Is vasectomy reversal likely to be associated with Downs syndrome?

Sep 22nd 2009adminVasectomy reversal

I have just turned 44 and my husband and I would love to have another child. We have an 8 year old boy (delivered by emergency c section) and a 6 year old girl (delivered by elective c section). My husband is 37 and had a vasectomy 6 years ago, so we are currently contacting clinics to have a vasectomy reversal. We are both healthy, non smokers who do regular exercise and have no health issues.

I still have a regular 28 day cycle and for the past 6 years have had very definite signs of ovulation and feel as though I ovulate from both ovaries. My mother was 52 when she went through menopause and I have 2 sisters, 51 and 49, who still have regular cycles as well.

I understand there is an increased risk of Downs Syndrome at my age, and we would have all the relevant tests for this, but what I would like to know is whether having the vasectomy reversal combined with my age may pose too much of a risk in terms of problems or deformities for the baby? I have read somewhere that there is an increased risk of deformities after a vasectomy reversal, but how true this is I don’t know. If the risk is too high we would probably, sadly, decide against the idea.

I sincerely hope you can help to reassure me! Thank you in advance.

The fertility of a woman decreases as she ages and most fertility experts would advise a woman at the age of 44 that her fertility potential should be evaluated with tests prior to undergoing any costly procedures to achieve a pregnancy. A family history of late onset menopause is an encouraging sign but not conclusive evidence that a woman at the age of 44 can still conceive children. There is no evidence that there is any higher risk of congenital abnormalities in the offspring of men who have undergone vasectomy reversal. However, there is a higher risk of certain genetic mutations in the offspring of women who are of advanced reproductive age (>35 years old).

Dr. Karpman’s website

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How often does vasectomy reverse itself?

Sep 22nd 2009adminPregnant after vasectomy & Vasectomy failure

From Misty:-
I need some help. My husband had a vasectomy 7 years ago. I am going crazy because I have all the signs of pregnancy that I have had with my previous three children but tests come back negative and so did the ultrasound. My husband started asking around and checking up in this, finding that vasectomies are really only a guarenteed fix for 3 -5 years then the body can repair itself. People are still asking me when I am due and I have not told anyone about having tests done for pregnancy. I would really like to know what the percentage is that a vasectomy can reverse itself?

Spontaneous vasectomy reversal 7 years after the procedure rarely occurs. Spontaneous re-canalization has been reported in less than 1% of patients after getting the all clear. Even in situations where re-canalization does occur, the sperm numbers are usually very low and it is difficult to achieve a pregnancy with such low numbers. The fact of the matter in this situation is that many conditions can have similar symptoms to pregnancy, but if repeated pregnancy tests and the ultrasound are negative then it is likely that the woman is NOT pregnant.

Dr. Karpman’s website

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Scrotal Pain & Discomfort 6.5 Years Post-Vasectomy

Aug 9th 2009adminPost vasectomy pain syndrome

From Paul:-
Brief history:

• Had traditional vasectomy (closed-ended, open incisions) in early 2003.
• General surgeon (did 2-3 per week) said left vas was difficult to find. Surgery seemed to take long but was eventually completed.
• Experienced substantial pain on left side for several months and frequent urge to urinate for several weeks. Eventually saw two urologists. First one prescribed Cipro & ibuprofen, and diagnosed epidydimitis. Second one diagnosed continued infection and prescribed Doxycycline and waiting. I was told the scrotal ultrasound showed nothing. Both urologists advised against further intervention.
• I never experienced any change in sexual function or pleasure.
• Discomfort eventually subsided and was gone for several years before starting to return to the same left side.

Over the past couple of years I’ve experienced spontaneous (that is, with no “jostling”) pain in the scrotum with increasing frequency, always on that left side (but not as painful as the first several months post-vasectomy). Additionally, that side of the scrotum is constantly tender to the touch – I have to constantly watch where and how I sit, make sure my daughter or the dogs (very small) don’t bump me there, etc.

I mentioned this to my GP, who ordered an ultrasound. The results noted a 2cm hydrocele – a hydrocele also was noted during an earlier ultrasound but I don’t have any details on it. My GP says hydroceles don’t cause pain – there was nothing to be done for me and I would have to tolerate the pain. That was the end of the conversation.

