Vasectomy Reversal

Vasectomy Reversal

What is a vasectomy reversal?

Vasectomy reversal is a surgical procedure to undo a vasectomy. About 15% of men who undergo vasectomy regret it, and 5% will desire reversal.

The most important factor determining reversal success is the experience of the surgeon. The surgeon should be a fellowship-trained reproductive urologist who can perform both vasovasostomy (VV) and epididymovasostomy (EV). The surgeon should use an operating microscope to aid visualization during the surgery.

A skilled surgeon can reverse vasectomy on most men regardless of the time elapsed since the surgery, even significantly longer than 10 years.

What are vas deferens?

During vasectomy reversal surgery, a surgeon reconnects each of the tubes (vas deferens) that were cut during the vasectomy (see diagram). Before being cut, the vas deferens carried sperm from a testicle into a male’s semen. After a successful vasectomy reversal, sperm will once again be able to travel toward the testicles. They will appear in a male’s ejaculate, allowing for potential fertilization with a female egg.

Pregnancy rates after vasectomy reversal can range from about 30% to over 90% depending on many different variables: the type of vasectomy reversal procedure used, the experience of the surgeon, the partner’s fertility, and whether the male had fertility issues before the initial vasectomy.

What are the different types of vasectomy surgeries?

Vasectomy reversal is a more difficult surgical procedure than a vasectomy and should be done using microsurgery. With microsurgery, an experienced surgeon uses a powerful surgical microscope to magnify the vas deferens up to 40 times its actual size.

The surgeon will typically reattach and reconnect the two ends of the vas deferens in one of two ways:

  • Vasovasostomy (VV):  the severed ends of each vas deferens are sewn back together
  • Epididymovasostomy (EV): the vas deferens are attached directly to the small organ (the epididymis) at the back of each testicle that holds sperm

An epididymovasostomy (EV) is a more complicated than a vasovasostomy (VV). It is generally only selected by the surgeon if a vasovasostomy cannot be done for various reasons or is not likely to be successful. The surgeon’s decision often depends on whether sperm are seen when fluid from the vas deferens is analyzed during the surgery.

For this reason, a surgeon decides which of the two procedures is needed during the surgery. Sometimes a combination of both procedures is required. For example, sometimes, a vasovasostomy is needed on one side, and an epididymovasostomy is required for the other.

What does vasectomy reversal surgery entail?

A surgeon typically uses general anesthesia to make a patient unconscious during surgery.  Additionally, all patients receive a local anesthetic that eliminates the pain and numbs the area.

During the surgery, the surgeon makes a small incision on the scrotum to expose the vas deferens and release them from the surrounding tissues. Next, the surgeon cuts open the vas deferens and examine the fluid inside. If sperm are present in the fluid, the ends of the vas deferens can be reconnected to reestablish a passageway for the sperm to travel through.

If the fluid contains no sperm, scar tissue, or a secondary epididymal obstruction (called an epididymal blowout) blocking the flow of sperm may be the cause. If this is the case, the surgeon may do an epididymovasostomy.

Vasectomy reversal surgery is often done in an outpatient clinic. The surgery generally takes 3-4 hours, in some cases, longer. The patient may need additional time to recover if general anesthesia was used.

Considerations and Preparations for a Vasectomy Reversal

When considering a vasectomy reversal, males should:

  • Research costs. Vasectomy reversal can be expensive, and many insurance plans may not cover it.
  • Research surgeons carefully. Vasectomy reversals are generally most successful when done by a surgeon who specializes in this surgery and is trained in and uses microsurgical techniques, including a surgical microscope. Experience and frequency of the surgery are also key.
  • Ensure that the chosen surgeon can perform vasovasostomy and epididymovasostomy, as the latter may need to be performed. Know the surgeon’s success rates and how often the vasectomy reversals completed resulted in pregnancies.
  • Know what steps you might need to take before surgery, including what medication should be stopped, such as blood-thinning medications, aspirin, ibuprofen, or others.

Before vasectomy reversal surgery, the surgeon will likely:

  • Take a medical history and perform a physical exam. This will ensure the surgeon that no health concerns could complicate surgery.
  • Check to see if healthy sperm can be produced. For most males, having fathered a child before is proof. After a vasectomy, testicles continue to produce sperm. But the amount of sperm produced may have decreased over time. Age, diet, smoking, and exercise, among other variables, can change how much healthy sperm is produced. Your surgeon may want to perform some tests before surgery.
  • Confirm that the patient knows if the chosen partner can have a child. This ensures that the patient’s fertility expectations align with all parties involved.

