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Are All Vasectomies Reversible social media preview

Are All Vasectomies Reversible?

Are all vasectomies reversible?I often see patients who are potential candidates for vasectomy reversal and it makes me think of a smart urologist whom I have known for many years. We were at a meeting of a local surgical society and having a glass of wine and talking to a third mutual friend, who was a reproductive endocrinologist. The urologist told us that he had a patient that was 50 years of age and had a vasectomy 8 years earlier. He added that the man’s present wife was 29 years of age (this is not that uncommon in Los Angeles). He had just referred the couple for In Vitro Fertilization (IVF) with sperm extraction. He said he did this because the man was 50 years old. Unfortunately, while he was a good urologist, he didn’t specialize in­—and knew very little about—infertility. After he walked away the reproductive endocrinologist looked at me and said exactly what I was thinking: that this was the perfect couple for a vasectomy reversal. The man had two kids and it had been less than 10 years since his vasectomy. The wife was young and fertile and ordinarily would not have needed IVF under other circumstances.

This was the perfect couple for a vasectomy reversal. The man had two kids and it had been less than 10 years since his vasectomy.

In patients less than 10 years from vasectomy the success rates for reconnecting the two ends of the vas together (thereby reversing the vasectomy) exceed 90% when there is sperm in the vas. The success rates are lower if there isn’t sperm, but the cost of a vasectomy reversal is less than one round of IVF. In addition, you can typically extract and freeze sperm at the same time as the reversal, so another sperm retrieval is unnecessary should the reversal fail.

So when is a vasectomy reversal the right choice?

Since the goal of a reversal is pregnancy, here are some good rules of thumb:

  • In men less than 15 years from their vasectomies the rates of success and pregnancy are quite high.
  • The younger the female partners, the greater the chance of making them pregnant following a reversal.
  • A successful reversal is less expensive than one round of IVF; and most couples will need more than one IVF cycle to achieve a pregnancy.
  • Unlike IVF, a successful reversal allows you to try every month to achieve a pregnancy.

While not all vasectomies are reversible, most are, and a reversal has many physical and economical advantages over IVF. Obviously, it’s wise to talk to your male fertility specialist about your options before proceeding and don’t hesitate to get a second opinion.


Learn more about Vasectomy Reversal and Sperm Retrieval, or to see Dr. Zeitlin:

 

 

Smoking...and Your Future Kid

Smoking…and Your Future Kid

Smoking and Children

A 28-year-old man recently came to see me after he and his wife had been unable to conceive for a year. She was 26 and healthy. He smoked 2 packs per day and liked to drink as well. He was about 20 lbs. overweight. I looked at his analyses. His sperm count was borderline and his motility and morphology were low (see my article “Yes, but am I fertile?” for a detailed explanation). I examined him, finding normal results from head to toe except for some wheezing. His hormone tests all came back normal. After his fertility testing was done, I told him that if he would stop smoking and drink less that his wife would probably be pregnant in the next 6 months. He asked me what he would have to do if he didn’t want to quit smoking and drinking.

If he would stop smoking and drink less, his wife would probably be pregnant in the next 6 months.

I told him that he would need to start with IUI, which is commonly referred to as artificial insemination, while his wife would need to be stimulated with hormones. I added that if it didn’t work after a number of cycles they would need to go to IVF, which is in vitro fertilization. I stressed that they were young and if possible natural conception was the way to go. First, it’s a lot more fun; you can do it from the comfort of your own home—or anywhere else as long as you don’t get caught. Second, It obviates the need for hormonal stimulation and its consequences such as multiple order births. You know…less twins and triplets. Last but not least, it’s free—as long as she isn’t charging him.

The Research

The Avon Longitudinal Study of Pregnancy and Childhood looked at pregnant British couples, questioning them about their time to conception and the factors that affected it. Hull et al., published this study more than a decade ago in Fertility and Sterility. What they found was that not only was the women’s pregnancy delayed by smoking, but also by exposure to second-hand smoke. In addition, when the men independently smoked more than 20 cigarettes a day, the chances of having a pregnancy delayed beyond 12 months increased.

Men who are alcoholics are prone to testicular atrophy, which is a shrinking of their testes. However, when Olsen et al., looked at moderate drinking in “Does Moderate Drinking Affect Fecundability? A European Multicenter Study on Infertility and Subfertility,” they found that there was no correlation between moderate alcohol consumption and delay to pregnancy.

So if You Want to Have Kids…

So what’s the take home message? There are a myriad of reasons to quit smoking and to not abuse alcohol, but if you are trying to get pregnant, consider this: if you’re going to have a kid you should get used to those things anyway because it’s not good for you, your partner or your baby. May 31st is the WHO’s World No Tobacco Day…quit then, or just quit today. Either way, your future kid will thank you.

