To get feedback from patients who have undergone treatment at our Center, click here to go to the Patient Comments page.

If you have any questions, you may call us at  (314) 576-1400.


Disc_Health_blurb_sm“Dr. Silber is world leader & pioneer of the most widely used in vitro fertilization techniques. His patients fly in long from distances all over the world for treatment at his fertility center and, he is happy to take care of the most difficult cases with warm personal attention and great technical skill.“


Failed Vasectomy Reversal? We Can Fix It.

Vasectomy Reversal is a procedure (first invented and reported by Dr. Sherman Silber in 1975) which allows men who have previously undergone vasectomy to become fertile again. The vas deferens is microsurgically reconnected and the epididymal blowouts are microsurgically bypassed, allowing sperm to travel out of the epididymis and into the ejaculate. In 85% of vasectomy patients blowouts are found in the epididymis. So failure to correct or bypass these blowouts leads to poor success rates. But with proper attention to these details 98% of men have a return of fertility. However, if these blowouts in the epidydymis are not bypassed, then a reconnection of the vas alone cannot possibly succeed.

What Causes A Failed Vasectomy Reversal ?

In most so-called “centers,” the only procedure performed to reverse the vasectomy is “vasovasostomy” to try to reconnect the severed vas. However, in most cases there is also “epididymal” blockage (closer to the testicles) created by the pressure build-up after vasectomy. Thus, there is no chance for most cases of “vasovasostomy” to be a success, because there is also blockage in the more delicate duct closer to the testis, and this would have to be bypassed also with a very tricky-to-perform “vasoepididymostomy” in order to have a successful result.

Another trap is that these less successful commercial operations are always performed at little outpatient centers or clinics, and not at a major hospital like St. Luke’s Hospital in St. Louis. Therefore, the patient is sent home, or to his hotel room, only a few hours after his operation. The natural consequence is often a huge amount of pain and swelling, and several miserable months of post-operative recovery. We think it is imperative for the patient to stay overnight for one night in the hospital, with drains in place and nurses changing the dressings, which prevents pain and swelling and results in a faster and much more pleasant post-operative recovery. When we “redo” a messed up “vasovasostomy” done elsewhere that had failed, despite it being a bigger operation to bypass all the scar tissue created by the previous failure, our patients are elated by how little pain and swelling they had to endure compared to their original failed reversal surgery in an outpatient office or clinic setting.

In fact, the only reason to do this operation in such an office or clinic setting is to save on overhead and make more money on the procedure. We do not condone this common practice. Furthermore, if cost is the important issue (and it is for many people), it is far less cost effective to have a “vasovasostomy” that fails, with significant pain and swelling afterwards, than to just do it right in the proper hospital setting the first time.

The next big trap is that clinics that cannot perform the delicate microsurgery required, will suggest you do sperm retrieval and IVF (in vitro fertilization) instead of vasectomy reversal. We have nothing against sperm retrieval and IVF, since it is our center at St. Luke’s Hospital that actually invented it in 1987, over 250 years ago. However, we invented it as a second choice approach for those in whom a reversal was not possible because of a complete absence of the vas deferens. Otherwise, it is so much nicer just to have one operation that restores your original fertility, without your wife having to go through months and months of painful injections involved in IVF, with a pregnancy rate lower than what you would achieve through natural intercourse once you have had a successful reversal.

Finally, it is important to realize that the testicles and the scrotum are a very private and sensitive area for most men. You don’t want to have a compromised procedure on that area of the body performed in the “procedure room” of an office based clinic, rather than in a proper operating room of a high quality hospital.

How We Fix Failed Vasectomy Reversal

Because of Dr. Silber’s extensive experience in over 10,000 cases, he has no trouble freeing up the scarred mess left by your previous failed surgery. If the failure is caused by scarring at the site of vas reconnection, he removes all scars, and makes a more perfect, indeed beautiful reconnection, of the vas to replace the scarred up previous surgery

If the failure of your previous vasectomy reversal is caused by “epididymal blowouts”, that is secondary blockage is the more delicate ductwork closer to the testicle, Dr. Silber can bypass this scarred mess also, resulting in a beautiful bypass of all blockage. Since the “epididymis” is such a miniscule microtubule, one thousandth of the thickness of your vas, very few microsurgeons can fix this blockage. However Dr. Silber with his greater than 10,000 cases experience, has no trouble fixing this.