I am also leery of GPs who say “there’s nothing to be done” as if they were specialists. This isn’t the first time I had a medical professional be cavalier about my scrotal pain issues, so I’m leery for that reason as well. But since my GP refuses to pursue this issue, I’m stuck unless I file a complaint and/or switch doctors. She’s otherwise provided good care, so I’m not ready to level any accusations yet.

I would like to clear this up soon; I’m unemployed but hope to find work in the next few months. I did wait-and-see until it was becoming unmistakably worse, and at 6.5 years post V it doesn’t seem like further waiting will help.

Any advice or suggestions would be greatly appreciated. Thank you!

Post vasectomy pain (PVP) syndrome can manifest in varied presentations and intermittently over time after the vasectomy. PVP is thought to be due to congestion of the epididymis or damage to the peri-vasal nerves at the time of vasectomy. Physicians not familiar with this condition will oftentimes overlook this as a cause of pain. Scrotal ultrasounds are often obtained to rule out more serious conditions when a patient complains about testicular pain. Scrotal ultrasounds will find problems such as hydroceles, varicoceles and spermatoceles in 60-70% of men when performed randomly. Some of these pathologies found on ultrasound can be confused with PVP. Hydroceles and spermatoceles are rarely associated with testicular/epididymal pain. Varicoceles can be associated with this type of pain, but the predictive value of correcting a varicocele is only around 50% for men with testicular/epididymal pain. A detailed physical examination by a specialist can diagnose PVP and treatments for PVP such as cord denervation, epididymectomy and vasectomy reversal are successful in up to 90% of patients with this condition.

Dr. Karpman’s website

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What do these semen analysis results mean?

Aug 9th 2009adminPost vasectomy semen analysis

From Jamielynn:-
Thank you so much for the information that you provided in my previous post for my husband and I. Like I stated to you before, I printed out a copy of the information and we took it to the surgeon. After a few weeks the surgeon called us back and said that he was able to talk to the chief of lab to perform this test for my husband. So this week my husband took in his sample at 3:45pm. At 5pm (1 hours and 15min later) my husband called the lab and talked with a lady. She said that his sample was next to be ran. When my husband asked ” well doesn’t it need to be ran within 30min,” She couldn’t respond. All she knew that it was next. So the next day my husband went to medical records and picked up a copy of the results. The results read
POST VAS SPERM PRESENCE- Present- non-motile H
POST VAS SPERM COUNT- 0-4/hpf H
POST VASECTOMY COMMENTS- 0-4/hpf
At that time we called the surgeon to go over the results. The surgeon stated that the results mean there are no live sperm. I has asked the surgeon if they were not alive due to when the test was ran? The surgeon said that he would need to talk with the chief of lab to see whats going on. I also asked the surgeon if after a year after the vasectomy shouldn’t there be “No Sperm, dead or alive” That he shouldn’t be producing any sperm after a year. The surgeon also stated to me that there has to be a extremely large amount of sperm to create a pregnancy. My husband and I feel that the surgeon is looking at us like we are crazy. We know that there is something there. We do not want to have to go through all the pain of taking a chance on getting pregnant again.

Now we are at the point where the surgeon wants to have a meeting with my husband and I to come up with a plan. (Whatever that means). I wanted to get your response as a second opinion on what to do from here. Without the information that you were kind enough to provided us with on the pelleted semen test we would not have come this far…. My husband I thank you for that. We greatly appreciate it.

The standard protocol in most general hospital labs is different from that of specialized fertility centers when it comes to evaluating semen analyses irrespective if it is a quantitative or post-vasectomy semen analysis. Most regular hospital labs do not incubate the semen at body temperature until it is ready for microscopic evaluation. The sample is left standing on the counter at room temperature until the technician is ready to evaluate the specimen, sometimes for hours. It is well known that sperm will die or lose motility after as little as 30 minutes when the sperm are kept outside of body temperature. In this case it is difficult to say if the sperm were alive or dead when they arrived in the lab since the specimen was not handled appropriately for evaluation of live sperm. Also, centrifuging sperm at high speeds can cause damage of the tail of the sperm resulting in loss of motility prior to microscopic evaluation. Please also refer to a previous questions regarding fertility at very low sperm counts from our previous posts.

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Has my vasectomy failed?

