Vasectomy reversal

Of the half a million men who have a vasectomy each year, 2 percent to 6 percent of them — 10,000 to 30,000 men — later decide to have the vasectomy reversed. This surgery reconnects the ducts that carry sperm from the testicles into the semen. After successful vasectomy reversal, sperm are present in your semen again and you may be able to get your partner pregnant.

Who is it for?

Men decide to have the surgery to restore fertility for a number of reasons, including loss of a child, remarriage or improved finances. A small number of men have a vasectomy reversal to treat testicular pain.

Before having vasectomy reversal surgery to restore fertility, your doctor will want to make sure you can produce healthy sperm. For most men, having gotten a woman pregnant before is proof enough. If your doctor is unsure whether you are producing enough healthy sperm, you may need a testicular biopsy. Your female partner also needs to be tested to make sure she doesn't have fertility problems.

Vasectomy reversal can be effective regardless of how long it's been since the original vasectomy. However, if more than 15 years have passed since the original vasectomy, you may have a lower chance of having enough healthy sperm in your semen to father a child.

Vasectomy is a straightforward surgery and an effective form of birth control — but surgery to undo a vasectomy is more involved and doesn't always work. The cost for a vasectomy reversal can range from $5,000 to $12,000 or more, and this procedure isn't usually covered by insurance.

How do you prepare?

Doctors usually perform vasectomy reversals at a surgery center or at a hospital. It's a delicate, microsurgical procedure that can be done using a few different surgical techniques.

• Before you choose a doctor, ask how many vasectomy reversals he or she has performed, and how many men have successfully fathered children after the reversal surgery.
• After choosing a doctor, meet with him or her to discuss the procedure, risks and potential complications. Include your partner in this initial consultation, if appropriate.
• Two weeks before and after your vasectomy, don't take aspirin, ibuprofen (Advil and Motrin, others) because they affect the platelets in your blood and can cause bleeding. Instead, use acetaminophen (Tylenol, others) if you need to relieve pain.
• Your doctor may ask you to clean and shave your scrotum before surgery and bring a clean jockstrap (athletic supporter) to wear after surgery.
• The surgery usually takes two to four hours. You'll also need time to recover from anesthesia. Arrange for someone to drive you home after surgery.

How is it done?

The surgery is more difficult than the original vasectomy because the tube that carries sperm from each testicle to your semen (vas deferens) must be sewn back together or attached to the epididymis. The surgery usually is done on an outpatient basis — without an overnight stay at the surgery center or hospital. Doctors can perform this surgery in one of two ways:

• Vasovasostomy (vas-o-va-ZOS-tah-me). With this procedure, the surgeon sews the severed ends of the vas deferens back together. However, sometimes this isn't possible and a more complex surgery is needed to restore the flow of sperm.
• Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tah-me). This surgery attaches the vas deferens directly to the epididymis, the coiled tube on the back of each testicle where sperm matures. A vasectomy can cause blockages or a break in the vas deferens or the epididymis. This surgery is used when a vasovasostomy won't work because sperm flow is blocked. The vas deferens is connected to the epididymis above the point of blockage.

You probably won't know ahead of time which technique is needed. The surgeon will make the decision during the operation. You may need a combination of the two surgical techniques — a vasovasostomy on one side and a vasoepididymostomy on the other.

Vasectomy reversal

Vasectomy reversal

A vasectomy reversal reconnects the vas deferens, the cord that carries sperm from the testicles. One of two surgical procedures may be used to reverse a vasectomy. A <strong>vasovasostomy</strong> reattaches the severed ends of the vas deferens to one another. A <strong>vasoepididymostomy</strong> attaches the vas deferens directly to the epididymis, the coiled tube on the testicle where sperm matures. The point where the vas deferens is reattached is called an anastomosis.

Close

What can you expect during the procedure?

You may have general anesthesia to make you unconscious during the surgery. Or, your surgeon may use an epidural, spinal or local anesthetic. In any case, your anesthesia will need to keep you completely still because the surgery is so delicate. It's done using a microscope that magnifies the surgery area five to 20 times, and any movements are magnified by the operating microscope.

The surgeon will make a cut on the underside of your scrotum, expose the testicle, and release it from surrounding tissues. Next, he or she will cut open the vas deferens and examine the fluid inside.

Fluid assessment
Once the vas deferens has been opened, the surgeon will do a naked-eye inspection of the fluid that comes out as well as examine a drop of the fluid under a microscope. This is an important part of the operation because it helps your doctor determine what type of surgery you need to restore the flow of sperm.

