Vasectomy Reversal Questions and Answers

After a vasectomy reversal, about 50% to 60% of couples have a baby within a 2-year period.

Your doctor will likely want at least one consultation prior to surgery. The examination permit the opportunity for the doctor to review your particulary situation and answer any concerns beforhand. Typically, no more visits or testing will be required. If you are from out-of-town, arrange a phone consultation.

The vas tube, which was obstructed as a result of the vasectomy, is prone to back pressure in the epidiymus. If sperm are identified in the vasal fluid a direct vas to vas connection (vasovasostomy) can be performed. The greater time since a vasectomy, the greater the odds the surgeon will see a "secondary epidimal obstruction." This means no sperm are identified in the vasal fluid from the cut end of the testicular vas. In such cases, a vasoepididymostomy will need be performed (a re-connection of the vas to the epididymis). This more involved surgury means reconnection of the vas tube will be more difficult.

After ten years since a vasectomy, research tells us that there is about a 40% chance that a vasoepididymostomy will need to be performed on at least one side. There is a high chance that the vasovasostomy can be performed if the vasectomy reversal is performed within 10 years of the vasectomy.

Other determining factors include a large segment of the vas having been removed, cauterization or ligation (tying off) of both ends of the cut vas instead of just one (i.e. doing a closed ended vasectomy instead of open ended).

Ultimately a vasectomy reversal will be be considered successful when a couple achieves becoming pregnant and giving birth. With respect to vasectomy reversal, this means returning sperm in the ejaculate. If a vasovasostomy is performed on both sides, there is about a 90% chance of having sperm return to the ejaculate. If a vasoepididymostomy is performed on both sides, there is about a 60% chance of having sperm return to the ejaculate. If a mixed operation is performed (vasovasostomy on one side, vasoepididymostomy on the other), sperm returns to the ejaculate in about 75% of cases. So to achieve this goal means taking into account timing, the patient, the surgury, healing and also considerations specific to the female partner.

For the best result, most vasectomy reversals require a general anaesthetic. While working under the high-powered surgical microscope, patients need to be completely still.

After ten years since a vasectomy, research tells us that there is about a 40% chance that a vasoepididymostomy will need to be performed on at least one side. There is a high chance that the vasovasostomy can be performed if the vasectomy reversal is performed within 10 years of the vasectomy.

Other determining factors include a large segment of the vas having been removed, cauterization or ligation (tying off) of both ends of the cut vas instead of just one (i.e. doing a closed ended vasectomy instead of open ended).

For the best result, most vasectomy reversals require a general anaesthetic. While working under the high-powered surgical microscope, patients need to be completely still.

Performing a direct vas to vas reconnection (vasovasostomy) is the most reliable type of vasectomy reversal with the highest success rates and is the surgeon’s procedure of choice. However when no sperm are seen within the fluid from the cut end of the testicular vas, this typically suggests a blockage at the level of the epididymus and a bypass re-connection or vasoepididymostomy should be performed. A word of caution – some surgeons who perform vasectomy reversals do not have adequate experience to perform a vasoepididymostomy. Either a vasovasostomy is inappropriately performed or the surgery is abandoned altogether. Choosing a surgeon who is experienced in microsurgical vasovasostomy and vasoepididymostomy is highly reccommended.

No doctor can predict with certainty what type of reconnection (vasovasostomy or vasoepididymostomy) will be required before the operation. This can be estimated with a reasonable degree of confidence based on the time since the original vasectomy, findings on physical examination and the patient’s age. A definitive decision as to the type of reconnection required can only be made during the surgery based by the presence of sperm and the quality of fluid from the vas. If sperm are identified from the cut end of the vas coming from the testicle and epididymus, this confirms that sperm are being produced and are able to swim to this point and a vasovasostomy can be performed. If no sperm are seen within the fluid from the cut-end of the testicular vas, this typically suggests an epididymal blockage and a bypass re-connection or vasoepididymostomy should be performed.

A vasovasostomy typically takes about 2-3 hours to complete. A vasoepididymostomy can take 3-4 hours to complete.

Yes. Moving sperm identified in the vas or epididymus at the time of a reversal can be saved, frozen and stored in a sperm bank just in case the vasectomy reversal is not successful. This sperm can only be used with in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI).

See section: Alternatives to Vasectomy Reversal

Typically, most men need 10 to 14 days to feel normal again.

See section: Vasectomy Reversal Recovery

All surgical procedures and aesthetics are associated with complications and risk. Fortunately, the risks and complications of a vasectomy reversal rare but may include: bleeding, wound infection, swelling, injury to the spermatic cord, epididymis or testicle and discomfort.

See section: Vasectomy Reversal Complications

It is best to wait 4-6 weeks before reinitiating strenuous exercise. Light exercise can be started 3-4 weeks after surgery.

See section: Vasectomy Reversal Recovery

After a vasovasostomy, sperm quality can take up to 6 months to mature. After a vasoepididymostomy, sperm quality can take up to 1 year to mature. Typically semen analysis is performed 8 weeks following surgery and then at 3-month intervals until pregnancy is achieved to ensure stable sperm quality.

Couples may resume sexual relations about 3 weeks after a vasovasostomy and about 4 weeks after a vasoepididymostomy. Pregnancy can be achieved any time after a reversal. Statistics tells us that about 50%-60% of couples are pregnant within 2 years of a vasectomy reversal.

See section: Vasectomy Reversal Recovery

It is recommended that the female partner be evaluated prior to having a vasectomy reversal. This can be performed by most gynaecologists. This is logical, considering the physical, financial and emotional commitment associated with a vasectomy reversal.

See section: Vasectomy Reversal Recovery

Yes.

See section: Vasectomy Reversal Recovery

A failed (unsuccessful) vasectomy reversal is defined as having no sperm in the ejaculate subsequent to the operation. These men can consider having the vasectomy reversal repeated or another surgical procedure known as vasoepididymostomy, or sperm extraction which involves in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI).

See section: Vasectomy Reversal Recovery

In certain circumstances it may be worthwhile considering vasoepididymostomy, or sperm extraction. In these cases, the assisted reproductive techniques inducing intrcytoplasmri sperm injection (ICSI) combined with in vitro-fertilization would be utilized. See the Alternatives for Vasectomy Reversal page.

Possible circumstances can include blockage of the partner’s fallopian tubes, spinal cord injury, men born without a vas deferens, testis cancer and a failed vasectomy reversal.

The cost of sperm extraction in conjunction with in vitro fertilization is considerably higher than a reversal. Therefore, very few "vasectomized" men will choose sperm extraction as the first procedure to restore their fertility.

See section: Vasectomy Alternatives for Vasectomy Reversal