By PETER JARET

Dr. Marc Goldstein is director from the Center for Male Reproductive Medicine and Microsurgery at Cornell College Weill Medical College. Dr. Goldstein was among the first surgeons introducing no-scalpel vasectomies within the U . s . States and stays an innovator in research in the area of male contraception and fertility.

Dr. Marc Goldstein.

Q: Do you know the most typical misconceptions about vasectomies?

A: One worry among men is the fact that following a vasectomy they’re likely to be shooting blanks. Actually, there’s no noticeable alternation in the quantity of a guy’s ejaculate, with what it appears as though, what it really has the aroma of, what it really tastes like. Under 3 % of the level of ejaculate consists of sperm.

An unexpected quantity of men also worry they’ll lose sexual function. They confuse sterility and impotence. A vasectomy can really improve a guy’s sex existence. Actually, in early 1900s, a German researcher popularized vasectomies like a rejuvenation operation for old men. Apparently , there’s a small rise in testosterone level following a vasectomy. It’s insufficient to refresh your sex existence. Still, lots of my patients say they like a much better sex existence simply because they don’t need to worry any more about undesirable pregnancies.

Q: Do you know the greatest problems connected with vasectomies?

A: The most important side-effect is chronic discomfort following a vasectomy. About one in 1,000 men experience discomfort afterward. Following a vasectomy, men still produce sperm at comparable rate as before, and individuals sperm need to go somewhere. They sometimes develop within the epididymis, that is a 16-feet-lengthy tightly coiled tube behind each testicle where sperm learn how to go swimming.

Some men become responsive to the buildup of pressure within the duct and start to see discomfort.

Q: What you can do to alleviate the discomfort?

A: Oftentimes, taking an anti-inflammatory medication for example ibuprofen, putting on an advocate and relaxing in a hot tub to improve bloodstream flow is sufficient to treat the issue. Eventually the discomfort disappears.

Whether it doesn’t, there are many options. We are able to redo the vasectomy, departing the testicle finish open, allowing the sperm to leak out, which relieves pressure within the epididymis. However this boosts the chance that sperm will discover a new funnel in to the ejaculate, so we must monitor men by doing periodic sperm counts. An alternative choice would be to take away the epididymis, that is a a lot more complicated procedure compared to original vasectomy. Or we are able to turn back vasectomy, which always relieves the discomfort. The downside, obviously, would be that the man is fertile again.

Q: Do vasectomies ever fail?

A: Hardly ever. Failure takes place when sperm get a new method to go into the vas making their distance to the ejaculate, a procedure known as recanalization. Within our clinic, we might have 1 failure in 4,500 vasectomies. Vasectomies may also fail when men don’t wait lengthy enough to be certain all of the sperm cells have left before getting sex without another type of contraception.

Q: How lengthy will it take to be certain all of the old sperm have left?

A: I tell patients it requires 15 ejaculations or six days, whichever comes first.

Actually, we advise men in the future set for semen analysis. and never to take part in sex with no contraceptive until we have seen no live sperm. Regrettably, no more than 75 % in men follow-through and do semen samples, based on the latest surveys. Given how low the compliance is, I’m surprised the failure rate isn’t greater.

Q: You pointed out vasectomy reversal. Do you know the likelihood of effectively restoring fertility?

A: That will depend on several things. The more it’s been because the vasectomy, the low the likelihood of a effective reversal. The expertise of choices also plays a job, because the procedure requires delicate microsurgery. We’re usually in a position to effectively reverse vasectomies within 95 % in men.

I ought to explain that the effective reversal doesn’t guarantee men will end up fathers. Which depends upon the fertility of the spouses too. However I’d say about 80 % from the men that undergo vasectomy reversals within our clinic will continue to have children.

Q: How are vasectomy reversals performed?

A: The operation to reverse a vasectomy is a lot more complicated compared to original vasectomy. It takes an over-all anesthetic and may take four or five hrs. The easiest strategy is to reconnect the 2 ends from the vas. The diameter from the vas is all about 300 microns, just three occasions the diameter of the real hair. Making this a fragile microsurgery. We sometimes uncover there’s an obstruction within the vas upstream where the vasectomy was performed. Then we must bypass the obstruction, connecting the vas straight to the epididymis, that is a more difficult procedure. Frequently we don’t know until we start the operation the way it must be performed.

Q: What advice can you offer men who wish to reverse their vasectomies?

A: Look for a surgeon with many different experience of performing the operation. It’s really worth visiting a significant clinic that performs a number of these operations. When the reversal operation doesn’t work the very first time, it’s easy to repeat the process.

Q: What number of guys have second ideas and wish to reverse their vasectomies?

A: The figures remain 2 to six percent between 10,000 and 30,000 men annually. Despite the fact that there exists a very good rate of success, I still tell men arriving for any vasectomy that this can be a permanent type of contraception. I attempt to make certain they’ve thought it through and spoken using their partner. I’m very reluctant, for instance, to do vasectomies on youthful single men that haven’t had children. Whenever we execute a vasectomy, we don’t wish to have to reverse it later.

Publish date: 6/27/2008