Preparing for vasectomy reversal surgery
There is no doubt that the most important issue that you should consider prior to vasectomy reversal is the skill and experience of the surgeon who performs your surgery. As a reproductive microsurgeon I am continually performing vasectomy reversals. In addition, I have a dedicated surgical team who exclusively assist me in performing vasectomy reversal. The same people doing the same procedures, all of the time, means maximum expertise and experience available to you.
Reasons for vasectomy reversal
Achieving a pregnancy is obviously by far the most common reason to have a vasectomy reversal - but it is not the only one. Long-term pain following vasectomy, while uncommon, does occur (so called post-vasectomy syndrome). Vasectomy reversal has a greater than 70% chance or relieving or reducing such pain and is a worthwhile indication.
While restoration of fertility (as measured by the return of sperm) is dependent upon microsurgical skill and experience, the single most important factor influencing the prospect of successful pregnancy following vasectomy reversal has nothing to do with the surgery itself or for that matter the man undergoing vasectomy reversal. It is the your partner's age. The older you are the more likelihood that you may have some additional medical problem that may influence the safety of surgery or the chance of complications. In addition, many people will think about the difference in age between parent and child as they get older.
It is important to be aware of your general state of health prior to any surgical procedure. There are a variety of conditions that may affect the outcome of your operation. Smoking has been shown to reduce fertility by affecting sperm function. Please ensure that I am made fully aware of your past medical history at the time of your pre-operative consultation.
The American Society of Reproductive Medicine position paper on vasectomy reversal states that provided that you are in good general health, "no specific or unique testing is required" prior to your operation.
Indeed preoperative testing for vasectomy reversal has very low sensitivity and specificity, which essentially means that the results of such tests have a high likelihood of producing misleading results. When tests such as ultrasound and sperm antibody testing are used to decide who should and who should not have a vasectomy reversal then this will do harm. Put another way, these tests are much more likely to exclude men from surgery who would ultimately have successful operation than to identify those who will not.
It is technically possible to microsurgically reanastomose both vas deferens in more than 99% of cases and the the only way to accurately assess those in which it is not feasible is to surgically explore the scrotum. Ultrasound does not discriminate sufficiently to be useful.
Sperm antibodies are produced after exposure of sperm to the immune system. About 60% of men develop sperm antibodies in their blood following vasectomy. The presence of sperm antibodies in the blood does not accurately predict pregnancy following reversal and so the value of testing for sperm antibodies pre-operatively is both controversial and unproven. The American Society of Reproductive Medicine recommends against performing pre-operative sperm antibody testing.