Vasectomy reversal — What to expect and how to prepare.
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.
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:
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.
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.
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.
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.
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
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 of vasectomy reversal include:
Call your doctor if you develop any of these signs and symptoms:
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.
Last Updated: 01/18/2007
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