
Some men are more sensitive to certain recreational substances than others, but beyond some level of use, we are all affected. I have a patient who smokes a lot of marijuana. He appears to be very happy, but he is not very fertile; the smoking several times a day has impacted his sperm production. I have similarly seen people indulge after their reversal with the same results.
- Use of other recreational substance like alcohol can also impact on fertility. Although most men can have a couple of drinks a few times a week without significant consequence, at some level of alcohol ingestion, there will be an impact. Chronic alcohol use can take its toll on sperm production through several mechanisms and effects can be long lasting or even permanent. Narcotics can also take their toll, especially in patients who suffer from chronic pain.
- One substance often indulged in by men that is often overlooked with respect to impact on fertility is supplemental testosterone use. I have seen patients for reversal with sky high testosterone levels and suppressed pituitary hormones due to taking testosterone. The problem is that by suppressing production of pituitary hormones, these men are also suppressing their sperm production and their reversal will fail if the situation is not corrected.
- Finally smoking is a bad idea in general and bad for your results. The micro vasculature (blood supply) that enables healing requires enough oxygen to work properly. The carbon monoxide in cigarette smoke will starve those healing tissues of the oxygen they need. With that said, however, don’t abruptly stop smoking right before the surgery. The reactive cough that you get can also be damaging to your healing. Best if you quit several weeks prior to your procedure, or, it it’s right before the procedure, cut down by half.
3) Time since vasectomy
There is a fair amount of literature on this issue. Every year that passes after the vasectomy is associated with a lower chance of reversal success. When it comes to reversal, sooner is better than later. Success rates within 5 years of reversal are very good, within in 10 years, good, and so on.
4) The woman; It takes two to tango.
If you are going through a procedure to reverse your vasectomy, then it only makes sense that your partner is proactive in getting checked out as well. Her health is also important to enable conception and to carry a child. She should see her gynecologist to make certain there are no significant fertility roadblocks on her side.
5) Post operative
Post op care and consideration is very important for a good result. The surgery uses suture finer than human hair to accomplish the reconnection. Tissue has to heal under good conditions for a good result. No sex, sports or strenuous activity is advised for a few weeks as well as wearing support. But even after sex is permitted, use your head. No full contact aerobics, no extreme mud wrestling, in short, no activity that is excessively strenuous for a few months.
Combine these behaviors with good surgical skills and you will have the best results possible for your surgery.