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ARTICLE

“Couples should carefully consider their options”

An interview with Dr. Robert Pugach, Medical Director

of West Coast Urology
by Yvette M.Manard, MPH

Did you know that five to ten percent of the over 600,000 men who annually undergo a vasectomy will choose to have theirs’ reversed at some time? The most often cited reason men decide to have a reversal is that they have undergone life changes, primarily remarriage, and they want to have more children. But why would a man undergo a surgical procedure to father a child with the availability of advanced reproductive technologies (ART)?

According to Dr. Robert Pugach, Medical Director of West Coast Urology, this is a very important question he discusses with his patients interested in vasectomy reversal. Dr. Pugach explains the reasons are threefold. “ART procedures are generally more expensive, require a woman to undergo In-Vitro Fertilization (IVF), and, most importantly, the success rate is better with a vasectomy reversal than IVF.” According to the Society for Assisted Reproductive Technology (SART) the national success rate for pregnancies in women under 35 years undergoing IVF is 30 percent, compared to 70 percent success rate for a vasectomy reversal.

Dr. Pugach recently completed an extensive clinical training course in advanced vasectomy reversal (vasovasostomy and vasoepidiymostomy) whereby his Center now offers a money back guarantee on the success of the procedure. “Before the development and refinement of microsurgical techniques, the results of vasectomy reversal were much lower. However, in recent years, with the development of better techniques and in the hands of a skilled microsurgeon to perform the reversal, excellent results can be obtained with a high chance of obtaining a pregnancy,” says Dr. Pugach.

Vasectomy reversal is an extremely delicate surgery because the vas deferens must be repaired microsurgically. During a vasectomy a man’s vas deferens (the tiny tubes that carry sperm) have been cut and, possibly, sealed. The result is that there is vas deferens can no longer carry sperm from the testicles. Repairing the inner channel of the vas deferens, means that each tube, which is approximately 1 millimeter in diameter, (smaller than a pinhead) will be repaired with up 24 stitches with minuscule suturing materials. It is a delicate procedure requiring a powerful microscope and skilled surgical hands.

The success of a vasectomy reversal not only depends on the skill and training of the surgeon but also on a number of other factors. Dr. Pugach’s key consideration is how long ago the vasectomy was performed. “For men who have had their vasectomy less than 10 years ago, the chances of success are better,” explains Dr. Pugach. “The results are best when a vasectomy reversal is performed within 5 years of the original surgery. Once the time goes beyond 10 years, overall results decrease although there can be successful outcomes 15 or even 20 years later.”

Unlike a vasectomy which is performed in an urologist’s office and usually takes less than 30 minutes, a vasectomy reversal is performed in a specially equipped hospital operating room using a general anesthetic. The surgery takes two to four hours to perform. Men can usually return to normal activities within 5 days and mild discomfort is experienced. The cost of the surgery is approximately $8000.

Sperm may not reappear for several months and men will typically return for a semen analysis in one to two months and periodically thereafter. Dr. Pugach has seen his patient’s sperm count and motility (movement) improve within three to six months and pregnancies for couples can occur within this time period.

It should be remembered that a microsurgical vasectomy reversal demands the highest degree of skill and experience to be successful. A couple should be well educated and carefully review their options.