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Re: Failed vasectomy?

Posted By HFHS M.D.-JL on May 26, 1998 at 08:07:08:

In Reply to: Failed vasectomy? posted by Diane on April 24, 1998 at 22:06:50:

We had post-vasectomy checks of my husband's semen done at 8 1/2 weeks and again at 11 1/2 weeks (20-plus ejaculations).  Both times the urologist called saying his specimens were still full of live sperm.  After the second check, the urologist said the surgery had failed and offered to do it again for free.  We had regretted the vasectomy almost immediately and had been looking into getting it reversed, so we declined his offer.  He refunded our money.  Now that we are trying to have another baby, we are worried that the doctor may have been hasty in assuming the vasectomy failed.  When we asked what my husband's count was, the doctor said they didn't count, just looked at a specimen under a microscope but that, after 11 1/2 weeks, there was no way a specimen should be teeming with live sperm.  My question is, how long can sperm live after a vasectomy?  We are afraid of disappointment when we get a semen analysis done and want to prepare ourselves for the possibility that the vasectomy worked after all.
Thanks for any insight you can provide.
Dear Diane,
Vasectomy failure is seen in 1 in 200 to 400 patients.  It is due mostly to technical errors such as removal of <1 cm of vas.  This may result in increased rates of spontaneous recanalization (seen in <1% of patients, usually within the first 3 months).
Persistence of sperm may indicate too few ejaculations.  It takes 74 days for sperm to grow, mature and be stored in the epididymis.  It takes eight to ten ejaculations to clear sperm from the distal vas deferens.  Postoperative semen analysis requires 2 samples without motile sperm for the surgery to be considered a success.  If at 3 months, motile sperm are found, the operation is considered a failure and should be repeated.

Let's say the vasectomy failed due to recanalization of the vas.  Could there still be decreased fertility/infertility?  Yes, and here is why.
The testis is "hidden" from the body's immune system by the blood-testis barrier.  A vasectomy creates an obstruction which disrupts this barrier and antibodies are made against the sperm.  Thus, the sperm are attacked by the bodies immune system and this alters the function of the sperm, making them less effective.  Whether these antibodies diminish or persist is uncertain.
As far as a fertility work up goes, you'll need, in addition to a physical exam:  1) a semen analysis;  2)   serum and antisperm antibody studies 3) serum FSH levels--especially in men with small testes (with a vasectomy, there is a risk to damaging the blood supply of the testes.)
If the vasectomy did work, it can be reversed.
Good luck.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely yours;
* Keyword:  vasectomy; complications/fertility

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