Vasectomy Reversal Antibodies

I am occasionally asked about anti-sperm antibodies and the impact it may have on a couple’s fertility after vasectomy reversal. My answer is fairly straight forward every time: It is highly unlikely that anti-sperm antibodies would cause infertility after vasectomy reversal.
Before I get into why there is very minimal impact, let me first explain more about anti-sperm antibodies.
The immune system forms antibodies (proteins) to protect the body from something harmful. In the case of sperm, the body may produce antibodies because of an allergy or because the body is recovering from an illness or injury.
For example, some think that a man’s body would have an allergic reaction to sperm if it were not for the testes and blood barrier between the scrotum and the rest of the body. In situations of vasectomy, vasectomy reversal, and other testicular trauma, some argue the body forms anti-sperm antibodies to kill the sperm that makes its way to other areas of the body as a consequence of the trauma.
On first glance, it might seem that anti-sperm antibodies are a logical reason for infertility. But the truth is that anti-sperm antibodies are a highly unlikely cause of fertility issues.
In 2003, the Department of Obstetrics and Gynecology at Yale University School of Medicine released a study that found: “Despite the increased prevalence of abnormal immune testing associated with early reproductive failure, the most rigorous studies have not proven a cause and effect between these phenomena.”*
The researchers looked closely at all the available immune tests and concluded that the results to these tests varied greatly and that the use of such testing couldn’t be supported. Additionally, the treatments for immunogenic infertility are not conclusive.
Anti-sperm antibodies and their role in infertility is a highly-debated topic. Anti-sperm antibody testing preoperatively has no role and should not be done. Approximately 60% of men who undergo bilateral vasectomy develop circulating anti-sperm antibodies afterward, and the effect of these on conception and pregnancy is controversial.
While preoperative anti-sperm antibody testing is available, its effects on postoperative fertility is of unproven benefit and should not be done.
Antisperm antibodies form in the great majority of patients after vasectomy. The fact that the majority of these men will conceive after a successful vasectomy reversal indicates that antibody testing before reversal cannot predict successful vasectomy reversal.
Antibody testing after reversal should only be considered if nothing else reversible is found for unexplained infertility after a successful vasectomy reversal.
*Kallen CB, Arici A, Immune testing in fertility practice:truth or deception? Curr Opin Obstet Gynecol 2003 Jun;15(3):225-31.

What Is The Success Rate For A Vasectomy Reversal?

Several factors can influence the success rate of a vasectomy reversal surgery.

Among those factors in play are:
• The technique chosen by the doctor;

• The length of time between the vasectomy and the reversal attempt; and

• The experience and skill level of the surgeon. .
In all vasectomy reversal attempts, the surgeon is attempting to restore the flow of sperm in the two vas tubes, which are attached to each testicle and carry sperm to a man’s semen. Though no surgeon can claim a 100 percent success rate, there are several other factors that influence a couple’s pregnancy rate.
There are two types of surgery: The simple method that I perform is vasovasotomy (VV), and the more complex is vasoepididymostomy (VE) that is done well by surgeons who do many repeat reversals.
Sperm counts are often adequate after three months with the simpler methods compared to four to six months after the more complex procedure. Conceptions have occurred as early as 2 weeks post-procedure in my practice. In both cases, sperm counts tend to improve after six months and beyond. The success rates and pregnancy rates are lower after vasoepididymostomy.
The length of time between the vasectomy and the reversal attempt, statistically, can impact success rates. Typically, in reversals attempted less than three years after the vasectomy, the success rate of sperm returning to the vas are in the 97 percent range. Live sperm return after 3-8 years is 90-95% for expert surgeons.

Though the surgery can be performed later than nine years after the vasectomy, success rates do drop off considerably with the simple vas reconnection, so I encourage potential patients more than 9 years from vasectomy to contact surgeons who do VE.

What Should I Consider Before Having Vasectomy Reversal Surgery?

Vasectomy reversal surgery must be considered by any couple hoping to conceive a child following a man’s vasectomy.

Although there are other methods that can be considered, vasectomy reversal surgery provides a safe, predictable option. That said, it is important that couples consider other factors prior to committing to reversal surgery.

Among the factors and questions to consider before committing to surgery:
• The man’s ability to produce sperm;
• A female’s ability to conceive a child; and
• The choice of which doctor will perform the vasectomy reversal procedure.
Most doctors will want to make sure a man can produce healthy sperm before attempting to reverse a vasectomy and restore the flow of sperm to the semen. If a man has not impregnated a woman in the past he should consider having a FSH laboratory test done. Certainly if he has small or soft testicles, he should have the FSH performed. , he may need a testicular biopsy. That is a simple procedure in which a needle is used to remove fluid from the testicles to check for sperm.

