Procedures and operations for men as part of a fertility treatment

Whether or not a man is fertile depends largely on his sperm production. This is controlled and regulated hormonally, but not all problems can be blamed on hormonal imbalance. Sometimes psychological factors are the reason, or else an obstruction somewhere along the sperm's journey both in the man's and woman's body.
See also the sperm quality for the requirements a sperm sample needs to meet for 'normal' fertility.

Vasectomy reversal


Indications
Preliminary tests
Vaso-vasostomy
Vaso-epididymostomy

Procedure anaesthetic

How does the UZ Brussel go about examinations or operations under anaesthetic?

Reanastomosis is performed under general anaesthetic and you will have to spend one or two nights in hospital after the operation. You will be admitted to a nursing ward of the UZ Brussel and prepared for the procedure.

Indications    

A reanastomosis is obviously only performed at a patient's request.
If you have previously had a vasectomy and decide at a later stage of your life that you would like more children after all, perhaps with a new partner, a vasectomy reversal operation could be the answer. Alternatively, a sperm extraction operation, - to extract sperm from the testicle or epididymis - when performed as part of an IVF - treatment with ICSI is also possible.

You may well ask then, why undergo a reversal operation, when alternative techniques exist and provide good results?
  • Primarily because reanastomosis restores your fertility and you will not be dependent on IVF treatment to father children. 
  • But also because even a suboptimal sperm obtained from a normal ejaculation following a reversal operation for use in ICSI will be of a better quality than sperm obtained surgically directly from the testicle. 
  • During the vasectomy reversal, sperm can be harvested and stored for later use. This means you already have a supply in case the vasectomy reversal does not result in a restoration of the vas deferentia.

Preliminary tests     

Up to 50% of men who have a vasectomy develop antibodies against their own sperm. This causes the sperm to become less motile and stick to each other. The presence or absence of these antibodies is therefore a decisive factor for your fertility.
A vasectomy reversal is therefore always preceded by an immunological blood analysis to determine whether your blood contains any sperm antibodies. This way a more realistic prognosis can be made regarding your fertility after the operation.
However, reanastomosis is, even if antibodies are present, preferable to any sperm extracting technique, unless your partner has a significant fertility problem as well.

Vaso-vasostomy - from vas deferens to vas deferens      

This technique joins the two severed ends of the vas deferens back together through an incision in the scrotum. This is done for both vas deferentia.
First we check whether there is any sperm in the end of the vas deferens which starts in the epididymis. If this is the case, it means there is a normal flow of sperm from that point, which increases the chances of the operation being a success to 90%.
However, this success rate only concerns the chances of the re-connection being successful. The chances of a pregnancy (via intercourse) after the operation are around 60% if your partner is younger than 35.

Vaso-epididymostomy - from epididymis to vas deferens    

If no sperm are found in the end of the vas deferens coming from the epididymis, it can indicate a blockage in the epididymis. The epididymis consists of 30 metres of tightly coiled tubules. Under the high pressure of sperm production, sperm cells can pile up and cause an obstruction. A swollen epididymis is a symptom.
In this case the surgeon will attempt to connect the other end of the vas deferens to a point beyond the blockage.
Technically, this operation is more difficult because a connection has to be made between a tube with a miniscule diameter (the coiled tubule of the epididymis) and the vas which has a much bigger diameter. It is like connecting the copper pipe of the water main with a sewer pipe and making sure it is watertight.
This method of reanastomosis therefore has a smaller chance of success: only one case in four results in a restoration of sperm flow through the vas deferens.
The procedure is sometimes performed to repair a blockage caused by infections (e.g. chlamydia).