T he American Society for Reproductive Medicine issued the following guideline:
"Since it is seldom possible to determine pre-operatively if vaso-epididymostomy will be required in a man undergoing vasectomy reversal, only surgeons skilled in both vaso-epididymostomy and vasovasostomy should perform vasectomy reversal"
Let’s first have a look at some definitions and terminology:
Microsurgery – 24X Magnification
Surgery is performed with magnification provided by an operating microscope. This is a large piece of equipment that stands on a foot-piece on the floor of the operating theatre. The eyepieces (for Urologist and assistant) are positioned above the operating field. Some operating microscopes also project the magnified image onto a high definition flatscreen monitor, so that the scrub sister and other theatre personnel can follow the progress of the operation.
Surgical Loupe Magnification – 4X Magnification
Loupes look like normal glasses that a surgeon puts on but they have special lenses that provide some magnification.
The anatomical structures involved in vasectomy reversal surgery are very small:
- The lumen / inside canal of the vas deferens that the Urologist has to re-connect during vasectomy reversal is often less than half a millimeter in size (0.4 – 1.5mm)
- The lumen / inside canal of the epididymis is less than 1/10 of a millimeter in size (0.08mm).
The sutures that should be used for vasectomy reversal are very thin:
- The recommended suture is a 10-0 nylon thread with a thickness of 0.02mm – barely visible with the naked eye.
- Although thicker sutures are easier for the Urologist to handle (especially if he is not using an operating microscope), they have the disadvantages of not providing a watertight seal and of causing scar tissue that may block the delicate tube a few weeks after the operation.
It is certainly possible to re-connect the vas deferens using only loupe magnification or even no magnification, but these techniques have much lower success rates than microsurgical procedures.
It is, however, not possible to do an accurate re-connection of the vas deferens to the epididymal tube – simply because it is too small a structure to see and to work on without proper magnification. The Urologist will only know during the operation if a vaso-epididymostomy is required (up to 60% of cases) and if he is not operating with a microscope he will not be able to perform the required procedure. Most Urologists will then just continue with re-connection of the vas deferens – a useless exercise that is sure to fail in these cases because of the blockage in the epididymis which has not been dealt with. (See Important Decisions).
To ensure the highest chance of success with your vasectomy reversal, an accurate and watertight reconstruction is essential. The exact location of every stitch must be controlled, whether the re-connection is to the vas deferens or the epididymis. Your Urologist must have the skill, knowledge and equipment to diagnose epididymal blockage (intra-operative semen analysis using an additional 400X magnification microscope) and to then modify the operation if required (vaso-epididymostomy in stead of vasovasostomy). If there is no epididymal blockage and only a simple vasovasostomy is needed, a precise two-layer closure using the appropriate suture materials should be performed.
Greetings I am happy to announce that the reversal was a success. We are 7 weeks pregnant. Thank you so much Dr Zarrabi. I must say I didn't expect results so soon only six months later. Reversal after 11 years it's unbelievable. Once again thank you to team Zarrabi and the wonderful staff at the hospital. Regards,
Dear Dr Zarrabi We are extremely grateful that The Creator guided us to you. From the first meeting on Tuesday to our last meeting Wednesday, you were patient, explained everything to us in detail and you were extremely warm in the manner in which you relayed the news to us. Thank you! It is your compassion and applied skill that has kept our hope alive. We pray that God keeps you in good health and with a long life, so that you may help many more people. To the rest of your staff - Thank you for the friendly communication and timeous feedback provided. You made us feel confident to embark on this journey. Best Regards
Good morning Dr Zarrabi I am recovering fast and am pain free and have been very diligent with my recovery. What an amazing experience. Thank you super much for arranging everything and Amir is a magician. From the moment I walked into the hospital until my departure I received 5 star care and everything went like clockwork.. I have nothing but praise and thanks for the whole team involved and could not be more impressed.. What an absolute pleasure this has been. Thanking you again most kindly!!