Choosing to extract and freeze sperm

Some males choose to have sperm extracted and frozen (cryopreservation) as part of their vasectomy reversal surgical procedure as a backup plan in case the surgery is unsuccessful. The patient wants to father a child through assisted reproductive technology (ART), such as in vitro fertilization (IVF). Sperm can be retrieved directly from the testicle during surgery in a procedure called testicular sperm extraction, or TESE. This is recommended for all men undergoing a reversal because the success rate is never 100%, and the average success is around 90-95% across all time frames for the vasectomy interval.

Are there risks involved with a vasectomy reversal?

Vasectomy reversal rarely leads to serious complications, but as with any surgery, there are risks. These include:

  • Bleeding within the scrotum. If some bleeding inside the scrotum occurs, it can lead to a collection of blood (hematoma) that causes painful swelling. The risk of hematoma is greatly reduced by following the surgeon’s instruction to use scrotal support, applying ice packs after surgery, and resting for the designated time. Your surgeon will also likely recommend avoiding aspirin or other blood-thinning medications before and after surgery.
  • Infection at the surgery site. This is very uncommon, but infections are a risk with any surgery and may require treatment with antibiotics if one occurs.
  • Chronic pain. Chronic pain after vasectomy reversal is uncommon. If this occurs, the surgeon will present pain treatment options.

Post-surgery care

After the surgery, patients wear tight-fitting undergarments such as an athletic supporter to support the scrotum and hold the gauze in place. The patient should not drive himself home after the procedure.

You should apply ice for 24 to 48 hours to reduce swelling.  For the first 24 hours after surgery, the patient should avoid getting the surgery site wet.

You may be sore for several days and should limit activities that might cause the testicles to move around too much. As the anesthetic wears off, the patient may feel pain or discomfort. For most males, the pain does not feel severe and improves after a few days to a week.  The stitches dissolve in about two weeks.

Post-surgery care

You should wear an athletic supporter for several weeks after surgery except while showering. You should also avoid any activity that might pull on the testicles or scrotum, including running, biking, heavy lifting, and other sporting activities, for at least 2-3 weeks after the surgery.

If your work entails sitting at a desk, work may resume a few days after surgery. But if your job involves physical labor, driving, or a lot of walking, it is important to talk to the surgeon about when it is safe to return to work. Taking a full week off work is the best plan for most men.

It is also important not to have sexual intercourse or ejaculate for at least a week after surgery.

Confirming surgery success

Approximately 6-8 weeks after vasectomy reversal surgery, your surgeon will examine your semen under a microscope to see if sperm is present. When surgery is successful, sperm typically appear in the semen within a few weeks.  However, the appearance of sperm can sometimes take a year or more if a bilateral epididymovasostomy was necessary. Unless a pregnancy occurs, the only way to tell if a male’s vasectomy reversal was successful is to check the semen. Therefore, multiple semen analyses may need to be done over time.

Even if a vasectomy reversal is successful, the success of achieving pregnancy depends on various factors, including the number and quality of the sperm present in semen and the female partner’s age and fertility.

What if the vasectomy reversal doesn’t work?

Vasectomy reversals are sometimes unsuccessful if there is an underlying issue with a testicle that is not detected during the surgery or if blockage develops after the surgery. Some men will have anti-sperm antibodies that immediately attack the reversal site and cause obstruction. Some men will have the surgery repeated; however, success rates are slightly lower for the second attempt.

In cases where a vasectomy surgery fails, there are options for pursuing pregnancy through sperm retrieval and in-vitro fertilization. Your fertility specialist will discuss all possibilities with you.

The Atlantic Reproductive Difference

At Atlantic Reproductive Medicine Specialists, microsurgeon Dr. Matt Coward has over 10 years of experience performing vasovasostomy (VV) and vasoepididymostomy (VE) vasectomy reversals using an operative microscope with simultaneous sperm banking.

If you are interested in learning more about getting a no-needle, no-scalpel vasectomy, call Atlantic Reproductive Medical Specialists today for a consultation @ (919) 248-8777

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