Ask the Doctor

From Alicia:-
Hello Dr. Karpman. I appreciate your time answering the questions submitted to you. I have looked through your archives and have not seen my issue addressed, and hope you may be able to help me. My husband is scheduled for a vasectomy reversal on Dec. 15 of this year. He has two children ages 8 and 10 from a previous marriage. His vasectomy was done 8 years ago. He said that he had been told by his doctor that he had a low sperm count at some point in the past, but he’s not really sure of what the numbers were (he’s not a real “detail” guy!). We have been told by the doctor’s office who will be performing the procedure that they will examine his sperm level before performing the reversal. This begs the question, for me anyway, what happens if they don’t see any sperm? Should they continue the procedure? I asked the woman who runs the office (maybe his nurse, not sure), and she said “obviously there will not be any sperm present because he has had a vasectomy”. It made me feel really stupid, so I was afraid, at that point, to ask for clarification. I had always assumed that men who had undergone vasectomies still produce sperm, it just doesn’t flow out the penis. Is this correct? Is there any way to check his sperm production levels before we spend all this money on a reversal? Or are sperm counts only “checkable” after the procedure is done, when it may be too late. I would just really hate to go through all this time and expense if it were for naught, especially if it could be determined by this doctor beforehand, and he still performed the procedure anyway to receive the payment. Any information you could give us would be most helpful. Thank you for your time.

The only way to confirm that a man’s fertility potential is present in the absence of sperm as is the case after a vasectomy is to perform a physical exam measuring the size of the testes and to obtain hormone tests such as FSH. These two tests are not 100% reliable but give us the best prediction of a man’s fertility potential, along with his previous history of paternity. Surgeon’s performing vasectomy reversals should always check for the presence of sperm in the vas deferens at the time of vasectomy reversal. However, the absence of sperm from the vas deferens does not signify poor production but merely that a secondary blockage may have developed and the “bypass” operation is required. Unfortunately, there is no better way to predict a man’s fertility potential until after the reversal. Couples in situations where there might be a spem production problem or problems with ovarian function should consider the alternative of sperm retrieval with IVF/ICSI.

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