Dr. Mistry and Donna Lee Discuss Vasectomies and Vasectomy Reversals
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I’m Dr. Mistry, as always, with my host Donna Lee. For those of you that listen to the show, you may recall that Donna Lee is in fact a comedienne, a professional comedienne. And she and I have a running gag that one day I’m going to come up with a whole comedy set.
Are you ready for my first one? What is the difference between a man and a woman?
There’s a “vas deferens.”
Don’t Know What A Vas Deferens Is?
The vas deferens is the tube that connects the testicles to the prostate, and that’s where sperm is transported so that we can make babies.
There are two different surgeries that we do for the vas deferens. This month, I was confronted with a patient who had a very enlarged vas deferens and it was very thickened. It was very tender and painful, it’s calcified vas deferens, and it’s one that resulted, we think, from a trauma that the patient experienced and has now led to infertility and chronic pain. So, we’re going to remove the whole vas deferens.
This process is just called a vasectomy, but that’s going to be a much bigger, much more involved procedure than we would usually associate with a vasectomy.
The Vasectomy Process
For those of you, if you’re at home from work and you’re able to recuperate, you may be interested in having a vasectomy during this time. The vasectomy is a very commonly performed, well-tolerated procedure. It takes about 20 minutes. We do it here in the office.
And we have great music that plays in the background—if you like 80’s new wave alternative because that’s pretty much all that’s going to play. You can tolerate the music because we do offer IV sedation, using intravenous midazolam, which wears off pretty quickly. Most patients are able to walk out of here even though they’re pretty loopy, sleepy, or really funny. They’re always smiling.
That’s another running joke we say about people when they go back to write reviews about the vasectomy, they say, “Well, don’t remember it, but everything went well.”
Single Visit Vasectomy
One of the reasons that we started the IV sedative is because it allows us to do something called a single visit vasectomy, which means that you can come in, get your consultation for the vasectomy, and get your procedure in the same day, which is extremely convenient. It makes it more likely that you’re going to go through with the procedure because you only have to come and wait in the waiting room and wait for me and you know, do all that stuff one time. At other offices, you have to go in 3 times, at least.
Benefits of IV Sedation
It becomes inconvenient when people are already kind of nervous about the procedure. We try to eliminate that one barrier by doing it. Another real benefit of the vasectomy with IV sedation is that you don’t remember it getting done. And early on in my practice, I had this theory that when you’re getting worked on down below, that’s already kind of an anxiety-provoking experience. If you can remember the pulling or the sharpness of any kind of instrument, I bet you kind of makes you like have some anxiety.
That sounds like a one-star Yelp review. And I think a lot of men were having discomfort after their vasectomy just because of that experience of having gone through it. As a result of that, we have much higher rates of actually completing the vasectomy because the anatomy is a lot easier to deal with. And we have fewer people complaining of pain and discomfort afterward. That’s really great. The IV sedation really puts us in a different category. We use a single incision.
But we do something else here too, and that’s the vasectomy reversal. We do quite a few vasectomy reversals as part of our male fertility offerings here. The vasectomy reversal is done on some estimates on about 10% of patients that have a vasectomy rethink that decision. You know, you never know. But what’s interesting is second wives are older than they used to be.
If you’re thinking about getting a vasectomy reversal, but your second spouse happens to be 38 or 42, then it may be wiser in terms of the chance of getting a baby to do an extraction. We can do this right from the testicle or epididymis and then go through IVF. We have some wonderful IVF partners that we use. And so that’s one of the important considerations that we ask men to go through before they make a decision on becoming dads again is what would be the most likely way for it to happen?
There are a number of reasons men want to have a vasectomy reversal. There’s remarriage, which is probably number one. There’s just rethinking family size as economic situations change. And then, of course, the most tragic is the loss of a child. It’s an unfortunate tragedy that we deal with probably, you know, 3 to 6 times a year, we have a couple come in with the tragic loss of a child. The vasectomy reversal is a way for that family to find some happiness out of a tragedy.
You can get a vasectomy reversal in the office in some places, you can go down there or someplace that will do it in the office. I think it’s much, much more comfortable to get it done under general anesthesia. It takes, you know, an hour and a half to do it and you’ve got to sit still for an hour and a half and somebody’s working on your stuff. I mean, so we do most of ours in the operating room.
How Much Does a Vasectomy Reversal Cost?
The price for a vasectomy reversal is around $6,000. It is not covered by insurance. And for an additional $500, we will collect sperm that you can cryo-preserve and you’re not going to find that opportunity virtually anywhere. It adds about half an hour to the case since it requires me to examine the sperm under a microscope to make sure there’s moving sperm. It gets sent to a cryo-preservation facility and, just for a little bit of extra money, you have that confidence that even if the vasectomy reversal doesn’t work, then you have sperm that’s in the freezer that you could use for IVF or some other assisted reproductive kind of thing.
Does It Really Work?
A lot of people think of the reversals like just a plumbing job. Like you just took a tube and you’re just, and you are just occluding, and you just have to take that occlusion out and put it back together. But that, you know, the reproductive anatomy is really a living, breathing, evolving system. So, when you occlude the vas deferens with a vasectomy, the sperm backs up into the testicle. Then, there can be damage done to the epididymis and testicle that doesn’t allow the vasectomy reversal to work.
The numbers I usually quote is if you’ve had a vasectomy in the last 2 years or less, the reversal rates about 90%. If it’s less than 7 years, the vasectomy reversal rate is somewhere between 75% and 85%. But if it’s a, you know, 15 years or older, that number can drop to as low as 35%. So, the time since your vasectomy could have a big impact on success as well as any pain or complications you may have had.
Listen to the original episode on The Armor Men’s Health Podcast.
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