Vasectomy is minor surgery to block sperm from reaching the semen that is ejaculated from the penis. Semen still exists, but it has no sperm in it. After a vasectomy the testes still make sperm, but they are soaked up by the body.
Each year, more than 500,000 men in the U.S. choose vasectomy for birth control. A vasectomy prevents pregnancy better than any other method of birth control, except abstinence. Only 1 to 2 women out of 1,000 will get pregnant in the year after their partners have had a vasectomy.
What is vasectomy reversal?
Vasectomy reversal reconnects the pathway for the sperm to get into the semen. Most often, the cut ends of the vas are reattached. In some cases, the ends of the vas are joined to the epididymis. These surgeries can be done under a special microscope (microsurgery). When the tubes are joined, sperm can again flow through the urethra.
There are many reasons to undo a vasectomy. You might remarry after a breakup or have a change of heart. Or you might want to start a family over after the loss of a loved one.
What happens under normal conditions?
Both sperm and male sex hormones are made in the paired testes (testicles). The testes are in the scrotum at the base of the penis. Sperm leave the testes through a coiled tube (the epididymis), where they stay until they're ready for use. Each epididymis is linked to the prostate by a long tube called the vas deferens (or vas). The vas runs from the lower part of the scrotum into the inguinal canal. It then goes into the pelvis and behind the bladder. This is where the vas deferens joins with the seminal vesicle and forms the ejaculatory duct. When you ejaculate, seminal fluid and seminal vesicles mix with sperm to form semen. The semen flows through the urethra and comes out the end of your penis.
What happens during vasectomy reversal?
Reversals are most often done by a urologist. Reversals can be done in an outpatient part of a hospital or at a surgery center. If a surgical microscope is used, the surgery is done while you're asleep under anesthesia. Your urologist and anesthesiologist will talk with you about your choices.
Using microsurgery is the best way to do this surgery. A high-powered microscope used during your surgery magnifies the small tubes 5 to 40 times their size. Your urologist can use stitches much thinner than an eyelash or even a hair to join the ends of the vas.
After you're asleep, your urologist will make a small cut on each side of the scrotum. Your urologist will trim the scarred ends of the vas where they were closed by the vasectomy. Your urologist will take fluid, (vasal fluid) from the vasal end closest to the testis. Your doctor will check to see if it has sperm in it. At this point, there are two types of reversal procedures you can have:
If there is sperm in the vasal fluid it shows that the path is clear between the testis and where the vas was cut. This means the ends of the vas can then be joined. The term for reconnecting the ends of the vas is "vasovasostomy." When microsurgery is used, vasovasostomy works in about 85 out of 100 men. Pregnancy occurs in about 55 out of 100 partners.
If there is no sperm in the vasal fluid, it may mean back pressure from the vasectomy caused a form of "blowout" in the epididymal tube. This blowout can lead to a block. Your urologist will need to go around the block and join the upper end of the vas to the epididymis instead. This is called a vasoepididymostomy, and it serves the same purpose as the vasovasostomy.
Vasoepididymostomy is more complex than vasovasostomy, but the results are nearly as good. Sometimes vasovasostomy is done on one side and vasoepididymostomy on the other.
What can I expect after the procedure?
Healing should be rather quick and fairly easy. Pain after surgery is most often controlled with pills. About 50 out of 100 men say the pain after the reversal is like after their vasectomy. Another 25 out of 100 say the pain is less than after the vasectomy, and 25 out of 100 say it’s greater. Pain bad enough to need medications rarely lasts longer than a few days to a week.
Most men can return to their normal routine and light work within a week. You’ll likely be told to take it easy and not have sex for 2 to 3 weeks. If your job is strenuous, ask your urologist when you can return to work. You’ll most likely wear a jockstrap for support for a few weeks.
It may take 4 months to a year for your partner to get pregnant after vasectomy reversal. Some women get pregnant in the first few months, while others may take years. Pregnancy rates can depend on the amount of time between the vasectomy and reversal. Sperm return to the semen faster and pregnancy rates are highest when the reversal is done sooner after the vasectomy.
Next to pregnancy, testing the sperm count is the only way to tell if the surgery worked. Your urologist will test your semen every 2 to 3 months until your sperm count holds steady or your partner gets pregnant. Sperm often appear in the semen within a few months after a vasovasostomy. It may take from 3 to 15 months after a vasoepididymostomy.
In either case, if the reversal works, you should stay fertile for many years. Only about 5 out of 100 men later get scars in the reconnected part. The scars could block the outflow of sperm all over again.
Who does vasectomy reversals?
Vasectomy reversals are most often done by urologists, but not all urologists do this type of surgery often. You should ask your urologist how many he/she has done, and to what level of success.
Margaret Vereb, MD, is the only fellowship trained andrology/male infertility specialist in West Virginia. She is an expert in vasectomy reversal as well as the care and management of men with hormone abnormalities and infertility issues.
Can all vasectomies be reversed?
Almost all vasectomies can be reversed, but if the vasectomy was done while fixing a hernia in the groin it may not be as easy to join the ends of the vas. The ends also may not be able to be joined if a very long piece was removed during the vasectomy, but this is rare.
Should I have a vasovasostomy or a vasoepididymostomy?
You can't tell before the reversal which method is best for you. Your urologist can only find this out during the surgery. If sperm are found in the vasal fluid, then a vasovasostomy is done. If there are no sperm in the fluid, your urologist will decide what to do based on other factors. If there's a block in the epididymal tube, then a vasoepididymostomy will be needed.
If no block is found, then the way the vasal fluid looks may help your urologist decide which method is best. For the most part, if the fluid looks watery, he/she will tend to do a vasovasostomy even if no sperm are found in the fluid. Fluid that looks creamy without sperm suggests that vasoepididymostomy is needed. Some patients may need a vasovasostomy on one side and a vasoepididymostomy on the other.
Is age a factor in conceiving after a vasectomy reversal?
Your age shouldn't affect the results of your vasectomy reversal. Most men keep making sperm for many years after their partners stop making eggs. Women become less fertile starting in their mid-30s, with a major drop around age 37. Your partner should check with her gynecologist to see if she is still ovulating before you agree to a reversal.
If a vasectomy reversal fails, should I try it again?
When done by skilled microsurgeons, success rates for repeat reversals are often the same as for first reversals. Your urologist will review the record of your prior surgery to help you decide. If sperm were found in the vasal fluid then, he/she will likely do a repeat vasovasostomy, which is more likely to succeed.
How much does a vasectomy reversal cost?
The cost of a reversal ranges between about $5,000 and $15,000 (plus other fees). Most health plans don't pay for reversals. You should talk with your health plan early in the planning to find out what they will cover.
Will a vasectomy reversal cure testis pain from my vasectomy?
Very few men get pain in the testis after a vasectomy that's bad enough for them to ask about reversal. Because these cases are rare, there aren't many studies of groups of these men. These studies suggest that it works for most men. Still, your urologist can't tell beforehand if a reversal will cure your pain.
Source: American Urological Association