Hi Dr Zarrabi, My apologies for the delayed feedback. We did however have sound reasons. We have been patiently waiting for the 12 week mark to confirm that all is well I am very happy to advise that my wife is 13 weeks pregnant. We found out about our blessing a week after you gave us the test results. All is progressing well so far with both baby and mom healthy. We would like to take this opportunity to thank you for all that you have done during this journey. Our miracle baby is due Jan 2019. Best regards
Dear Dr Zarrabi Thank you for all your hard work in assisting us. Dr’s website was so informative and it really played a big factor in persuading me to travel to you for my partner’s op. I was a bit sceptical in the beginning with all the internet scams out there and it was a risk to outlay the cash upfront and not know what you are getting. But you’ll made our stressful experience as easy as possible with step by step instructions, before, during and after the op. It’s so rare to find an honest Dr like Dr Zarrabi. You’ll acted in the most professional manner and most of all, Dr always kept his word. It was a miracle just to be able to do the op as so many things had to come together behind the scenes just to make it happen. Best Wishes,
M’s pregnancy was problem-free. We are happy to advise that we welcomed the little one on April 17, 2018 weighing 3.265kg. Little E is just over 2 weeks old now and in perfect health.
Hi team! Recovery is progressing with no real pain or complications. Thanks again for your help leading me through the process, it was by far the best medical experience I’ve encountered. Please pass along my gratitude to Dr Zarrabi, he was outstanding. Thanks again
Dear Dr Z, A patient’s testimonial is less of a recognition of a doctor’s professional expertise, and more of a recommendation of a doctor’s ability to listen, care and heal. I can vouch for the fact that your abilities are unmatched. Surgeons like you are not just doctors, but real life-savers. I talked to God in my prayers, and in your services I have seen some of His favours. The nightmare of my illness slowly became a dream of recovery, all thanks to you and your staff. I was an ordinary patient of ordinary means but you and your personnell took care of me as if I was the most important person on earth. Before saying that you are an extraordinary doctor, I want to tell you that you are an extraordinary human being. Thanks for showing so much care and concern. May you always be blessed with God’s grace to help so many more patient’s. Thanking you.
Good Morning Dr, My wife and I would like to express our gratitude for what you did for us in July 2016. I can say that the reversal was a huge success. Thank you so much. Our little miracle L was born on 02-02-2018, 2.710kg and 49cm in length. She is a week old today. Attached is a few photos of our little one. Once again thank you.
Good day Dr Zarrabi I hope you are keeping well. It has been 10 months since we did the Varicocele repair and a lot has happened since then and obviously it’s been quite a journey. But needless to say it was not all in vain. Hence my e-mail to you today. If you recall we went back to your clinic in August for one last Invitro (6th). The result was that we had a better count and better mobility due to the Varicocele repair as what we ever had before with the previous 5 Invitros. And I am very pleased to announce that E had a successful/positive result and she is 3 and half months pregnant now. We would just like to express our Sincere Gratitude to you and your staff for all your assistance and prayers through the whole process. Kind regards,
We want to thank you and Dr Zarrabi for being kind and gentle…. There is such a huge difference in patient care, follow-ups and bruising between the previous Dr and Dr Zarrabi’s offices. I thank God that we went to your practice and I will let you know if there is a little heart beat inside of me… Lots of Love.
Good day Dr Zarrabi Trust you well. I just wanted to say thanks very much for your professionalism and great help on my husband’s operation. Today I have a very healthy active 9 month old son thanks to you. At one stage we had just given up because nothing happened but then this miracle came along. Keep up the great work. Thanks and regards,
Dear Dr Zarrabi We have the best, if not surprising news, 'M is PREGNANT!!! She been feeling funny in the latter part of August as I was starting my course of prelox. We are overwhelmed and overjoyed. Thank you, thank you so so much.
