Fertility: S01 E29 – What To Do After A Vasectomy – Dr. Whitten

Thank you again for joining us for another educational video today, I’m Dr. Scott Whitten from the Nevada Center for Reproductive Medicine and today I’m going to talk to you about what options do patients have when the male partner has had a vasectomy performed on them. Obviously you know that vasectomy is a very common procedure that utilize for contraception in guys and what is performed during a vasectomy is there is a tube that takes sperm from the testicle out to the ejaculate out its called the vas deferens. So when you do a vasectomy your actually cutting ore removing a segment of that tube which interrupts the flow of the sperm that comes out in the ejaculate. So after the vasectomy is performed guys don’t really experience any difference in the ejaculation that they experience for the fluid that comes out but there’s really no sperm in that fluid. So when they come see me and ask for what can we do to get pregnant then there’s really of couple of options for them. There’s really 3 options for most guys for most couples. first option would be you could see a urologist regarding a possible vasectomy reversal and that is a procedure done underneath the microscope in the operating room where they actually put the two ends of the tubes back together again and try to restore that flow of sperm back out into the ejaculatory pregnancy could be achieved with intercourse. Unfortunately depend upon how long it’s been since the vasectomy which performed really dictate whether that’s potentially going to be a successful procedure for you or not you also can’t forget about the female issues that need to be taken into consideration like female age other infertility issues so you can’t look at it just as an isolated issue you have to look at a couple male and female in total and see if it’s the right treatment for them. So vasectomy reversal would be done by your urologist not by myself I’m a reproductive medicine specialist but what we would do in our office is option number 2 is we’re able to extract sperm from either the testicle itself or the storage compartment on the side of the testicle which is called the epididymis and if you can see in this diagram down here is the testicle right on top is the epididymal structure and that is where the sperm where store and are waiting to come out in the vas deferens. So we can access that area with a small needle and actually obtain some sperm from there. There’s 2 procedures that we use in our office and its performed done in another stage which called Pasa. A per containous epididymal sperm aspiration which simply means a needle’s placed through the skin and into that structure to remove some sperm or we could do a test procedure which is testicular extraction of sperm where we actually go up stream to the testicular tissue remove a little bit of sperm there now either one of those techniques there is only a very small amount of sperm that’s obtained and therefore we have to use that sperm very efficiently so the only way to use that sperm is actually to do in vitro fertilization where we can utilize a technique called IXIE or intracytoplasmic sperm injection I know there’s a lot of terms here IXIE simply means taking a single sperm in a glass needle placing it inside the egg and injected it into the egg you only need one sperm per egg so you can actually get away with very few sperm when you do that it brings patience fertilization rates back to normal so it means the ability to turn an egg  into an embryo by the sperm is that the same as normally If I mix the whole bunch of sperm with an egg in a dish and they fertilized normally but unfortunately this would get you to the in vitro fertilization process fortunate that has high success rates in the advantages of being able to look at genetics of embryos and you can refer to are there videos for some of that information the pay set and the testing procedure are also can be used for any kind of obstructed issues that are going on with the male genatillia for example there is a particular circumstance where guys who are carriers of cystic fibrosis they didn’t have vas deferens develop or the best evidence that there is solid and not a tube so that sperm can go through there and that case you treat it just like you would have a vasectomy patient so there are other circumstances when we will use this procedure not always in post vasectomy cases but the pasa and the testing procedure are very good in office procedures to obtain sperm and guys have had a vasectomy and still result in very high success rates there still a third option some patients do consider which is it the male doesn’t want her to undergo any procedures by urologist or by myself then the couple can decide to use donor sperm and that you obtain donor sperm from a sperm bank and their sperm has been inseminated into the uterus of the time when the woman is ovulating helping them to get pregnant unfortunately then the the male does not have a genetic tie to The Offspring and and that most of the time that’s what patients desire when they come in and see us so keep in mind there’s three options for most couples if you want to learn more about these options please come and see us and I’m happy to talk to you more in detail in your particular situation my name is Dr. Scott Whitten Nevada center for reproductive medicine thanks for listening.