It is also important that a female partner see an OB physicianto be tested if she has not borne children to ensure there are no fertility problems. If she is over 39, eEven if she has gotten pregnant in the past, see should consider seeing her doctor or getting ovulation testing. (There are reliable over the counter kits available.) her doctor will want to know if she has regular menstrual cycles and possibly conduct a pelvic exam. Her doctor may recommend other tests. These might include tests to make sure her fallopian tubes are not blocked and that she is ovulating.

When choosing a doctor who will perform a vasectomy reversal procedure, ask about his personal experience with reversal surgeries and success rates – both his and overall success rates of restoring the flow of sperm, and of impregnation. Be sure to ask about the risks and for your doctor to explain all of your vasectomy reversal options.

How To Choose Your Vasectomy Reversal Doctor

The choice to reverse a vasectomy is obviously a significant life decision and one that should be taken with great care, research and assurance.

Choosing a vasectomy reversal doctor is central to this critical decision. When seeking a vasectomy reversal doctor, men will often turn to the doctor who initially performed the vasectomy.

While this is a good first step, the initial vasectomy doctor may not have significant experience with vasectomy reversal surgeries or the vasectomy reversal surgery process. They can often, however, suggest a medical professional with significant experience in vasectomy reversals.

Several factors should be considered when choosing a vasectomy reversal doctor, including:

Experience. Many surgeons offer vasectomy reversals, but usually conduct a fraction of the vasectomy reversal surgeries performed by specialists. In addition to greater experience, specialists are often more involved and familiar with emerging technologies involved in reversal surgeries. Ask each doctor about the number of procedures he performs in a week or month and, if possible, for referrals.

Preferred methods. The reversal procedure can be conducted more than one way. Talk to your vasectomy reversal surgeon about which methods he prefers and is most comfortable with. If your vasectomy was more than nine years ago, you should, if possible, see a specialist who does the more complicated vasoepididymostomy or “bypass” procedure frequently.

Cost. While cost should not be the sole factor in choosing a vasectomy reversal doctor, nobody can ignore the often high costs of specialized procedures. Because vasectomy reversals are rarely covered by insurance, cost is an increasingly important factor. Talk to potential surgeons about how they arrive at their costs for the vasectomy reversal surgery.

What Are The Different Procedures And Cost Options For Vasectomy Reversal?

The question I often get from a new patient is, ‘Why is surgery in your office so much cheaper than the hospital?’

I get where they are coming from. The last thing that anyone would want to bargain hunt for is surgery. They are putting their health, and the ability to have children, in my hands.

With modern advances in vasectomy reversal surgery, having the procedure doesn’t mean a long complicated surgery with a huge hospital bill to match. Microscopic vasectomy reversal surgery is an affordable, but very safe procedure for men who want to restore fertility.

When performing microscopic vasectomy reversal, I am able to use in-office local anesthesia to reconnect the cut ends of the vas deferens to restore fertility. Many patients find this appealing because local anesthesia enables them to have a two-hour outpatient procedure rather than being put under general anesthesia or having to stay overnight in the hospital. Because the procedure is minimally invasive, the recovery is much shorter and easier.

Compared to traditional vasectomy reversal surgery, in-office microscopic procedures are dramatically less expensive, but offer the same end result–the potential for the ability to have children. The cost for microscopic vasectomy reversal in my offices is $1,700. In stark contrast, a traditional reversal surgical procedure includes a surgeon’s fee ranging from $2,500 to $10,000, anesthesia fees in the $2,000 to $5,000 range and hospital or outpatient surgery center costs ranging from $2,000 to $5,000.

This less invasive option also means less upfront preparation. Because I can answer many questions through email and the phone, in addition to the preoperative phone meeting, there’s no need for pre-op visits. Before going in for surgery in a hospital, patients are put through extensive lab tests to make sure they are healthy enough to go under general anesthesia. But since I use local anesthetic, the pre-operative time spent in the office the day of surgery is minimal.

Complex Bypass Vasectomy Reversal Surgery

Patients more than nine years from vasectomy aren’t good candidates for my microscopic vasectomy reversal surgery so I refer them to other surgeons who perform complex bypass vasectomy reversal surgery. Over time, and more frequently after nine years, obstruction can form in epididymis from the increased badk pressure that results from the vasectomy. If this condition is present, a bypass procedure is required to return complete reproductive functionality. The end of the vas deferens is connected directly to the epididymal tubule beyond the level of obstruction. The added complexity of this operation is reflected in higher surgical fees.

