Vasectomy Reversal
What is a Vasectomy Reversal?
A vasectomy reversal (also called vasovasostomy) is an operation using a surgical microscope that aims to re-establish the connection between the two ends of the vas deferens that were separated at the time of prior vasectomy. Even though your vas deferens were cut during the vasectomy, your testes continue to make sperm. Thus, the goal of a vasectomy reversal is to have sperm return to the ejaculate.
Am I a Candidate for Vasectomy Reversal?
Increasing numbers of men are coming to the urologist for vasectomy reversals. Common indications are remarriage, couples who have ‘changed their mind,’ or a change in life circumstances and desire to initiate a pregnancy. Another indication would be for severe post-vasectomy testicular pain; a vasectomy reversal has been shown to improve pain control.
What Do I Need to Know Before Surgery?
Before surgery, your surgeon will examine the genitals to palpate the vasectomy defect within the scrotum. Additional important information that your surgeon will want to know is how long ago the vasectomy was performed. Your surgeon may order labs to check your hormone levels.
Surgery:
Given the vas deferens is a delicate tubular structure with a very narrow lumen, a surgical microscope and sutures as thin as human hair are needed. The surgery can take 2-4 hours depending on the complexity of the intra-operative findings. Additionally, if the patient is interested, sperm can be retrieved at the same time to cryopreserve and potentially use in the future; this would be as a “backup” in case inadequate sperm counts are present after surgery. The patient will be discharged the same day after surgery.
After Surgery:
Pain after surgery is generally well tolerated with medication. Patients are instructed to avoid sexual activity of any kind and strenuous activity for 3 weeks, to allow for healing the newly created vasal connections. A semen analysis is obtained approximately 6 weeks after surgery to check for the presence of sperm in the ejaculate. Repeat semen analyses may be recommended to ensure that the vas deferens remains patent.
What is the Success Rate of a Vasectomy Reversal?
The surgeon who performs your reversal should be skillful with microsurgical technique as precise suture placement is critical to the success of the procedure. Success rates of this procedure also depend on whether sperm and fluid are still present in the vas deferens at the time of surgery. If there is no fluid noted, sometimes the vas deferens has to be reconnected to the epididymis (also called an epididymovasostomy) because of a secondary obstruction in the epididymis. A specially trained microsurgeon would have the ability to performed this more difficult procedure.
If a vasovasostomy is performed, there is a >90% likelihood of return of sperm in the ejaculate post-operatively. However, if an epididymovasostomy is performed, the likelihood of finding sperm in the ejaculate drops to 50-85%. It is important to keep in mind the female partner in regards to pregnancy after vasectomy reversal. Having sperm in the ejaculate post-operatively does not guarantee a pregnancy; further, pregnancy rates decline with increasing female age (this should be taken into account when deciding whether to pursue vasectomy reversal).