 


 

Whether or not you are a smoker, if you are concerned about your fertility or sexual health, please see your doctor. If you would like to see Dr. Zeitlin, please schedule a consultation.

Four Things To Do this Easter to Have a Baby

Four Things To Do This Easter to Help You Make a Baby

Four Things To Do this Easter to Have a Baby - Dr. ZeitlinAlas, spring is upon us! The flowers are in bloom and love is in the air.  Temperatures are rising and clothes are shrinking. Doesn’t it all just make you want a have a baby? Even if you hadn’t already been thinking about having a baby, the season can certainly put you in the mood. And with Easter coming up, this might just be the perfect opportunity.

Christians celebrate Easter in honor of the resurrection of Jesus Christ, but the spring celebration and its symbols of fertility (eggs and rabbits) have been around for thousands of years. The Easter season definitely celebrates new life. Speaking of life, here are a few ways to maximize your chances of fertilizing an egg of your own this Easter Sunday.

1. Impress your spouse

Easter Egg HuntNothing screams parent more than playing with kids. If your spouse ever had doubts about your parenting ability, he or she is sure to feel more certain once they see you scavenging for chocolate eggs, putting band-aids on boo-boos, and supervising the nearest little ones. Be good with kids. It’s hot.

2. Eat the right food

Easter HamHam is a popular staple of Easter dinner. And you know what’s popular for making babies? Zinc, which also happens to be abundant in ham—a popular Easter staple. According to the American Pregnancy Association, it contributes to semen and testosterone production (and is also good for child development during pregnancy). So eat your ham, get your zinc, and boost your fertility.

3. Chocolates bunnies!

Easter chocolate bunnies Some say all you need is love, but a little chocolate here and there never hurts. Or what about both? Chocolate is known to stimulate the release of phenylethylamine, or PEA, which arouses the nervous system, increases heart rate, and is suspected to produce feelings of love.  Chocolate bunnies aren’t just for kids, they can also help you have them. So get some chocolate and get going!

4. Schedule some quality time

easter-coupleBetween dealing with extended family, excited children, and heavy planning in the kitchen, Easter can be stressful. Make sure to plan some “us” time between the egg hunts, eating, and catching up with relatives. And that doesn’t mean just fooling around in your childhood bed—unless you are into that. All is fair in love and fertility!

So whether you’re celebrating the resurrection of Jesus, the return of spring, or just want to increase your chances of getting pregnant, seize the opportunity, in the name of Easter.

Yes, but am I fertile?

Yes, but am I fertile?

Yes, but am I fertile?As a urologist specializing in male fertility, perhaps the most common question I get asked by new patients is, “am I fertile?”

To find out, I’ll examine them, draw hormones and get two semen samples for analysis. As soon as I get the results back from the lab, I’ll review them and go over the numbers with my patient. Most of the time, it’s good news and I tell him that the results are “normal.” Often, there is one semen parameter—like concentration, motility or morphology (the numbers of sperm, their ability to move and their shape)—that may not meet the normal value for that particular laboratory.

And, almost invariably, I’m asked: “but am I fertile?”

In a very interesting study published by Guzick. et al. in the New England Journal of Medicine, they set out to define which males were fertile by semen analysis parameters. They looked at 765 couples who were unable to conceive for at least a year and 696 fertile couples as the control groups. All the men were 20- to 55-years-old. All of the women partners had normal evaluations.

The resulting semen analysis numbers greatly overlapped among the groups. Fertile men had a mean (average) concentration of more than 48 million sperm/cc, 63% motility and 12% normal morphology . The values that best defined infertility were a concentration of less than 13.5 million sperm/cc, less than 32% motility and less than 9% normal forms. Patients defined as indeterminate had concentrations ranging from 13.5 million sperm/cc to 48 million sperm/cc, 32–63% motility and 9–12% normal morphology. As you might expect, infertility increased with decreasing sperm concentration, percent motility and normal forms.

Guzick fertility table(NOTE: Infertile males were also more likely to smoke and drink. So if you’re looking to start a family, here’s another good reason to break those habits now.)

The study concluded that while the parameters provide useful information for diagnosing infertility none of the measures alone or in combination can be diagnostic of infertility. A semen analysis is like a photo snapshot – you might look different day to day or different times throughout the year, and so might your semen analysis.

Two to tango...and conceive.More often than not, the real question my patients want to know is “can I have a child?” For most men I see, the short answer is “yes”…under the right circumstances and treatment. Of course, men are only half of the equation. It takes both partners in the relationship to achieve a pregnancy, and depends on what, if any, assisted reproductive technology they are both willing to go through. Ultimately the old adage is true, it takes two to tango. Enjoy the dance.

 

 


If you’re having trouble achieving a pregnancy, please schedule a consultation.