John J. Bauer, M.D.
Vasoepididymostomy refers to the surgical procedure in which the vas deferens is connected to a single epididymal tubule in order to bypass a blockage in the epididymis. Blockages in the epididymis can result from infections in the epididymis (epididymitis), previous vasectomy, trauma to the epididymis, or injury from previous scrotal surgery.
In experienced hands, vasoepididymostomy results in greater than 75 percent potency rates and greater than 50 percent pregnancy rates. The success of surgery depends on many factors including when the original surgery occurred, the technique used, and the degree of scarring. In most cases, a thorough history combined with the physical examination can help predict the likelihood of success after vasoepididymostomy.
Vasoepididymostomy takes between 3 and 5 hours. It is performed under general or regional anesthesia with the assistance of an operating microscope. The patient can return to desk work as early as 3 days after surgery, however, strenuous physical activity (jogging, weight lifting, sex) is limited for one month. The follow-up care consists of an office visit one month after surgery to check the incisions and to analyze a semen specimen. The specimen must be produced at home and brought in to the office within one hour of production. If no sperm are seen, the next specimen is obtained in two months. In some cases, it may take over a year for sperm to return to the ejaculate. In most cases, however, sperm is seen in the initial specimen.
At the time of vasoepididymostomy, sperm are routinely retrieved for cryopreservation. The epididymal fluid, which is typically rich in sperm, is retrieved at the time of the operation and preserved in a special medium. The sample is then cryopreserved by the IVF specialists and is available for future use, if necessary. The fees for cryopreserving and storing sperm are available at the IVF office.