None — Male Reproduction
A pregnancy occurs when sperm from a male fertilizes (unites with) an egg from a female. The sperm are produced in the testicles, then travel through a coiled tube, called the epididymis, where they mature. Mature sperm travel through the vas deferens (a tube connecting the epididymis with the prostate gland), then to the seminal vesicle and ejaculatory duct. During ejaculation, the sperm mix with fluid from the prostate and seminal vesicles to form semen, which is forced out through the urethra.
Vasectomy for Birth Control
A vasectomy is a form of birth control for men. After the surgeon gives a numbing injection, a small cut is made into the upper area of the scrotum. Next, part of the vas deferens is pulled outside. The tube is tied off and severed to disrupt the connection in the sperm-carrying tube. The ends are placed back inside the scrotum and the incision is closed with stitches or surgical glue. The procedure is then repeated on the other side.
In a variation of the vasectomy, special instruments are used to tie off and cut the vas deferens through a very tiny incision. This procedure, called a "no-scalpel vasectomy" doesn't require stitches.
Researchers estimate about 600,000 vasectomies are performed in the U.S. each year. It can take several weeks for a man's sperm count to drop to zero. Thus, an alternative form of birth control should be used until tests show there is no sperm in the semen.
Reversing a Vasectomy
A vasectomy is considered to be a permanent form of birth control. However, researchers estimate about five percent of men who have had the procedure later change their minds and opt for a reversal. There are many reasons a man may want to restore his fertility. Sometimes he remarries or loses a child. In other cases, the couple may have simply changed their minds about the number of children they want to have in the family.
While a vasectomy is a relatively simple procedure, a reversal is not. To restore fertility, the surgeon must locate and reconnect the ends of the severed vas deferens. Before the connection is re-established, the physician withdraws a small amount of fluid from the end closest to the testicle to look for sperm. If there are no sperm present, there is most likely a blockage somewhere in the tube and reconnecting the ends will not restore fertility. In these cases, a more complicated surgery is needed. The other end of the vas deferens must be connected to a point above the blockage.
The pregnancy success rate after a vasectomy reversal varies. According to the American Urological Association, it takes an average of one year before pregnancy occurs. The longer the time from the vasectomy and the older the female, the less likely a couple will achieve a pregnancy.
One alternative to a vasectomy reversal is in vitro fertilization (IVF). Sperm are extracted from the epididymis then combined in a lab with eggs from the woman. IVF is a very complex and expensive process, costing $10,000 to $15,000 or more. The older the woman, the less likely IVF will lead to a successful pregnancy.
Surgical Robot for Vasectomy Reversal
Sijo Parekattil, M.D., Microsurgeon with the University of Florida in Gainesville, is using a surgical robot for vasectomy reversals. The robot enables the surgeon to sit at a console while using high-powered magnification and cameras for viewing and robotic arms to manipulate surgical instruments. The robotic arms eliminate tremor from the surgeon's hands, allowing precise, fine-tuned movement. In addition, there is less fatigue for the surgeon since he sits at a console rather than standing over the patient.
Parekattil says with the robot, he is able to shave about 30 to 40 minutes off the surgery. Though this doesn't seem like a significant benefit, it reduces the amount of time the patient spends under anesthesia. The UF researchers compared outcomes of vasectomy reversal in men having robotic surgery against those who have traditional microsurgery. Two months after surgery, average sperm count was much higher among men who had the robotic reversal (54 million sperm count) versus those who had the microsurgical reversal (11 million).
Vasectomy reversal is generally not covered by health insurance. The robot adds about $1,800 to the total cost of the surgery.
For general information on vasectomies or vasectomy reversal: