Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS
Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS

Determining the Type of Reversal Surgery

For many reversal surgeons, there is no choice in the type of reversal surgery performed. Those trained only in non-microsurgical techniques, or with little or no training or experience in microsurgical techniques, especially epididymal repair, will only perform a vas-to-vas repair (VV). If you are fortunate enough to have no epididymal obstruction, and the surgeon has adequate training in microsurgery, you may have a reasonable chance for a successful outcome.

However, experience has shown that a significant percentage of men will develop epididymal obstruction after vasectomy — even those who are a relatively short time after vasectomy. Surgeons experienced in microsurgical reconstruction and epididymal repair (VE).

In the past, success rates for epididymal repairs were relatively poor, even with microsurgery, and every effort was made to avoid this procedure where possible. With much improved success rates, many of these previously-unrecognized epididymal blockages can be addressed successfully. Furthermore, successful epididymal repair is often associated with significantly improved sperm quality and fertility.

There is no reliable way to determine the presence of epididymal obstruction before surgery. Statistics such as time post vasectomy may indicate a higher chance of its occurrence, but on an individual basis, this can only be determined at surgery.

Determining the Need for Epididymal Repair

sailboatAt the time of reversal surgery, the vasectomy site is removed, which allows fluid to be expressed from the testicular end 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 considered to be unobstructed.

Experience has shown that the incidence of obstruction is very high in men who have no sperm (regardless of fluid appearance), sperm parts only, or inactive (non-motile) sperm with fluid which appears thick or creamy.

Direct inspection of the epididymis is necessary in all such questionable situations. The point of blockage can generally be detected by the appearance of the epididymal tubules (which can be seen through the thin, translucent outer layer of the epididymis), whether the tubules are distended above a point and decompressed below, and by testing the epididymal fluid directly for the presence of active sperm.

Sperm flows from the testes, into the efferent ducts, and down the epididymis toward the vas. Above the obstruction, the epididymal tubules will be distended, and often have a creamy fluid seen through the wall of the tubule. Below the obstruction, the tubules are decompressed and often more translucent. These transition zones help identify points of obstruction (of which there may be more than one), but specific testing for sperm in the epididymal fluid (by opening the tubule, and examining the fluid under a lab microscope) must be preformed to ensure the obstruction is bypassed.

Additional Information

Thank you for helping our dreams come true.
J.W., Atlanta
Easter blessings to you and your family from us. We are having a special celebration and invite you to join us -- we celebrate the life of our new daughter.
C.K., California
Our family now has 7 blessings, 3 of which you had a very special part in. Thank you!
G.S., Alaska
Our child is a true gift from God. God bless you for turning my vasectomy around after 30 years with so much care and love. We will always love you.
J.C., Tennessee
The reversal surgery was a great success! We are sorry we didn''t contact you sooner. Thank you again for your willingness to provide such a special service for families.
M.F., California
My husband had a vasectomy reversal four and one-half years ago performed by Dr. Finnerty. Three and one half years after, we were able to conceive a child. Our daughter is such a constant joy in our lives.
C.J., California
We have been so excited about our new son and he has been such a joyous addition to our family ... Thank you so much for your devotion and belief in vasectomy reversal, we have been so blessed by our little guy. Of course, he can never take the place of our daughter who died, but he sure brings new joy to us ... Again, thank you for all you did! We have been so blessed....
M.M., Camas, WA
My husband had his vasectomy nearly 13 years before the reversal, which resulted in the birth of our daughter.
R.B., California
Thank you again for making possible the blessings God had in store for us in the way of children ...
T.P., Minnesota
I am writing to send our heartfelt thanks to you for your expertise. On September 9th, you performed my husband''s procedure. Three weeks later, we conceived our first daughter. She was born exactly 43 weeks post-op. Since then, we have welcomed a son and also another daughter. We''ll always be grateful.
M.H., Vancouver, WA
A child is God''s most precious gift. We joyfully announce the birth of our son.
J.C., Idaho
We were very excited to learn just before Christmas that the surgery was a success. We saved the news for out kids until Christmas Eve and what a blessing their reaction was, it couldn''t have been a better Christmas present! We do thank you so much for providing your services at realistic fees, we could never have done it had there not been options other than what we found locally.
T.S., California
My wife and I would like to give you and your staff a hearty "thank you" for the professionalism and care given us...following my son''s departure to our heavenly Father. Your calming manner and assurance that we had a reasonable chance at reattaching my vas deferens, which might allow us to get pregnant, was at fruition soon after our stay in Tacoma. 14 days following the procedure, my wife ... had become pregnant!. We lost our first son, and Dr. Finnerty, touched by God, enabled us to have another son ...
J.G., Washington
We wanted to share our delightful news with you. We were blessed with a beautiful baby daughter in October.
D.W, Oregon
A little over 5 years ago, my husband and I flew from Chicago to your office to have his vasectomy reversed. We both want you to know how grateful we are -- to you, to your staff, and for your expertise. Since the surgery, we have had Michael (almost 4!) and Mary Jo (10 months) ... We feel it is important for you to know what a difference you made in our lives, and what an awesome grace it was to have you as our surgeon. Words cannot convey how much we appreciate what you have made possible for us -- we will be eternally grateful!
C. & K.P., Chicago