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Vasectomy Reversal

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.

What is a vasectomy reversal?

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.

What are the different types of vasectomy reversals?

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 (figure 1).

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 (see next section).

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.

What can be expected after a vasectomy reversal?

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.

Frequently Asked Questions:

Who performs vasectomy reversals?

Urologists are the surgical specialists who most frequently perform vasectomy reversals. Since not everyone focuses on this procedure, make sure to ask your urologist how many he or she has done — and to what level of success. Also, if your urologist recommends a microsurgical approach, you have the right to ask about his or her experience and success rates with this technique especially since this is a technique that requires additional training.

Can all vasectomies be reversed?

Almost all vasectomies can be reversed. However, if the vasectomy was performed during the repair of a hernia in the groin, there may be more difficulty reconnecting the ends of the vas. Rarely, reconnection of the ends of the vas is not possible because such a long segment of the vas was removed during the vasectomy procedure.

Should I have a vasovasostomy or a vasoepididymostomy?

It is not possible to determine before the reversal operation which procedure will be best for you. The urologist can only determine this during the vasectomy reversal procedure. If sperm are present in the fluid that is obtained from the end of the vas that is connected to the testicle, then a vasovasostomy is performed. If sperm are absent from the fluid obtained from the end of the vas that is connected to the testicle, the urologist then uses several criteria to determine which operation is best for you. The urologist will inspect the epididymis to determine if a blockage is present in the tube within the epididymis. If a blockage is seen, then a vasoepididymostomy will be required.

If no blockage is apparent, then the appearance of the fluid that is obtained from the end of the vas connected to the testicle may help determine which operation is best for you. In general, watery appearing fluid influences the urologist to perform vasovasostomy even though sperm are not present in the fluid, while creamy appearing fluid suggests that vasoepididymostomy is required when sperm are not present in the fluid. Several other factors also may be considered to help the urologist determine which operation is best for you. Some patients may require a vasovasostomy on one side and a vasoepididymostomy on the other side.

Is age a factor in conceiving after a vasectomy reversal?

Your age should not influence the result of your vasectomy reversal. Most men continue to produce sperm from their testicles for many years after their partners have entered menopause and are no longer ovulating, or producing eggs. In fact, a woman's fertility starts declining in her mid-30s, with significant impairment beginning around age 37.

If female age is a factor, your partner should check with her gynecologist to see if she is still ovulating before you agree to a reversal. Abnormal results from a simple blood test to measure hormone levels on the third day of menstruation indicate a significantly lowered chance of fertility. However, women should not be deceived by a normal reading because it does not always guarantee that a woman will be able to get pregnant.

Are there alternatives to vasectomy reversal?

Yes. Your doctor can obtain sperm from the testicle or epididymis by either a needle aspiration or surgery. But the sperm are not useful for simple, inexpensive office artificial inseminations. Instead, the sperm that are obtained by such methods require the more complex, expensive ($12,000 to $17,000) in vitro fertilization (IVF) techniques using intracytoplasmic sperm injection (ICSI).

Most centers report a 30 percent to 50 percent pregnancy rate each time IVF with ICSI is performed if the female partner is younger than 37, but much lower rates if she is older. Since studies consistently show that vasectomy reversals are more cost-effective in achieving pregnancy than sperm retrieval and IVF with ICSI, your better option is with the reversal. However, insurance coverage for one procedure and not another, may influence a couples decision on how to proceed. Factors that may affect the decision to proceed with vasectomy reversal or sperm retrieval with ICSI include cost, years since vasectomy (and possible need for epididymovasostomy) and age of the female partner.

If a vasectomy reversal fails, should I consider a repeat reversal?

The success rates for repeat reversals are generally similar to first reversals in the hands of experienced microsurgeons. In making a recommendation, your urologist will review the record of your previous procedure. If sperm were present in fluid obtained from the lower end of the vas during that operation, he or she will probably perform a repeat vasovasostomy, a less complicated procedure than a vasoepididymostomy, but more likely to produce success.

How expensive is a vasectomy reversal?

Costs vary widely, ranging between about $5,000 and $15,000 for surgical fees, not including anesthesia and surgical center fees. Most insurance companies do not pay for this procedure. Therefore, you should discuss the finances of your operation early to see if your insurance company might be the exception to the rule.

Will a vasectomy reversal relieve pain in the testicle that developed after my vasectomy?

It is fortunate that only a very small percentage of men develop pain in the testicle after a vasectomy that is sufficiently severe for them to inquire about a vasectomy reversal to relieve pain. Because such situations are rare, there are few reports of groups of patients who undergo vasectomy reversals to relieve pain in the testicle. Most of these reports indicate that the majority of patients who undergo a vasectomy reversal for relief of pain in the testicles indeed are relieved of their pain. However, your urologist cannot determine in advance that your pain definitely will be relieved if you undergo a reversal.