Robotic Systems For Vasectomy Reversal Surgery Mean Higher Costs

There are other procedures that are available for vasectomy reversal, including laser and fibrin glue. Another procedure uses robotic systems integrated with endoscopy tools for surgical visualization and robotic technology to perform surgical movements. With the assistance of high technology guidance robotics, the cost for procedures of this type is obviously much higher than in-office microscopic surgery.

Considering the scope of the procedure, robotic surgery is going a bit overboard for a relatively simple vas to vas reconnection procedure. For the majority of patients, in-house microscopic surgery is the best method for reversing a vasectomy affordably and safely.

Myths About Vasectomy Reversal Surgery

My goal is to provide patients and prospective patients with all of the information they seek – the full story and the truthful story.

Unfortunately, there are many myths when it comes to vasectomy and vasectomy reversal surgery; here are some of the more prevalent ones along with the real truth behind the myth.

Myth: Once a man has a vasectomy, he stops producing sperm.
Truth: Men make sperm following a vasectomy regardless of how long it’s been since the surgery (unless other factors, such as injury to the testicles or other medical problems, present themselves). Fact: The body continues to make sperm even following a vasectomy.

Myth: Don’t even consider a vasectomy reversal surgery if your female partner is over 35.
Truth: Female fertility does decline with age, that is a fact. But many women can and do still conceive well into their 30s and 40s. I wouldn’t ever tell a patient to not consider the vasectomy reversal procedure solely on the basis of the age of his female partner.

Myth: Always go with the vasectomy reversal doctor whose office is most conveniently located for you.
Truth: Location, like price, is just one factor to consider when looking at all of your vasectomy reversal surgery options. In fact, your health, your peace of mind and, ultimately, the effectiveness of the surgery are far more important than your drive time or your convenience level. The potential results of your vasectomy reversal surgery should outweigh anything else in your decision-making process.
My commitment is to give you all of the facts and information so that you can make the most informed choice that makes the most sense for you.

Why Does The Success Rate Of Vasectomy Reversal Decrease Over Time?

When considering a vasectomy reversal, the most important factor in determine the success of the procedure is the amount of time that has passed since the original vasectomy surgery. Since the chance for a successful vasectomy reversal decreases over time, this is the first question a doctor will ask a prospective patient.

Let’s take a look at how the success rate is determined and what affects this rate.

The Breakdown: Years Since Vasectomy And The Success Rate of Vasectomy Reversal Surgery

The rate of success for vasectomy reversal surgery has been extensively studied and a correlation has been developed between that success rate and the amount of years since the original surgery. The best category of patient is those who have had a vasectomy within the previous three years. In this case, there is a 97% chance of return of live sperm, which translates into a pregnancy rate of over 80% in my practice.

For patients with more than 3 years but less than 9 years from their vasectomy, the chance for a return of live sperm is still 91%. This rate correlates to a 74% chance of pregnancy. For those men who have gone more than 9 years before reversing their vasectomy, there is a 72% chance of return of live sperm and a 42% pregnancy rate in my experience.

Why Does The Success Rate for Vasectomy Reversal Surgery Drop Over Time?

A vasectomy works by preventing sperm flow out of the testicles by creating an obstruction in the vas deferens. However, this does not stop sperm production. This results in an increase in pressure on the vas deferens which can cause a second obstruction in addition to the surgery site. This second obstruction occurs more commonly with increasing time because of the cumulative effects of high pressure in the system.

This prolonged high pressure can result in breakdown of the thin walled tube in the epididymis, a  small sac resting on the testicle that contains the tubes where sperm mature and are stored. This breakdown or “blowout” of the wall causes scarring and blockage of the system. This is more common after 9 years from vasectomy.

Another reason success rates drop over time is effects of prolonged increased pressure on the testicle itself. This is not nearly as important as the second blockage, but there are changes that occur.

There is a myth that reversals do not work because of anti-sperm antibodies. These antibodies, like the ones produced to fight viruses, are produced by the body as a protective measure. After a reversal, antibody production ceases. While it is estimated that less than 5% of vasectomy reversals may suffer from anti-sperm antibodies, it is not a major factor.

Is it worthwhile to travel for your vasectomy reversal?

Yesterday I got a phone call from a nice lady in New York.
She wanted to know where the practice was located. This is a lot like
when someone calls me up to ask the cost of the surgery. It is
obvious from the website that the cost is $1,700, but they like to
hear it over the phone to believe it more.

Well, this is a little different because while the person with
the cost question is hoping the actual price is the same as on the
site, the caller from New York was most likely hoping that the
location was different than on the site because, after all, she saw
the ad in New York.

She didn’t seem surprised when I told her I was in Oklahoma.
She merely said she was looking to have it done in New York and
with the usual pleasantries, the conversation ended.

