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Vasovasostomy or vasectomy reversal is a urological procedure to re-establish fertility. 500,000 men each year have a vasectomy in the United States, and ultimately 2% to 6% will request reversal. The most common reason is to produce secondary offspring following remarriage to a younger woman. This procedure offers the best degree of technical success when performed microscopically, because finer sutures are less likely to produce obstruction of the internal channel at the reconnection site. Regional or local anesthesia is favored. Prior to surgery, the female partner should be gynecologically evaluated to be sure she is fertile and that she safely can carry a baby to term. Usually the procedure is performed through bilateral upper scrotal incisions. The site of prior vasectomy is identified and edges of vas above and below are freshened. Perfect right angle cuts make for a tight closure. Good anastomotic technique also includes accurate mucosa (inner lining of the vas) to mucosa approximation, leak proof anastomosis (connection), tension free anastomosis, preserving a good blood supply for optimal wound healing, and atraumatic handling of tissues. The likelihood of reappearance of sperm in the ejaculate versus pregnancy of couples followed up to three years is 97% / 76% respectively when the vasectomy had been performed less than 3 years prior. The success rate diminishes when reversal is performed 3 to 8 years post vasectomy to 88% / 53%, after 9 to 14 years 79% / 44%, and after 15 years or more 71% / 30%. Under unusual circumstances a vaso-epididymostomy may be indicated when there has been a "blowout" in the epididymis structure interposed between the testicle and the vas. Another consideration after failed vasovasosotomy is to aspirate sperm directly from the testis and via in vitro techniques fertilize at one time several eggs produced by hyperstimulation.  Intracytoplasmic  sperm injection (ICSI) involves the insertion of a single sperm into the cytoplasm of a mature egg.  Given well-selected couples with implantation of 3 to 6 embryos/blastocyts at one time, the "take home" baby rate is 15 to 20% (American Society for Reproductive Medicine).   Comprehensive vasovasosotomy fee at the Reed Centre is $6,200.00. Consultation is $250.

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