Larry I. Lipshultz, M.D., Professor of the Scott Department of Urology at
Baylor College of Medicine, was born in Philadelphia, Pennsylvania, and
graduated from Franklin and Marshall College. He earned his M.D. and completed
residency training at the University of Pennsylvania. He also completed a
two-year fellowship at the University of Texas Medical School at Houston in
male reproductive medicine.
In his active clinical practice, Dr. Lipshultz specializes in male
infertility and male reproductive disorders. As a member of Baylor's
faculty, he is a popular teacher and has trained more than 30 fellows now in
practice throughout the U.S. As Clinical Director of the Laboratory for
Male Reproductive Research and Testing, his interests are in discovery of new
growth factors secreted by the Sertoli cell and the development of new
techniques for micromanipulation of sperm. The laboratory has received a large
NIH grant to determine the correlates of fertility in spinal cord injured men. Newly
developed techniques for micromanipulation of sperm have assisted a large
number of infertile patients to achieve pregnancies over the last few years.
Well-known author, editor, and lecturer, Dr. Lipshultz has published
more than 200 scientific papers, most of them on the subject of male
reproduction. Dr. Lipshultz currently serves on the editorial boards
of the journals Urology, Advances in Urology, and Contemporary
Urology. He has acted as guest editor for complete issues of World
Journal of Urology and Urologic Clinics of North America. In 1995 he
edited a book Urology and the Primary Care Practitioner published
by Mosby-Wolfe Medical Communications, a division of Times Mirror International
Publishers Limited. Dr. Lipshultz is the editor and author of the
authoritative textbook of male reproductive medicine and surgery entitled Infertility
in the Male.
Active in numerous scientific organizations, Dr. Lipshultz has served
as a member of the Board of Directors of the American Society for Reproductive
Medicine and as President of the Society for the Study of Male Reproduction.
Dr. Lipshultz was President of the American Society for Reproductive Medicine
from 1998-1999.
Dr. Larry Lipshultz Curriculum Vitae
Vasectomy Reversals
(Microscopic Vasovasostomy
and Epididymovasostomy)
A vasectomy reversal is an operation that reestablishes a connection between
the two ends of the vas deferens that were separated at the time of a prior
vasectomy. Sometimes the vas deferens is reconnected to the epididymis
(epididymovasostomy) because of a secondary obstruction in the
epididymis. The entire procedure is performed under a special
microscope.
Sperm production takes
place in the testis. After passage through the efferent ducts, sperm are
stored and undergo maturation within the epididymis. Those sperm that
have not passed through the epididymis are generally not able to fertilize eggs
under normal conditions. The epididymis is a continuous, tightly
coiled tube approximately 15-18 feet in length, which leads into the vas
deferens. The vas deferens is responsible for directing and propelling
the sperm into the urethra.
Increasing numbers of men
are coming to the urologist for vasectomy reversals, most commonly because of
remarriage and the desire to initiate a pregnancy. Vasectomy reversals
are also requested by couples who have merely "changed their minds,"
as well as by couples who have lost a child and are attempting to initiate
another pregnancy. Fortunately, microsurgical advances are now
resulting in significant pregnancy rates.
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SUCCESS
RATES
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The success of
a vasectomy reversal depends on:
1. The skill of the surgeon.
2. The findings at the time of surgery.
The surgeon
should be skillful with microsurgical technique, as precise suture placement is
critical to the success of the procedure. The surgeon must also have the
ability to perform the more difficult epididymovasostomy procedure.
As mentioned previously,
other important factors in determining a successful outcome are the surgical
findings.
When the vas is opened, fluid will flow from the testicular side of the
vasectomy site. If sperm are present, then we expect 90% or more of
patients to demonstrate a return of sperm with an associated 60%-70%
pregnancy rate. If no sperm are present, yet the vasectomy fluid
looks abundant and appropriate for ultimate sperm production (e.g., clear,
watery), then a direct vasovasostomy is performed with a successful outcome
of approximately 50%. If poor-quality fluid is present (e.g., thick,
pasty) and sperm are absent, or no fluid at all is found, then an
epididymovasostomy (connection of the vas to the epididymis) is performed
with a successful outcome of approximately 40%-50%.
We use a two-layer
anastomosis utilizing microscopic sutures and the latest microsurgical
equipment. We perform approximately three of
these procedures weekly on an outpatient basis. The arrangement allows you to
return home or to a nearby hotel without actually being admitted directly to
the hospital, thus saving considerable expense and making the overall
experience much more pleasant. We perform the surgery at the day
surgery unit at St. Luke's Episcopal Hospital or The Methodist
Hospital; both of these facilities feature state-of-the-art
microsurgical equipment and a hospital staff well-trained to assist in these
procedures.
Operating time for a vasovasostomy or
epididymovasostomy is approximately 3 hours. A general anesthetic
usually is used, but a regional anesthetic (spinal or epidural) can also be
selected. We prefer that out-of-town patients stay in Houston for at
least 1 day after surgery. Postoperative follow-up includes an evaluation
of wound healing at 10 days to 2 weeks and a semen analysis at 6-8 weeks.
Monthly semen analyses are then obtained for approximately 4-6 months, or until
the semen analysis stabilizes. If semen quality is less than expected,
anti-inflammatory medication are often introduced to decrease scarring.
Cryopreservation of sperm
(sperm banking) is
routinely performed at the time of vasectomy reversal if whole, motile sperm
are present. Cryopreservation is performed as a safety
"backup" in case inadequate sperm counts are present after
surgery. Because vasectomy reversals may infrequently scar, despite
good initial results, cryopreservation may also be performed on ejaculated
specimens early in the course of recovery when semen quality is exceptionally
good. Sperm are stored at the Scott Department of Urology's Sperm
Bank.