Ask the Doctor

From Chris:-
I just had a consultation this afternoon, and the doctor told me that my vas deferens was to deep and would be difficult for me to have the procedure in his office. He recommended having the procedure in the hospital after I was put under. All I know is that while he was feeeling for the vas deferens I was in tremendous pain. Have you ever heard of this before? I really want to help my wife who is sick of the pill and the new noa ring but I really do not feel comfortable going through a huge procedure at the hospital. I have read up and asked a lot of my friends and they tell me it was a quick office procudure. What are your thoughts? Any help would be appreciated

Male scrotal anatomy varies amongst individual men as does ability and comfort level of individual vasectomy surgeons. Some men have a “tight” scrotum or additional scrotal pathology such as a cord lipoma, incompletely descended testicle, varicocele or hydrocele that can increase the difficulty of performing a vasectomy. If a surgeon is uncomfortable performing a vasectomy under a local anesthetic in the office then it should be done in the operating room with a general anesthetic. However, it is rarely necessary to perform vasectomy in the operating room. A second opinion from an experienced vasectomy specialist may be useful in understanding if a trip to the operating room is truly necessary.

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From Charlene:-
The guy I’m seeing had a cyst on his testicle. It has been there for quiet some time. He has lived with pain for 18 years. They just now found out what it was. He would have pain from time to time. Some of the pain would make him want to jump out of his seat. Sex was also painful for him. We stopped having sex last December. In January he had surgery and they removed the testicle along with the cyst. He asked his dr about having sex and how soon we could again. The dr said when he was ready it would be ok. We tried in March to have sex. He doesn’t think he ejectulated from the experience. He still has some mild discomfort from time to time. He says he can live with that for now. But he has no sex drive. He doesn’t ever get a hard on anymore or have the urge. I keep asking him to call the dr but he doesn’t want to. He would rather give up sex. Is this normal? What can we do to change this? Will he just start having urges over time? The surgery was in Jan it is now mid June.
Thank you for your help.

Sex drive (libido) and erections are highly dependent on having a normal testosterone level. Testosterone is almost exclusively produced by a man’s testicles. Removal of one of the testicles can decrease a man’s testosterone level by 50% initially. Usually, the remaining testicle will grow to compensate for the decreased function of the absent testicle. This compensatory function of the remaining testicle is highly variable in terms of time and quantity of testosterone produced. A good general rule of thumb is to check a man’s testosterone level 3-6 months after removal of a testicle to determine wether or not testosterone replacement therapy is indicated. Testosterone replacement therapy is readily available and comes in the form of transdermal gels, patches, injections, subcutaneous pellets and buccal pellets.

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From Jennifer:-
What are the chances that a vasectomy can fail a 2nd time? My husband had his first done in early May 2007. The pieces they sent to the lab were confirmed as vas deferens. Testing in late June showed that he still had plenty of live sperm. He was tested again in September 2007 and his numbers had gone up. He had it redone in October 2007, testing in December 2007 and March 2008 showed there to be 0 sperm.

I just want to know if there’s a chance that they’ll grow back together again. I did become pregnant in July 2007 (we knew and stopped using birth control). We are most definitely done having children, but the worry that it failed once, and could happen again, is always with me.

Most vasectomy failures are apparent within the first 3 months and demonstrate at least non-motile sperm on one of the first two semen analysis reports, as is the case in this reader. Vasectomy failure after this initial period is very rare, but has been reported in the literature and is due to re-canalization of the vas deferens. Periodic testing every few months during the first 1-2 years can identify re-canalization if it should occur. Re-canalization becomes increasingly rarer the further a man is from his vasectomy. Even though there are no absolutes in life, or medicine for this matter, vasectomy still offers the highest rate of contraception compared to other methods. Late vasectomy failure is reported at 0.01% compared to condoms that have an approximately 11% failure rate. The only form of contraception that is more reliable than vasectomy is abstinence! If abstinence is not suitable contraception, then men should consider vasectomy as the next best thing.

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From Barb:-
My husband had a vasectomy in January 2004. He had a reversal in November 2006. We conceived our daughter three months later. When our daughter was six weeks old in January 2008 my husband had another vasectomy. He has had semen analysis’ done very six weeks since the second vasectomy and each sample shows that there is still sperm. The sample in April showed 28,000,000 sperm per mL and motility was 4%. The sample in June showed 9,400,000 sperm per mL with 37% motility. The latest sample shows 84,000,000 sperm per mL and 6% motility. I am wondering if the latest results were maybe supposed to be 8,400,000 to indicate a decrease in sperm? Also, how can the sperm count and motility vary so much? Do these tests indicate a vasectomy that has failed and in the future will continue to be a failure.

Persistent motile sperm in the ejaculate after a vasectomy represents a failed vasectomy on one or both sides. Care should be taken during sexual intercourse to prevent an unwanted pregnancy. Repeat vasectomy should be performed if sterility is desired.

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From Kal:-

I’ve read that men who are considering children later by banking sperm aren’t ideal candidates for vasectomy. That is me, exactly. Can you please elaborate why anyone would feel regret about storing sperm “just in case”?

Although vasectomy reversal is a highly successful operation for returning sperm to the ejaculate, it is not 100% successful in every man and therefore we do not recommend vasectomy for any man who is still contemplating having children in the future. Sperm banking ensures that the man will have sperm available without needing an intervention, but this is most often a limited supply and should be carefully used for IUI or IVF. The success of IUI per cycle is approximately 17% in the most ideal situations. The success of IVF is approximately 35-40% per cycle. Thus, multiple cycles of IUI or IVF might be required and a man would have to bank numerous vials of sperm which can become costly. In addition to the initial cost of sperm banking, there are annual fees associated with banking each vial of sperm. Men should never regret storing sperm prior to performing a vasectomy, but they must understand that it does not ensure that they will be able to get someone pregnant with that sperm. We always encourage men to utilize some other form of temporary contraception, other than vasectomy, if they are considering having children in the future.