Reviewed: January 2011

Last updated: March 2013

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Vasectomy Reversal Glossary
  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • anesthesia: Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.

  • anesthesiologist: A physician who supervises the administration of anesthesia during surgery.

  • anesthetized: Administered an anesthetic.

  • artificial insemination: The clinical insertion of sperm in the woman's uterus.

  • ejaculate: The fluid that is expelled from a man's penis during sexual climax (orgasm). To release semen from the penis during an orgasm.

  • epididymis: A coiled tube attached to the back and upper side of the testicle that stores sperm and is connected to the vas deferens

  • fertile: Able to produce offspring.

  • fertility: The ability to conceive and have children.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • general anesthesia: Person is put to sleep with muscle relaxation and no pain sensation over the entire body.

  • groin: The area where the upper thigh meets the lower abdomen.

  • gynecologist: A physician who specializes in treating female health.

  • hernia: Condition in which part of an internal organ projects abnormally through the wall of the cavity that contains it.

  • hormone: A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.

  • ICSI: Also referred to as intracytoplasmic sperm injection. Involves the injection of a single sperm directly into the cytoplasm of a mature egg using a glass needle.

  • in vitro: An artificial environment like a test tube.

  • in vitro fertilization: Also referred to as IVF. A complicated process during which a woman is given medications to stimulate her ovaries to produce multiple eggs. The eggs are retrieved by aspiration and are then exposed to a man's sperm. Resulting embryos that develop may then be placed into the woman's uterus.

  • incision: Surgical cut for entering the body to perform an operation.

  • insemination: Insertion of sperm into the woman's uterus.

  • intracytoplasmic sperm injection: Also referred to as ICSI. Involves the injection of a single sperm directly into the cytoplasm of a mature egg using a glass needle.

  • intracytoplasmic sperm injection: Also referred to as ICSI. Microscopically injecting a single sperm into each female egg.

  • ions: Electrically charged atoms.

  • IV: Also referred to as intravenous. Existing or occurring inside a vein.

  • IVF: Also referred to as in vitro fertilization. A complicated process during which a woman is given medications to stimulate her ovaries to produce multiple eggs. The eggs are retrieved by aspiration and are then exposed to a man's sperm. Resulting embryos that develop may then be placed into the woman's uterus.

  • menopause: The time in a woman's life when menstrual periods permanently stop.

  • menstruation: The periodic blood flow as a discharge from the uterus.

  • microsurgery: Delicate surgery performed with the aid of miniaturized precision instruments.

  • microsurgical: Performed with the aid of miniaturized precision instruments.

  • needle aspiration: Removing fluid or contents from a body cavity with a long, hallow needle.

  • obstruction: something that obstructs, blocks, or closes up with an obstacle

  • obstructive interval: The time between a vasectomy and its reversal.

  • ostomy: A surgical procedure such as a colostomy or ileostomy, in which an artificial opening for excreting waste matter is created.

  • ovulating: The period when the ripening and release of an egg from the ovary for possible fertilization.

  • pregnancy: The condition of being pregnant.

  • scrotum: Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.

  • semen: Also known as seminal fluid or ejaculate fluid. Thick, whitish fluid produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • semen: The thick whitish fluid, produced by glands of the male reproductive system, that carries the sperm (reproductive cells) through the penis during ejaculation.

  • semen analysis: A laboratory study of semen to determine the concentration, shape and motility of sperm.

  • sperm: Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.

  • sperm count: The laboratory measurement of the number of sperm in the semen.

  • sperm duct: Epididymis which transports sperm from the testis.

  • stent: With regard to treating ureteral stones, a tube inserted through the urethra and bladder and into the ureter. Stents are used to aid treatment in various ways, such as preventing stone fragments from blocking the flow of urine.

  • testicle: Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testis: Also known as testicle. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urge: Strong desire to urinate.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • vas deferens: Also referred to as vas. The cordlike structure that carries sperm from the testicle to the ejaculatory duct, whicn in turn carries it to the urethra.

  • vasectomy: A surgical operation in which the vas deferens from each testicle is cut and tied to prevent the transfer of sperm during ejaculation.

  • vasoepididymostomy: The more difficult of the two vasectomy reversal procedures. Connects the upper end of the vas to a tiny tube within the epididymis to bypass a blockage.

  • vasoepididymostomy: Complicated vasectomy reversal technique. In this procedure, the urologist must bypass the blockage in the epididymis by connecting the upper end of the vas to the tube in the epididymis above the point of the blockage.

  • vasovasostomy: The easier of two vasectomy reversal procedures. Connects one end of the vas to the other end.

Vasectomy Reversal Anatomical Drawings

click images for a larger view
 

 

 

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