Good morning Gillian I just want to send you this email to say a big thank you for all your assistance in making our trip a success. We are safely back home and everything with M is going great so far. Dr Zarrabi really is the best! I will keep you posted on any further developments. Thank you kindly and have a blessed day.
Hi Doctor Baby girl YP was born on the 12th of April 2017. You do amazing work and she turns 3 months old tomorrow. See pics attached… Regards
Dear Dr Zarrabi A and I feel truly blessed to have been able to have this reversal done by Dr Zarrabi. The fact that he is able to even perform an operation of this nature is truly amazing and we are fortunate to have somebody in this country that has the skillset to perform Micro surgery reversals. I imagine it must be very rewarding to make such a positive difference in people’s lives. In addition to this we found it to be easy and hassle-free to undergo the surgery in spite of the fact that we live more than 1500 kilometres away. Thank you for the professional, efficient and friendly way that you assisted us throughout this process. I will be sure to let you know as soon as A is pregnant (she may already be). Once again thank you.
Good day Dr Zarrabi Thank you so much to You and your Staff. We (my Wife) recently did a blood test; and it came out positive - that she is pregnant. Thank you soo much Dr Zarrabi; thank you for helping us in our journey.
Thank you so much, doc I truly appreciate all your support and valuable information. I hope your stay in the USA is amazing, you have been the most amazing medical professional i have ever dealt with and I'm extremely grateful that you've helped me all along. Kind regards,
Good day Dr Amir I hereby would like to thank you all for the excellent and friendly service we received. Everyone on the doctor’s staff was professional and efficient, they made me feel at ease in a stressful situation. I felt that I made a good choice in coming here and, as a group, each of the staff members cared for me and wanted to help me get better. I was thoroughly impressed with the facilities and services at the hospital. Everyone knew what needed to be done, at what time and did it with a smile and compassion. Any questions that myself or wife had was answered quickly and with a friendly disposition. In closing, I would like to thank you for all that you did even after I was dismissed and had a little complication Dr Zarrabi assisted and was ready to take action. It is professionals as yourself and facilities like your hospital that made me decided to use you from the beginning. Regards,
Dear Dr Zarrabi We are not sure you will remember us, amongst all your clients! D and I came to see you in November 2013 for a vasectomy reversal procedure. You were a little concerned that his vasectomy was 15 years in the past and he was 55 at the time. We visited your practice this month for the first scan of our expected little one - we wanted to share the good news with you! We did conceive within 3 months of the procedure but had an early miscarriage and what with the ups and downs of life over the last 2 years didn't get this far until now. SO - D is in peak condition and our baby is due on Christmas day this year. Thank you so very much for all the microsurgery and D says please send him 1000 business cards to hand out wherever he goes! We will send you a picture of the three of us for your collection when baby is born. With heartfelt gratitude and deepest thanks.
Dear Dr Zarrabi We are writing to you to thank you for your amazing care, concern and professionalism. Since meeting you we have has such a wonderful experience working with you. Thank you for everything!! It is greatly appreciated. Wishing you a good evening. With gratitude,
Hi Amir Hope all's well on your side. I am pleased to announce that L is pregnant - exactly 1 year to the day of the reversal! We had it confirmed with a blood test today. We just thank you for your skill and optimism. Just interested to know... Have we set a new record for length of time between vasectomy and reversal: 18 years ;-) thanks again to you and your team. Cheers D.
Dear Dr Zarrabi We'd jusyt like to inform you that the operation you did was a big success. We still had to go for the sperm analysis test but found out yesterday that I am pregnant!. I am now 6 weeks pregnant and just wanted to convey our heartfelt thanks for the successful operation. Thank you very much
Hi Doc, Looks like the operation you did was a huge success. My wife is now 11 weeks pregnant. So it took us about 1 year and 3 months to get pregnant. Regards,
Hi Amir Thanks again for your help! DIt was a great experience! Very professional! World Class!! Regards
Dear Dr. Zarrabi, Hope you are well. I just want to say thank you for a fantastic service and care I received. It was nice to chat with you first and it made me feel like I am in the right hands. The staff in the clinic were also great. Warm and kind and understanding. A service that stands out compared to other clinics or hospitals where nobody comes to check on you and you never see anybody around.