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From Brad:-
I had a Vasectomy over 10 years ago. I had constant pain since. I saw a Urologist and was told that the only option was a Epididymectomy. I had the surgery and the pain got worst and I now suffer from Erectile disfunction. Why can’t we still do a reversal using part of the other side or a vein or even a donar organ? I am willing to try anything.

If I had fully understood the surgery I would have never had it done. I thought that they could always use some of the Vas Deferens. Please any help would be greatly appreciated..

Sperm is produced in the testicle and then travels to the epididymis where it matures and is stored. The epididymis is then connected to the vas deferens at the opposite end from which it is connected to the testicle. The vas deferens then travels behind the bladder until it is connected to the ejaculatory duct. Vasectomies can only be reversed by reconnecting the vas deferens at the previous vasectomy site or by connecting the vas deferens directly to the epididymis. Since the epididymis has been removed (epididymectomy), re-connecting the vas deferens will not have any benefit since there is no epididymis. To my knowledge, donor organ transplantation of the epididymis has never been perfomed nor would it be successful if attempted.

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I’m sorry if this question has been asked already, I didn’t have time to check because I’m in a hurry. Okay, my best friend has this new boyfriend and he’s 16 years old, and he convinced her to have sex with him, but at first she said no because they didn’t have protection and she was scared of getting pregnant. Then he told her that his mom took him to get a vasectomy because he was having sex with too many girls. I would just like to know if what he said is possible or not? Thank you, and I really appreciate it.

It is unlikely, but not impossible, that any physician would perform a vasectomy on a 16 year old boy.

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From Sreenu:-
The following report came after 1 year of my vasectomy
Clarify whether the operation successful.Kindly tell me is it necessary to have the test one more time.
SPECIMEN COLLECTION
Nature of collection : masturbation
Period of absence : 3 days
Time of colln : 7.40pm(IST)
PHYSICAL EXAMINATION
Volume :03ml
Colour : opaque
Liquification time: 30min
Reaction : alkaline
MICROSCOPIC EXAMINATION
Sperm count <0.1 millions/ml
Sperm motility : nil
Active : nil
Sluggish:nil
Non-motile : 100%
Sperm morphology : abnormal forms 25% include pinhead forms

This semen analysis reports demonstrates persistent non-motile sperm in the ejaculate one year after a vasectomy. Most surgeons would not consider a man sterile under these conditions and would recommend repeat testing after 6 weeks and repeated ejaculations. This semen analysis could also represent the earliest signs of re-canalization of the vas deferens. If this is the case, then we should see increased number of sperm and some sperm with motility upon re-check in 6 weeks. The sample should be properly handled by the testing facility within 30 minutes of collection to assess for sperm motility.

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From Christy:-
My husband had his original vasectomy 5 years ago and his reversal June 13 2008. The dr said there were tons of sperm in his left testicle and not so many but still quite a few in his right. They were able to do the VV on him. He gave his first sample on August 8th, I spoke with the nurse about it today and she said that there were so little sperm that they couldn’t do a count on anything. Then she said that the dr would probably suggest IVF. To my knowledge it was at least good that there were sperm in his semen at 8 weeks out. So should they be suggesting IVF at this point? Like I said, I haven’t talked to the dr about this yet,my husband and I have a consultation with him on Thursday, August 21. Another thing is, my husband had epididymidus(sp) about 3 weeks after his VR and a lump had formed on his testicle because of it. 3 weeks after completing his antibiotics he still has the lump and the same feeling that he has the infection. Could this be why there was a low count? Thank you in advance!

The first semen analysis after a vasectomy reversal usually is not indicative of a man’s fertility potential after a vasectomy reversal. Usually, there is still some residual swelling in the tubes and this can mask the true success of the surgery. The fact that motile sperm are present at the 8 week mark after a vasectomy reversal suggests that one or both tubes are at least partially open.

Epididymitis after the vasectomy reversal is not a good prognosis. It can cause scarring of the epididymis preventing sperm from flowing even if the surgery was successfully performed. However, if the epididymitis occurred only on one side then the opposite side should still have unobstructed flow of sperm. The best course of action in such situations is to undergo a course of anti-inflammatory treatment and to re-assess the sperm count in 6-8 weeks. If the sperm count is persistently low by 6 months then one should consider proceeding to IVF. Sperm banking should be considered to have available sperm for IVF/ICSI if the count does not improve or worsens.

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From John:-
When I asked my doctor about a suture he said that it is not necessary because the incision is cauterized. Within two days the incision was open and has yet to heal on day 6. Is it normal not to use sutures? Should I be putting something on the wound area to promote healing?

The incisions for a vasectomy are oftentimes very small and do not require any suture after the procedure is completed. Some physicians prefer to use a single suture to ensure that the wound edges do not separate and that there is no unnecessary drainage from the incision. I personally prefer to place a single self-dissolving suture after the procedure to ensure that patients are not concerned about any staining of their underpants. If a wound is slow to heal or the skin edges separate, the best practice is to keep the area as clean and dry as possible to give it the best possible chance of healing. Incisions can also fail to heal in the setting of an infection. If the wound becomes infected it will become red, weep and possibly be associated with pain. Antibiotics are necessary in this situation.

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