Aug 9th 2009adminPost vasectomy semen analysis

From Tom:-
I had a vasectomy in September, 08 from a board certified urologist. Post semen analysis at 3 months was positive (no other specifics available on this test). Another test was done at 6 months and was positive with a count of 20,000. Yet another test done at 9 months and results showed “Rare, non-motile”. My doctor says this happens in rare cases and I shouldn’t be worried. He wants another test at 12 months. I conservatively estimate I’ve had 50-60 ejaculations (probably closer to 70). The first 6-8 ejaculations contained blood, but that cleared after 3 weeks or so. I am 44 years old in good health.

I’m concerned that my vasectomy has failed and I’m angry. How do you recommend I proceed? Is there anything I should be doing to determine if my doctor did something wrong?

Thank you very much.

Persistent motile sperm at very low counts 6 months after a vasectomy likely represents recanalization of the vas deferens. This is the typical quantity of sperm seen after this occurence and emphasizes the importance of demonstrating two ejaculates without any sperm prior to confirming sterility. Contrary to common perception, the sperm counts of men with recanalization are usually very low in number with a low percentage of motile sperm. This is because the entire vas deferens has not grown back to its original state but instead a single or a few microscopic canals have formed allowing a small amount of sperm to get through the vasectomy site. The sperm count can intermittently show sperm with rare non motile sperm at other times. These patients should be followed closely and told to continue to use a contraceptive until two consecutive semen analyses 6-8 weeks apart are completely absent of any sperm or opt for a re-do vasectomy. Recanalization can be temporary with successful azoospermia demonstrated over time. This case also emphasizes to those couples wanting to have more children after a vasectomy but trying to avoid vasectomy reversal or sperm retrieval with IVF/ICSI the reality of recanalization. Recanalization sperm counts are usually too low and of poor quality to initiate a natural pregnancy, but we can’t tell patients wanting sterility that they are fine to have unprotected intercourse. Recanalization should not be perceived as a fault of the surgeon. Instead, it is more a reflection of how potent the growth factors released are after the vas deferens is cut or injured.

Dr. Karpman’s website

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Tethering of vas deferens

Aug 9th 2009adminGeneral questions

I am wondering how common it is to have the vas deferens tethered and what is done to usually prevent this from occuring?

Tethering of the vas deferens after a vasectomy can occur and results from the scarring to adjacent tissues after the vasectomy. The biggest problems I have seen with tethering of the vas deferens is in patients where the tethering occurs to the scrotal wall. Patients describe a pulling sensation or pain, especially with ejaculation and certain activities. Treatment for this condition is usually surgical and requires mobilizing the vas deferens from the surrounding structures, wrapping the spermatic cord around the vas deferens or, alternatively, cutting back the vas deferns. The exact incidence of this occurrence is unknown but it is not a common finding after a vasectomy.

Dr. Karpman’s website

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Post vasectomy lumps

Aug 9th 2009adminMiscellaneous symptoms after vasectomy

From Jim:-
I had a vasectomy done 13 months ago. A few months later I noticed a very small lump at the bottom left of my left testicle. Since then I’m sure it has grown slightly. It is not a smooth feeling lump, feels sort of sharp/pointy and if I put pressure on it then I feel a very dull pain. Appears to be on the edge of the left teste but not part of it. I’m obviously concerned and would appreciate some feedback. Thanx, Jim

Any new lumps, masses or lesions in the testes whether they are in the testicle or adjacent to the testicle should be evaluated by a physician. Any lesion that is demonstrating growth over a period of time is even more suspicious for a malignancy. Obviously, our biggest concern is some type of cancerous growth and this can only be evaluated by a physician. These recommendations are universal and irrespective of the time since a vasectomy was performed.

Dr. Karpman’s website

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Post vasectomy problems

Jul 18th 2009adminMiscellaneous symptoms after vasectomy & Post vasectomy pain syndrome

From Brian:-
Hello Dr. Karpman,

I had a bilateral, no-scalpel vasectomy 2 weeks ago. One opening near the front top of my right side, the other lower down toward the middle of the left. I felt absolutely no “tugging” pain during the procedure, which I’ll assume was due to the fact that the vas did not have to be shifted to the middle of the scrotum.