Hello Dr. Zarrabi, It has been a hectic couple of months. I have great news, M is 11 weeks pregnant and to top it off I didn’t even go for the sperm test. We found out the week that the test was scheduled. Thank you! You have worked miracles we never in our wildest dreams thought that it would happen so soon. We will keep you updated as the pregnancy progresses and might even come introduce the little one next time we are in Cape Town. Regards
Dear Dr Zarrabi, Many thanks to you and the gift that you have given to me. I really wish that I were here to celebrate with you. Thanks once again for your great skill and miraculous hands.
Hi Doc, Just a quick email to share our wonderful news - we are pregnant!!! We can't thank you enough for all you have done, and not giving up when most doctors probably would have just shrugged their shoulders. I know you were a tool in the Great Healer's hands, but nonetheless, a BIG thank you!! Can't wait to send our updated family picture. Have a wonderful, blessed day!
Dear all, After much soul searching, S and I decided to reverse his vasectomy and try naturally before resorting to other options. S had his vasectomy reversal done by Dr Amir Zarrabi. We never got to do the 6 month sperm test as I had fallen pregnant. The pregnancy was uneventful and our son was delivered at 39 weeks.
Hi Dr, Thank you so much for this report!! I am in tears right now, I did not even realize how much I was stressing about this until I got your e-mail!! You really have made this year the best one ever and we will highly recommend you to anyone we can. Your support and complete handling of our case including your after service has been so amazing! We are both so grateful to you. Kind regards,
Dear Dr Zarrabi This letter is long overdue…but for a very happy reason. My wife and I would like to express our heartfelt appreciation for the efforts you made and the application of your considerable skill in reversing my previous vasectomy done 13 years ago. Before proceeding with the surgery you fully explained what we could expect in terms of a timeline, and we complied with all the steps along the post-surgical way. As per your instruction we were supposed to have a sperm analysis done 3 months after the operation but when my wife missed her date we knew something was going on and I didn’t even have to go for the sperm test. We were ecstatic to learn that the surgery was successful and that I was once again delivering viable “swimmers”! We are now 12 weeks pregnant and all thanks goes to you. Doctor we are so blessed to came across your information on the website just when we were at our lowest. We have been through ICSI twice, as we thought it would have a better chance of success. With even everything as normal and positive as could be both sessions was unsuccessful. It costed us a fortune and we didn’t realize that if we did our homework properly the first time, we could had our baby in our arms right now. That is why we are extremely thankful that you have done such a great job. We never doubted you once…we just knew this was it. Words are a poor conveyance of the gratitude we feel, but please accept them with the knowledge that you have made us very happy as a result of your outstanding skill and diligence. Warmest regards,
Hi Doctor Amir, We hope that you and your family had a wonderful Christmas and new year. We have some wonderful news, D is pregnant!! This miracle was conceived naturally!! She is just over five weeks today and we are both over the moon. We would like to thank you again for all that you have done for us to make this miracle happen! We will keep you updated. Kind regards,
Dear Dr Zarrabi, As you can see from the attached pics, our 2015 started off extremely well, all thanks to you... KL was delivered via c-section at 08:31am on Friday the 2nd Jan 2015. Weighing 3.22kg and measuring 51cm. She is gorgeous! I'd like to extend a very big thank you to you and your staff for making our dream come true. A is thrilled to be a big sister. Take care and best regards,
Good day Dr Zarrabi We are happy to announce the birth of our baby girl TH. She was born on the 4th of February 2015 weighing 3.350kg. This was a miracle to us. We would like to thank you for making our dream come true by resulting in a successful vasectomy reversal on my husband G in October 2013. Thank you so much doctor!