• If the fluid contains sperm and plenty of clear fluid, surgery to reconnect the ends of the vas deferens — a vasovasostomy — is likely to work.
• Fluid below the vasectomy site that is thick or pasty, or that contains no sperm or partial sperm, can be a sign that there is scar tissue blocking the flow of sperm. In this case, attaching the vas deferens directly to the epididymis — a vasoepididymostomy — may be the best option.

Freezing sperm
If your doctor finds sperm during the surgery, you may choose to have some frozen in case your vasectomy reversal doesn't work. If after vasectomy reversal you're not able to father a child through sexual intercourse, your frozen sperm may be injected directly into an egg. This is a type of in vitro fertilization called intracytoplasmic sperm injection (ICSI).

After surgery
Immediately after surgery, your doctor may cover the incisions with bandages. You'll put on your jockstrap to hold any bandages in place and apply some pressure to reduce swelling and movement. You'll need to rest with an ice pack placed on your scrotum to reduce swelling. As the anesthetic wears off, you may have some pain and cramping that can be relieved with acetaminophen. For most men, the pain isn't severe and gets better after a few days to a week.

After you return home, take it easy. You may be sore for several days, which you can treat with acetaminophen or, if your doctor prescribes it, acetaminophen plus codeine. You may also have bruising, but the discoloration should lighten and disappear after about two weeks. Any stitches should dissolve in seven to 10 days.

• For the first two days after surgery, avoid bathing and swimming.
• Refrain from sports and heavy lifting for at least three weeks.
• If you have a desk job, you'll probably be able to return to work three days after surgery. If you perform physical labor or have a job that requires much walking or driving, talk to your doctor about when it's appropriate to resume working.
• You shouldn't have sexual intercourse or ejaculate for about four weeks. At that point, you may resume sexual activity.
• You'll need to wear a jockstrap for several weeks at all times, except when showering. After several weeks, you'll need to continue to wear a jockstrap during exercise.

Results

In successful vasovasostomy, sperm usually appear in the semen after a few months. After a vasoepididymostomy, it takes longer — from three to 15 months. Vasectomy reversal leads to pregnancy in about 52 percent of couples within two years. While some pregnancies occur within a few months after a vasectomy reversal, the average is about a year after the procedure.

Sometimes problems with conception are due to female infertility. When the female partner doesn't have fertility problems, couples are more likely to conceive a child after a vasectomy reversal.

Your surgeon will want to examine your semen after surgery to see if the operation was successful. Unless you achieve pregnancy, a sperm count is the only way to tell if your vasectomy reversal was a success.

If vasectomy reversal doesn't work
Vasectomy reversals sometimes fail if there is a sperm blockage that wasn't recognized during surgery, or if a blockage develops sometime after surgery. Some men have a second-attempt vasectomy reversal if the procedure doesn't work the first time.

Experts are investigating whether anti-sperm antibodies — proteins that develop after a vasectomy — might interfere with fertility after vasectomy reversal. Research shows anti-sperm antibodies can inhibit the function and movement of sperm, but experts are still not sure about their effect on fertility after a vasectomy reversal.

Risks

Risks of vasectomy reversal include:

• Bleeding within the scrotum. This may lead to a collection of blood (hematoma) that causes painful swelling. You can reduce this risk by avoiding aspirin before and after surgery and following your doctor's instructions to rest after surgery.
• Infection at the surgery site. This isn't common, but is a risk with any surgery.
• Inflammation. Sperm leakage into the scrotum can prompt your immune system to form an inflammatory mass called a sperm granuloma. Granulomas usually occur sometime after surgery and can be a sign that a vasectomy reversal wasn't successful.
• Damage to nerves and blood vessels. In some cases, this reduces fertility after a vasectomy reversal.

Call your doctor if you develop any of these signs and symptoms:

• Fever
• Swelling that worsens or won't go down
• Difficult urination
• A marble-sized lump in your scrotum
• Bleeding from an incision that continues after you've pinched the site between two gauze pads for 10 minutes

Looking ahead

Different surgical techniques can be used to perform vasectomy reversal. Experts are evaluating the outcomes of various surgical techniques to determine which ones are most successful. While surgeons can apply research about the best techniques to their own practice right away, other developments are on the horizon that will take longer before they are commonly used:

Experts are investigating the use of new methods to replace stitches, including glue, use of lasers and biological tissue. They think that once developed, methods other than stitching may decrease surgery time and provide better results.

• Researchers are developing robotic instruments for use in vasectomy reversal and other delicate surgeries. Although the technology is still in the initial stages, robots have the potential to improve surgeons' ability to perform technically challenging operations.
• Experts are testing the use of artificial stents to reconstruct the vas deferens during vasectomy reversal surgery. So far, the stents haven't been tested on humans, but initial studies with rabbits indicate that their use may lessen the possibility of sperm obstruction after vasectomy reversal.

Related

Male condom
Vasectomy