At the time of reversal surgery, the vasectomy site is removed, which allows fluid to be expressed from the testicular side of the vas. In the past, the presence of any sperm or sperm parts was thought to indicate that no obstruction was present. Even men with no sperm — if the fluid appearance was clear — were thought to be unobstructed.
Experience has shown that the incidence of obstruction is quite high in men who have no sperm (regardless of fluid appearance), sperm parts, or inactive (non-motile) sperm with fluid which appears thick or creamy. Sperm may persist between the blockage in the epididymis and the vasectomy site for many months, perhaps even a year or longer.
Direct inspection of the epididymis is necessary in all such questionable situations. The point of blockage is easily detected by the appearance of the epididymal tubules (which can be seen through the thin, translucent outer layer of the epididymis), and by testing the epididymis directly for the presence of active sperm.
In the past, success rates for epididymal repairs were relatively poor, even with microsurgery, and every effort was made to avoid them where possible. With markedly improved success rates, many of these previously-unrecognized epididymal blockages can be addressed successfully. Furthermore, successful epididymal repair is associated with significantly improved sperm quality and fertility. The success rates cited for Dr. Finnerty’s surgeries are based on an older decision-making process, and are increasing becoming outdated, as successful correction of previously-unrecognized epididymal blockages gives way to much better fertility rates.
