Vasectomy reversal is a surgical procedure requested by between 5 and 10 percent of the estimated 600,000 men who undergo a vasectomy each year in North America. Even though a vasectomy should be regarded as a permanent form of male birth control, it is possible to make many men fertile again when they undergo a vasectomy reversal.
The most common reason men want a vasectomy reversal is because they have had a lifestyle change, usually because they remarry after a divorce and want to start a family, or they and their partner have changed their mind about having a family. Regardless of the reason, men and their partners should seek professional advice from the surgeon who will perform the microsurgery, as well as others who may weigh in on the decision, such as a spiritual advisor or other family members.
What is vasectomy reversal?
A vasectomy reversal is a microsurgical procedure in which a surgeon restores the ability of the vas deferens to transport viable sperm in ejaculate, with restored fertility and pregnancy being the ultimate goals. The procedure is usually performed by a urologist and requires special microsurgical skills. Unlike a vasectomy, which takes about 15 to 30 minutes, a vasectomy reversal can take about 2 to 3 hours or longer, depending on which surgical procedure is performed. Vasectomy reversal is done as an outpatient procedure, however, and does not require men to stay overnight in the hospital.
The most common vasectomy reversal procedure is a vasovasostomy, which involves surgically connecting the cut ends of the vas deferens with sutures that are finer than human hair. In about 20% to 30% of men, however, scarring in the epididymis from their vasectomy prevent sperm from reaching the vas deferens. In those cases, a different vasectomy reversal, called an epididymovasostomy (also known as a vasoepididymostomy) is performed. An epididymovasostomy bypasses the scarring in the epididymis that prevents the sperm from flowing freely through the vas deferens.
Choosing a surgeon for a vasectomy reversal
When choosing a surgeon for a vasectomy reversal, you want an individual who has had a lot of experience performing this microsurgical technique. Ask your family doctor or urologist for recommendations, inquire at area hospitals for referrals, and do an in-depth search on the Internet for vasectomy reversal professionals in your area. Hopefully you will find several candidates from which to choose, and many of them will have a website that you can study.
Make sure you check on each individual candidate’s background, the success rate of his or her vasectomy reversals, and how many of the procedures the candidate has performed. Many urologists now have additional fellowship training to master microsurgical techniques. See if he or she has won any awards or published peer-reviewed articles on vasectomy reversal. Once you have two or three possible candidates, arrange a preliminary visit or consultation. Go to the visit with a list of questions and your partner/spouse.
Make your final decision based on the responses to your questions, how comfortable and confident you felt with the doctor, and how you were treated. For example:
- Did the doctor answer all your questions to your satisfaction?
- Did the doctor take his or her time with you, or did you feel rushed?
- Did the doctor say or do anything that was especially impressive?
- What was your spouse’s impression of the doctor?
How successful is a vasectomy reversal?
The most common questions men and their partners ask are, “How successful is a vasectomy reversal? and “What are the chances we can have a baby?” The chances of successfully restoring the ability of the vas deferens to transport viable sperm depends on several factors, including how long it has been since the vasectomy was performed.
Success rates tend to be higher (up to 97%) if the original vasectomy was performed less than ten years before the vasectomy reversal is done. The chances that such a vasectomy reversal will result in pregnancy may reach 76% in such cases.
However, the longer the time span between when the vasectomy was performed and the vasectomy reversal is done, the less chance the reversal will be successful and pregnancy will be the result. Men who had a vasectomy more than 15 years before they choose to have a vasectomy reversal have about a 70% chance their vas deferens’ continuity will be restored and a lower likelihood that pregnancy will result.
Another factor that has an impact on the success of a vasectomy reversal is what the surgeon finds once he or she views the vas deferens and its contents in the operating room. If sperm are present in the vas deferens, 90% or more of men can expect the vasectomy reversal to be successful, with an associated 60% to 70% pregnancy rate. If there are no sperm but the vas fluid is abundant and provides a healthy environment for eventual sperm production, then the success rate of a vasovasostomy is about 70%.
If, however, the vas fluid is thick and pasty and there are no sperm present, then an obstruction has likely formed above the vasectomy site. That’s when the surgeon must perform the alternative surgery, an epididymovasostomy. An epididymovasostomy involves suturing the cut ends of the vas deferens directly to the epididymis, which allows the surgeon to bypass the obstruction. This surgical procedure is more complex than a vasovasostomy. Both types of procedures are done using a special operating microscope. If an epididymovasostomy is done on both sides, the success rates are 50% to 60% because the tubes of the epididymis are much smaller (one-fifth the size) of the vas deferens.
Sperm banking before a vasectomy reversal
At the time a vasectomy reversal is done, men are typically asked if they want to bank their sperm. Freezing or cryopreservation of sperm is routinely done at the time of vasectomy reversal in case a man’s sperm counts are not adequate to result in pregnancy after surgery and is especially recommended if an epididymovasostomy is necessary. Preserved sperm can be used for in vitro fertilization at a later date if the couple is unable to get pregnant. There is an additional charge for harvesting sperm during a vasectomy reversal, as well as a yearly storage fee from the sperm bank.