Now, I have had similar conversations a number of times over the
years and often when the person sadly says, “Well, I am in  Georgia
(or Alaska or Pennsylvania)…”I will often respond, “We have had a
number of people come from Georgia (or Alaska or Pennsylvania…)”.
Then comes the light bulb, “Oh, really!”.

I didn’t respond to my friend in New York in that way, although I
could have because one of my first patients was from The Big Apple
and several have come through since.

There are different reasons why patients want the surgery close to
home, and one of them is that traveling to Oklahoma adds expenses
they would not have if they were operated on in their home state.
Let’s take a look at them:

YOUR TRAVEL EXPENSES: Chances are you do not live in Muskogee, Oklahoma.
Men from all 50 states of the Union have come to my office to have the
procedure, however, we all know travel is not free. Whether you decide
to drive or fly, the cost of coming to my office is more expensive
than visiting a doctor in your neighborhood. Add roundtrip airfare,
rental car and/or gas expense to my fee.

YOUR HOTEL ACCOMODATIONS: I recommend a 2 night stay, but most of my
clients return home the day after the procedure. Add the cost of a 2
or 3 night hotel stay to my fee.  (But, keep in mind, if you are from
NY or Boston or Chicago or some very large metro area...you might be
pleasantly surprised by the hotel rates in Muskogee, Oklahoma.)

YOUR MISC EXPENSES: Travel always comes with both expected and
unforeseen expenses. Meals, forgotten personal items that need to be
purchased, etc. Add some additional “buffer” costs to my fee.

So, as you can see, there ARE additional costs to having me perform
your procedure, but I think you’ll find that even after adding these
expenses to my fee, I’m still more affordable than all the
alternatives available to you...

$1,700 surgery cost
$300 for 3-night hotel stay in Muskogee
$200 Misc expenses
$800 Round trip air fare to Tulsa (example is from LA)
$120 3-day rental car
$50 gas for rental car

TOTAL: $3,170.00

Compare the total cost above to the average of $7,000 to $10,000 for
most procedures and you’re still saving from $3,000 to nearly $7,000!

And, of course, I offer a satisfaction guarantee and I
have hundreds of satisfied clients that I can put you in touch with.

The Pain of Vasectomy vs. The Pain of Reversal

One of the questions I get about my procedure is, “Doctor, how much will it hurt?” .

Well, actually, it won’t hurt much at all. The physical pain is usually nothing more than a few pricks of the needle for the local anesthetic and some mild discomfort after the surgery.

I do administer mild sedation pills, but those are really just to help you through the discomfort of holding still for a couple of hours while I do the procedure.

In fact, there is a 95% chance you’ll actually fall asleep during the procedure!

Bottom line is that the physical pain is no where near as great as the emotional pain that most couples feel about not being able to conceive after a “pre-mature” vasectomy.

I know. Because I experienced that emotional pain after I had my vasectomy. In contrast to my patients, who often doze during the procedure, many couples stay up nights worrying…wishing they had not gone through with the vasectomy. Wishing they had waited. Wishing for an affordable way to make that pain go away.

Now that is real pain.

But it’s pain I can help alleviate. And there’s nothing more satisfying as a doctor – not only to be able to heal someone physically, but to also help bring joy and emotional health.

Why Pay for a Stranger’s Vasectomy Reversal?

Why are most vasectomy reversals so expensive?

Well, I can give you a host of reasons why…most are performed in facilities or large hospitals with huge overhead costs, most are performed in major metropolitan areas with higher costs of living…but the main reason that most vasectomy reversals are so expensive is because a small number of patients require what is called a “bypass” vasectomy reversal.

This bypass procedure is much more complicated and expensive than the simple reconnection that most patients require. And there are situations where it is required. This is the case about half the time on the rare occasion that a first reversal fails, and also not uncommonly if the time from vasectomy is more than 9 years. Then a complicated bypass is often required.

But this procedure is rarely required for a first vasectomy reversal within 9 years of the vasectomy.

ARE YOU PAYING FOR SOMEONE ELSE’S VASECTOMY REVERSAL?

But, in order to offer the complicated and expensive procedure to the patients who DO need it, the doctors who perform them charge more for the simpler reconnection procedure. This explains the much higher fee for the simple procedure in this setting.

In essence, the patients who DO NOT need the expensive procedure, help pay for the ones who do.

SO HOW CAN I CHARGE SO MUCH LESS FOR THE SIMPLE PROCEDURE THAN MOST SURGEONS?

Because I NEVER perform the more complicated procedure. I refer patients who may need the bypass surgery to other providers.

That way, you only pay for what you need.