Despite the claims that I would be back to normal in 3-5 days, I’m still having problems. Since day 3, I have had a quite persistent dull ache in my testicles. The pain sometimes radiates into my lower abdomen and pelvic regions. I have tried jock straps, Cipro, and ibuprofen, but the pain does not seem to be going away. I can best describe it as the sensation that lingers after someone or something hits you in the balls. Both sides seem about equally affected, but the left is slightly worse. Part of my left scrotum is numb from time to time.

My first couple of ejaculations after the procedure have felt “funny”, with less sensation. This pain is not debilitating, but it is frustrating, and I fear it may adversely affect my sex life, which is the ultimate irony. I had the vasectomy done for the opposite effect.

1. My urologist is very nice. He is a male infertility specialist, so I assume he’s also taken care of said people after they have their children and needed permanent birth control. However, it appears that most no scalpel vasectomies use only one hole. Do you think the bilateral nature of my operation added to my post operative-pain?

2. How long does this post-vasectomy pain take to resolve? I typically heal much slower than most folks after surgery. If this situation will take care of itself, then I won’t worry as much. Some sites say 2-12 weeks.

3. How does one determine enough time has passed to pursue non-conservative treatments for the pain? If a reversal is needed, is it better to do it quickly after the vasectomy, or is it wiser to wait for a natural resolution?

4. I have read that the buildup of sperm causes the potential swelling and pain after a vasectomy. How would the buildup of sperm in a post-vasectomy system differ from a man who was merely celibate?

5. I had ongoing pelvic pain/non-bacterial prostatitis for 5 years before surgery. Did this make me more susceptible to this type of pain? My prostatitis symptoms were discomfort during urination and the occasional rectal pain.

Thanks,

Prostatitis is a common problem as men get older. The symptoms of prostatitis are varied and different in individual patients. The presenting symptoms of prostatitis can include pain or discomfort in the perineum, suprapubic area, testes, penis and lower back. There are also usually associated voiding symptoms. Prostatitis is oftentimes confused for other conditions such as epididymitis and kidney stones because of the location of the radiating symptoms. Most cases of prostatitis are not due to bacterial infection and should not respond to antibiotic treatment. A discussion of prostatitis is warranted on this website since the symptoms of post vasectomy pain syndrome can overlap with prostatitis and can cause confusion for patients and physicians alike as to the nature of a patient’s symptoms. Any patient with PVPS should be evaluated for and treated for prostatitis as part of the evaluation process.

Dr. karpman’s website

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Discharge from vasectomy wound

Jul 18th 2009adminMiscellaneous symptoms after vasectomy

I had a vasectomy 2 weeks ago, now where the incision was on both sides has a gaping hole. The stitches have already dissolved and I am having bloody discharge coming from the holes, I have been back to the Dr. and he put me on antibiotics. I just want to know if it is normal to have gaping holes with discharge?

A poorly healing incision site with drainage usually represents an infection. The scrotum is naturally covered with bacteria and regardless of how much disinfectant is used on it prior to performing a vasectomy, some bacteria still remain. Most infections of the vasectomy sites will improve with a course of antibiotics. Diagnosis, treatment and follow-up with a physician is important to prevent a spreading infection.

Dr. Karpman’s website

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Is there any way to ejaculate after bladder neck removal?

Jul 14th 2009adminGeneral questions

From Elaine:-
My partner had a bladder neck removal over 6 months ago. We didn’t really talk about having children, but now I’m thinking about them and was wondering if there was anything we could do to try and get him to be able to ejaculate. I think he has a slight ejaculation so is there any thing that would help us have a child together anything at all?

Any type of surgery that “removes the bladder neck” will cause retrograde ejaculation in the male. Semen is normally deposited in the posterior urethra during a process called emission. The bladder neck should close at this time allowing the semen to be propelled forward when the man finally ejaculates. Absence of the bladder neck will cause some if not all of the semen to flow backwards into the bladder. This is inconsequential unless you are trying to have a baby. Fortunately, the sperm can be easily retrieved from the bladder after adequate preparation of the bladder and then injected into the uterus to achieve a pregnancy. A crude method of achieving pregnancy in these situations has been reported as “vaginal voiding.” The man can urinate into the vagina after his orgasm. I do not recommend doing this for multiple obvious reasons. Instead, consultation with a fertility specialist can help retrieve the sperm from the bladder for insemination.

Dr. Karpman’s website

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