What to Do If You Do Not Want To Fix the Failed Reversal

For anyone who has had a vasectomy, or even one or more previous failed vasectomy reversals, the simplest, most cost-effective approach, as well as the best chance for a pregnancy would still be to reconnect your ducts microsurgically. This involves no greater surgical discomfort than the sperm retrieval and gives a 95% chance for a successful return of fertility, as compared to a 40% pregnancy and delivery rate per treatment cycle with sperm retrieval and ICSI. However, we do make sure to offer you the benefit of both vasectomy reversal and ICSI.

Common Crude Methods

 

Relatively crude surgical techniques like those depicted above will occasionally be successful, but this usually results in scarring down with a poor channel for sperm to go through leading to poor sperm quality and no pregnancy. Eventually such a crude channel scars down completely and the patient has very few or no sperm coming through.
Relatively crude surgical techniques like those depicted above will occasionally be successful, but this usually results in scarring down with a poor channel for sperm to go through leading to poor sperm quality and no pregnancy. Eventually such a crude channel scars down completely and the patient has very few or no sperm coming through.

Figure 2. Diagrams of preparing epididymal tubule for end-to-side vasoepididymostomy.
Figure 2. Diagrams of preparing epididymal tubule for end-to-side vasoepididymostomy.

Diagram showing placement of first mucosa suture for end-to-side vasoepididymostomy.
Diagram showing placement of first mucosa suture for end-to-side vasoepididymostomy.

Figure 4. Diagram showing first 3 posterior mucosal sutures for end-to-side vasoepididymostomy.
Figure 4. Diagram showing first 3 posterior mucosal sutures for end-to-side vasoepididymostomy.

Figure 5. Diagram showing completed mucosal anastomosis end-to-side vasoepididymostomy.
Figure 5. Diagram showing completed mucosal anastomosis end-to-side vasoepididymostomy.

Success stories

paulsrudDear Dr. Silber,

We can’t begin to thank Dr. Silber and all of his staff for everything that they have done for us! From the moment that my husband went to his hometown doctor and was told that his vasectomy reversal was not going to work and I looked up Dr. Silber on the internet, our lives changed DRASTICALLY… for the better! Dr. Silber helped my husband have a successful vasectomy reversal which resulted in freezeing sperm at the time this as well. We were very happy that this was done because shortly thereafter, we found out that between my fertility issues and my husbands issues we needed to use that frozen sperm and the ICSI procedure to conceive. Thankfully Dr. Silber was able to assist us with this and we gave birth to a healthy baby boy 7 years ago, named Logan. WHAT A BLESSING!

We have told Logan about this process from the start. He has always wanted to meet Dr. Silber so when we were able to see him this September, it was certainly a dream come true for our family! Thank you again Dr. Silber! You truly mean the world to us!

The Paulsruds

Jody, Sarah & Logan
Eau Claire, Wisconsin


LisDr. Silber and Staff,

We are excited to send you the announcement of our daughter, Thea Rose. She was born October 20, 2009 and perfect in every way.

Our vasectomy reversal was done October 7, 2008. This was our second reversal attempt. It proved to be a difficult surgery requiring double VE connection. We found out we were pregnant only three months after the surgery. We were thrilled and a bit shocked to find out we were pregnant so soon after surgery.

Thank you so much for helping us complete our family. It would never have been possible without your talent and skill. We are grateful to you for making our dream a reality.

Our deepest gratitude,
Jim and Ami Lis
Lockport, NY

 


Dr. Silber explains that ICSI offspring are normalClick To Return to the Main Male Infertility Page


Also listen to Dr. Silber’s radio commentaries:

audio-icon-NEW

Listen to Dr. Silber’s internet radio chat on msnbc.com. (47:26 min.)

audio-icon-NEW

Listen to Dr. Silber and Joan Hamburg discuss the exciting new procedure for determining exactly how long a woman has left on her biological clock. (25:52 min.)

If you have any questions, you may call us at  (314) 576-1400.