Vasectomy reversal

Vasectomy reversal is surgery to undo a vasectomy. It reconnects each tube (vas deferens) that carries sperm from a testicle into the semen. After a successful vasectomy reversal, sperm are again present in the semen and you may be able to get your partner pregnant.

Success rates with vasectomy reversal will range from about 40 percent to over 90 percent. Many factors affect whether a reversal is successful in achieving pregnancy, including time since a vasectomy, partner age, definition of success, and surgeon experience and training.

What Happens during Vasectomy Reversal??

Reversals are most often done on a come-and-go basis by a urologist. Reversals can be done in an outpatient part of a hospital or at a surgery center. If a surgical microscope is used, the surgery is done while you’re asleep under anesthesia. Your urologist and anesthesiologist will talk with you about your choices.

Using microsurgery is the best way to do this surgery. A high-powered microscope used during your surgery magnifies the small tubes 5 to 40 times their size. Your urologist can use stitches much thinner than an eyelash or even a hair to join the ends of the vas.

After you’re asleep, your urologist will make a small cut on each side of the scrotum. Your urologist will trim the scarred ends of the vas where they were closed by the vasectomy. Your urologist will take fluid, (“vasal fluid”) from the vasal end closest to the testis. Your doctor will check to see if it has sperm in it. At this point, there are 2 types of reversal procedures you can have:

Vasovasostomy

If there is sperm in the vasal fluid it shows that the path is clear between the testis and where the vas was cut. This means the ends of the vas can then be joined. The term for reconnecting the ends of the vas is “vasovasostomy.” When microsurgery is used, vasovasostomy works in about 85 out of 100 men. Pregnancy occurs in about 55 out of 100 partners.

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Vasoepididymostomy

If there is no sperm in the vasal fluid, it may mean back pressure from the vasectomy caused a form of “blowout” in the epididymal tube. This “blowout” can lead to a block. Your urologist will need to go around the block and join the upper end of the vas to the epididymis instead. This is called a “vasoepididymostomy” and it serves the same purpose as the vasovasostomy.

Vasoepididymostomy is more complex than vasovasostomy, but the results are nearly as good. Sometimes vasovasostomy is done on one side and vasoepididymostomy on the other.

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Risks

Almost all vasectomies can be reversed. However, this doesn’t guarantee success in conceiving a child. Vasectomy reversal can be attempted even if several years have passed since the original vasectomy — but the longer it’s been, the less likely it is that the reversal will work.

Vasectomy reversal rarely leads to serious complications. Risks include:

  • Bleeding within the scrotum. This can lead to a collection of blood (hematoma) that causes painful swelling. You can reduce the risk of hematoma by following your doctor’s instructions to rest after surgery. Ask your doctor if you need to avoid aspirin or other types of blood-thinning medication before and after surgery.
  • Infection at the surgery site. Although very uncommon, infections are a risk with any surgery and may require treatment with antibiotics in certain situations.
  • Chronic pain. Persistent pain after vasectomy reversal is very uncommon.

What Can I Expect after a Vasectomy Reversal?

Healing should be rather quick and fairly easy. Pain after surgery is most often controlled with pills. About 50 out of 100 men say the pain after the reversal is like after their vasectomy. Another 25 out of 100 say the pain is less than after the vasectomy, and 25 out of 100 say it’s greater. Pain bad enough to need medications rarely lasts longer than a few days to a week.

Most men can return to their normal routine and light work within a week. You’ll likely be told to take it easy and not have sex for 2 to 3 weeks. If your job is strenuous, ask your urologist when you can return to work. You’ll most likely wear a jockstrap for support for a few weeks.

It may take 4 months to a year for your partner to get pregnant after vasectomy reversal. Some women get pregnant in the first few months, while others may take years. Pregnancy rates can depend on the amount of time between the vasectomy and reversal. Sperm return to the semen faster and pregnancy rates are highest when the reversal is done sooner after the vasectomy.

Next to pregnancy, testing the sperm count is the only way to tell if the surgery worked. Your urologist will test your semen every 2 to 3 months until your sperm count holds steady or your partner gets pregnant. Sperm often appear in the semen within a few months after a vasovasostomy. It may take from 3 to 15 months after a vasoepididymostomy.

In either case, if the reversal works, you should stay fertile for many years. Only about 5 out of 100 men later get scars in the reconnected part. The scars could block the outflow of sperm all over again.

Is there anyone who is automatically NOT a candidate for vasectomy reversal?

There are certainly some patients who are better candidates than others; time from the vasectomy is not necessarily a reason not to have a reversal. However, in the case of a couple where the woman has, for instance, had a tubal ligation, sperm aspiration combined with in-vitro fertilization is probably a better choice than performing vasectomy reversal followed by tubal ligation reversal.

What is the effective rate of reversal?

The success rate varies based on several factors. Time from the vasectomy certainly helps to predict how likely it would be to be able to put the two ends of the vas deferens back together; however, getting return of sperm into the ejaculate does not guarantee pregnancy, so pregnancy rates typically vary from 30 to 70 percent, whereas patency rate, that is the return of sperm, can be as high as 95 percent.

Are there other means of “fertility” that I should consider as options to reversal?

The only other option to a reversal that would allow use of a man’s sperm with the woman’s egg would be surgical sperm retrieval (through either extraction or aspiration) combined with in-vitro fertilization. The sperm removed from the testicle can be injected directly into the eggs that have been retrieved from the woman after she has been stimulated with hormone injections.This is a very effective but expensive treatment with relatively good success rates. However, it is not possible to remove enough sperm from the man’s testicle to inseminate the woman.

If antibodies from your immune system are present, why does this affect pregnancy rates?

There is some debate about the effects of antibodies on pregnancy rates after vasectomy reversal. Approximately 70 to 80 percent of men who have had vasectomies will have antibodies to their sperm. However, these antibodies rarely prevent the sperm from fertilizing the egg. Therefore, we counsel patients that it is unnecessary to routinely test for antibodies, as they rarely will have a bad effect upon the success rate.