Vasectomy is one of the most common methods of birth control in the United States. At times, however, circumstances may arise in which a couple wishes to have a child after the male has had a vasectomy. Because of the greater availability of assisted reproductive techniques, as well as improvements in microsurgical techniques, more couples can now conceive a child following vasectomy. Vasectomy reversal to restore male fertility is possible in the vast majority of cases.
There are two types of reversals, depending upon the level of obstruction in the male reproductive tract:
- Vasovasostomy is the reconnection of the two ends of the vas deferens, the ducts through which semen is carried from the epididymis to the ejaculatory duct in order to move sperm.
- Vasoepididymostomy is the connection of the epididymis to the vas deferens.
The decision of which to perform is made at the time of surgery, depending upon what the surgeon finds. The method is related to the length of time since the vasectomy, because a longer time period can cause a secondary obstruction in the epididymis.
Below, Jay Sandlow, MD, a Medical College of Wisconsin urologist, discusses vasectomy reversal:
The initial evaluation consists of a thorough history and physical exam to identify any other conditions that may lead to fertility problems. We also may evaluate the female partner to determine if she has any significant fertility problems before moving forward with a vasectomy reversal.
Important information for the history includes the date of the vasectomy and any medical conditions, medications or previous surgeries. It also helps to identify any problems that may have occurred following the vasectomy procedure.
The physical exam consists of a general exam, as well as a detailed genital exam to assess the condition of the vas deferens. We do not routinely check any blood tests or conduct a semen analysis unless there are specific reasons to do so.
The success of a vasectomy reversal is related to the time from the vasectomy, as well as the experience of the surgeons. The best results for reversal are typically obtained by surgeons with extensive training in microsurgery and who perform many vasectomy reversals each year. Our fertility specialists perform vasectomy reversals on a regular basis, with results that are as good or better than those reported nationally. We are happy to answer any questions that you may have.
During the procedure, the surgeon uses an operating microscope to reconnect the ends of the vas deferens, and any movement the patient may make is magnified. Because it is difficult for most men to lay still throughout the procedure, most vasectomy reversals are performed under general anesthesia.
Upon exposure of the two ends of the vas deferens, the fluid that comes from the side connected to the testicle is sampled. If there are sperm in the fluid, a vasovasostomy will be performed. In this procedure, the success rate of sperm returning to the ejaculate is 97 percent within six months, with a 60 percent to 70 percent pregnancy rate within one year, regardless of the length of time since the vasectomy.
If a pasty, creamy material is obtained from the fluid, this signifies a blockage closer to the testicle, most likely in the epididymis. This requires performing a vasoepididymostomy. This procedure has a 70 percent success rate of sperm returning to the ejaculate within six months, and a pregnancy rate of 25 percent to 35 percent.
If one side requires a vasovasostomy, while the other side requires a vasoepididymostomy, then the rate is 85 percent and the pregnancy rate is about 50 percent.
The procedure will take about two to three hours.
Almost all men are able to return home the same day of their vasectomy reversal, with an occasional patient requiring an overnight stay, usually for nausea and vomiting. Men can expect to feel a bit more discomfort than when they had their vasectomy.
Most men are able to return to work within five to seven days. We typically see patients back at six weeks, at which time we conduct a semen analysis. If sperm are present, we offer freezing subsequent samples to provide insurance in the case of scarring, with subsequent loss of sperm. This occurs in approximately 7 percent to 10 percent of cases.
In general, the cost for a vasectomy reversal to achieve pregnancy will be lower than the cost of assisted reproductive therapies, such as in vitro fertilization. This assumes that the female partner does not have any significant fertility problems.