Vasectomy Reversal (Vasovasostomy)

Vasectomy is a male birth control method.  This procedure and female tubal ligation techniques are considered permanent birth control methods.  Vasectomy reversal connects both ends of previously ligated and cut vas deference (tubes).  Since the tubes are tiny, this requires microsurgical techniques and an operating microscope or a powerful loupe.

Vasectomy reversal is mostly an outpatient procedure.  Patients should expect to leave the clinic/hospital in 1-3 hours after the surgery.  Generally, local anesthesia is sufficient, but patients should stay still during the microsurgical part of the operation.  Therefore, general anesthesia may be needed.  Sometimes, the surgery can start with local anesthesia, and if required, general anesthesia can be applied if the patient can not stay still.

The success rate of a vasectomy reversal depends on many variables.  The patient’s expectation is achieving a pregnancy after a reversal surgery, not only the appearance of sperm in the ejaculate.  The vasectomy can be reversed, but the couple may not achieve pregnancy eventually.  Therefore, we must evaluate the vasectomy reversal candidates and their partners concerning their fertility potential as couples.

We offer 20% reduction in the cost of IVF with testicular sperm if the patient does not have any sperm in the ejaculate six months after the surgery. (PLEASE NOTE THAT THE COUPLE SHOULD BE FERTILE OTHER THAN THE VASECTOMY PROBLEM – Drugs for ovulation induction are not included)

WHO IS THE CANDIDATE FOR A REVERSAL

Vasectomy reversal is done naturally on men who want to gain their fertility.  However, patients should remember that they need time and a fertile partner to achieve a pregnancy.  Therefore, before deciding on a reversal, their partner should have a thorough examination by a fertility specialist.  For example, a female partner over 36 years old with a poor ovarian reserve may not be pregnant after a successful vasectomy reversal.  Although some patients have sperm in their ejaculate three months after surgery, they should expect to achieve a pregnancy within one or two years.  It means that female partners should have a good fertility potential at the time of the surgery and two years after surgery.  If the surgery fails or no pregnancy happens in 2 years, even if the surgery is a success concerning the patency of tubes, they should still have a good chance with IVF treatment.   Otherwise, IVF may be a better first-step treatment.  Of course, when one chooses between a reversal or IVF/ICSI with testicular sperm, the cost of the treatment is important as well.

In summary, you should discuss the indication for vasectomy reversal with your fertility doctors very carefully.

The couple should have an excellent cumulative pregnancy chance within 1-2 years after the surgery.  If delaying your IVF treatment for 1-2 years jeopardizes your pregnancy chance, you may not consider vasectomy reversal and go for direct IVF with testicular sperm.

If the couple wants to have more than one child, then having a patent vas (open tube) can give them a more economical way to have children after the vasectomy reversal.  The idea is to reduce the cost per child.  Of course, here, you must compare the price of IVF/ICSI with testicular sperm and the cost of reversal.

Patients with these conditions should expect a better pregnancy rate after a reversal.

  • The female partner should be less than 36 years old.
  • Male partner’s age is also important.  If he is already over 55 years old, he may not want to wait for a long time to have a child even if his partner is young.
  • The female partner should have an examination before the reversal and have a good chance of fertility.  The uterus and endometrial cavity should be normal, and the ovarian reserve should be fine.
  • Male partners should have proven fertility before vasectomy.  If the vasectomy was done before having any child, or any previous sperm tests, the sperm production must be proven with TESA (Testicular sperm aspiration).  Otherwise, even after a successful surgery, the patient may not have enough sperm in the ejaculate.  In that case, IVF must be the preferred option.
  • Some men develop antibodies to their own sperm if a vasectomy is done eight or more years ago.  This is not considered poor fertility potential for IVF

SURGERY

The standard procedure for a vasectomy reversal is a vasovasostomy.  It is the reconnection of the vas deferens by cutting above and below the damaged segment and carefully stitching the two fresh ends back together. We perform a “three-layer” connection with 8 to 10-0 fine sutures. This technique requires significant surgical skill and results in a precise connection.  This surgery can be done through a 5 mm incision of the scrotum if the vasa can be identified easily through the skin.  In that case, the recovery is very fast and most patients can return their normal lives right after surgery on the same day.  Sometimes, we need to make a large incision and take out the testicles and dissect the cut part of the vasa.

Vasoepididymostomy or epididymovasostomy is connecting the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy.  When there is no sperm in the testicular site of the previously cut vasa, surgeon may need to go down and anastomose the distal part of the vasa to the finer tubules where sperm can be found.   The success rates are lower, costs more and takes more time to perform the surgery.

After Surgery

The surgery usually takes 1-4 hours, then 3-4 hours after surgery to recover from the anesthetics.  Then, the patient may go home.  If there are no complications, then patients should expect to return to their routine daily activities, including sport and sex, in 3 weeks.

Reversals are more successful during the first ten years after a vasectomy.

In general,

  • Pregnancy rates of greater than 50% (cumulative pregnancy change in one year if the female partner has no fertility issues)
  • The highest pregnancy chance occurs if the reversal is done within three years after the vasectomy.

If you have the reversal ten years after the vasectomy, the cumulative pregnancy chance one year after the reversal is between 5 to 30% depending on the age and fertility potential of the female partner.

Risks

Risks of vasectomy reversal include:

  • Infection at the site of surgery.
  • Fluid buildup in the scrotum (hydrocele) may require draining.
  • Injury to the nerves in the scrotum.
  • The anastomosis site may become obstructed again due to the scarring of the tissue by time, even if there is sperm in the ejaculate after the surgery.