There are many reasons to reverse a vasectomy like remarriage following a divorce or having a change of heart or starting a family over after the loss of a wife or child. Regardless of your reason, there are now advanced methods to restore your fertility. How do you know the options that are right for you? By arming yourself with the latest information, you can make informed decisions with your doctor.
A vasectomy is a minor surgical procedure in which the sperm duct, or vas deferens, is cut in order to achieve sterility. Vasectomy reversal restores fertility by reconnecting the ends of the severed vas deferens, which is located in each side of the scrotum, or by connecting the vas deferens to the epididymis, the small organ on the back of the testis where sperm matures. These procedures can be accomplished through various approaches, including microsurgery, to restore the passage for sperm to be ejaculated out the urethra are usually accomplished with microsurgical technique.
Reversals are generally performed in an outpatient area of a hospital or in an ambulatory surgery center. The operation is usually performed with general anesthesia if the surgical microscope is used, as any movement is magnified under the microscope. The choice will depend on the preference of the surgeon, patient and anesthesiologist.
Once the patient is anesthetized, the urologist will make a small opening (cut) on each side of the scrotum and first remove the scarred ends of the vas at the point of blockage created by the vasectomy. The urologist will then extract a fluid sample from the end closest to the testicle to see if the fluid contains sperm.
The presence of sperm in the fluid is an indication that there is no obstruction between the testicle and the location in the vas from which the fluid was obtained, and particularly that there is no blockage in the epididymis. When sperm are present in the fluid, the ends of the vas can be connected to reestablish the passageway for sperm. The medical term for reconnecting the ends of the vas is vasovasostomy.
The microsurgical approach is recommended and uses a high-powered microscope to magnify structures from five to 40 times their actual size. Use of an operating microscope provides better results, as it allows the urologist to manipulate stitches smaller in diameter than an eyelash to join the ends of the vas. When microsurgery is used, vasovasostomy results in return of sperm to the semen in 70-95 percent of patients and pregnancy in 30-75 percent of female partners, depending upon the length of time from the vasectomy until the reversal.
If the urologist does not find sperm in the fluid sample, it may be because the original vasectomy resulted in back pressure that caused a break in the epididymal tubule. Because any break in this single, continuous tube can result in a blockage, the urologist will have to employ a more complicated reversal technique called an epididymovasostomy or vasoepididymostomy. In this procedure, the urologist must bypass the blockage in the epididymis by connecting the "upper" (abdominal) end of the vas to the epididymis above the point of the blockage.
While vasoepididymostomy is a more complex procedure than vasovasostomy due to the very small size of the tube inside the epididymis, recent advances in the surgical technique have made outcomes nearly as good as for vasovasostomy. You may need a combination of the two techniques, with a vasovasostomy done on one side and a vasoepididymostomy on the other side. Vasoepididymostomy usually requires a longer incision into the scrotum.
Recovery from a vasectomy reversal should be relatively swift and fairly comfortable. Any pain that might be experienced after surgery can be controlled with oral medications. About 50 percent of men experience discomfort that is similar to the level they had after the original vasectomy. Another quarter report less pain than accompanied the vasectomy. A final 25 percent say the pain is somewhat greater than after the vasectomy. The reassuring news is that any pain severe enough to require medication rarely lasts longer than a few days to a week.
Most patients are back to normal routine and light work within a week. Urologists usually want their patients to refrain from heavy physical activity for two to three weeks. If your job requires strenuous work, you should discuss with your surgeon the earliest time you can return to work. You will be advised to wear a jockstrap for support for several weeks. You will likely be restricted from having sex for approximately two to three weeks.
It takes on average one year to achieve a pregnancy after a vasectomy reversal. Some pregnancies occur in the first few months after the reversal procedure, while others do not occur until several years later.
One of the main factors influencing pregnancy rates is the obstructive interval, which is the duration of time between your original vasectomy and the reversal. As the table below shows, rates of both the return of sperm to semen and subsequent pregnancy are highest when the reversal is performed relatively shortly after the vasectomy.
The urologist will request a semen analysis every two to three months after surgery until your sperm count either stabilizes or pregnancy occurs. Unless a pregnancy occurs, a sperm count is the only way to determine surgical success. While sperm generally appear in the semen within a few months after a vasovasostomy, it may take from three to 15 months to appear after a vasoepididymostomy.
In either case, if the reversal works, the patient should remain fertile for many years. The possibility of subsequent pregnancies is an important advantage of this procedure over sperm retrieval techniques for in vitro fertilization (see frequently asked questions). Only approximately 5 percent of patients who have sperm appear in the semen after a vasectomy reversal later develop scarring in the reconnected area, which could block the passage of sperm again.