Vasectomy is one of the most effective forms of birth control treatments available and is nearly 100 percent effective in preventing pregnancy. While vasectomy is a permanent form of birth control, men who wish to have their fertility returned can undergo vasectomy reversal (vasoepididymostomy), to essentially “reconnect” the vas deferens and return sperm into the ejaculate. Men who have had a successful vasectomy reversal are now capable of achieving pregnancy naturally. Roughly 5% of men who have had a vasectomy choose to have it reversed.
Common questions about Vasectomy Reversal
In addition to returning fertility after vasectomy, a vasectomy reversal may also be an effective treatment for chronic pain after a vasectomy. Roughly 1-2% of men who have a vasectomy may experience long-term pain. There are many causes of pain after a vasectomy, but in some men this pain is due to the blockage of the vas deferens. By undergoing a vasectomy reversal, this blockage can be relieved and pain may be significantly reduced.
Unfortunately, there are no definitive predictors for who needs a complex reconstruction. Men who have had more time elapsed since their vasectomy are more likely to need vasoepididymostomy. While some parts of the physical exam may suggest a blockage, the decision of whether a vasoepididymostomy is only determined at the time of surgery. During vasectomy reversal, the vasectomy site will be isolated, and the fluid will be obtained from the testicular end of the vas deferens. The fluid is examined under a microscope, and if the fluid is found to be thin and containing sperm, a vasovasostomy is performed. If the fluid is thick, pasty and no sperm are seen under the microscope, this is evidence of a second blockage and a vasoepididymostomy is performed. During vasoepididymostomy, the vas deferens is connected to a coiled tube called the epididymis. Vasoepididymostomy is a complex operation requiring a surgeon with extensive training in microsurgery. There is no way to predict whether someone has this secondary blockage prior to surgery, so it is important to find a surgeon who is experienced in microsurgery and can perform a vasoepididymostomy.
Vasectomy reversal may not be best for everyone. Sperm can be surgically retrieved from the testicle without the need to undergo vasectomy reversal. This sperm can then be cryopreserved and utilized with in-vitro fertilization (IVF) to successfully achieve pregnancy. Sperm retrieved surgically are immature, incapable of fertilizing an egg on their own, and in-vitro fertilization is required to achieve pregnancy. In-vitro fertilization may be a better option when your partner is older, or you wish to avoid the need of a vasectomy in the future.
In general, vasectomy reversal tends to be less expensive than assisted reproductive technologies, such as in-vitro fertilization, and financial factors may drive a couple’s decision to pursue vasectomy reversal. Couples who wish to have more than one child or wish to achieve pregnancy naturally through intercourse may also prefer vasectomy reversal.
Dr. Johnson is part of a team of fertility specialists at the Washington University Fertility and Reproductive Medicine Center, where he partners with reproductive endocrinologists to provide the most effective procedures and technologies in fertility treatment today. Call 314-362-8200 to schedule an appointment with Dr. Johnson.
Overview of vasectomy removal procedure
Vasectomy reversal is the surgical reconstruction of the male reproductive tract after vasectomy. The vas deferens (tube that is cut during vasectomy) is responsible for carrying sperm from the testicle to the prostate, where sperm is mixed with semen at time of ejaculation. By reconnecting the tube that carries sperm from the testicle, sperm can again be seen in the ejaculate and spontaneous natural pregnancy can be achieved.
Vasovasostomy is the most common approach of performing a vasectomy reversal. This is accomplished by directly suturing the two cut ends of the vasectomy back together. When performed by a surgeon experienced in microsurgery, success rates can be as high as 95%.
Men of any age can have a successful vasectomy reversal. However, some men may develop a second blockage closer to the testicle, making vasectomy reversal more complex. These men, who may have gone 15 or 20 years since their vasectomy, can undergo vasoepididymostomy, a surgery that involves connecting the vas deferens to a very small, coiled tube called the epididymis.
During sperm production, newly made sperm leave the testicle and enter the epididymis, where they mature into functional sperm. After a vasectomy, the sperm reach the dead end at the vasectomy site and have nowhere to go. Over time, pressure can back up into the epididymis, and this pressure may cause scarring and lead to a secondary blockage site. By connecting the abdominal end of the vas to the epididymis, this secondary blockage can be by-passed and successful reversal achieved. Vasoepididymostomy requires specialized experience in microsurgery.
Vasectomy reversals are generally performed in the operating room with the patient under general anesthesia. All patients go home on the same day as their surgery, and surgery typically takes 2-4 hours, depending on whether vasoepididymostomy is required. During surgery, two small incisions (1-3 cm) are made in the incision through which the doctor performs the operation. These incisions are closed with absorbable suture, and bandages applied over each incision. Men are encouraged to wear tight-fitting underwear, or preferably an athletic supporter to help reduce swelling. Most men require prescription-strength pain medicine for 2-3 days. After surgery, men should avoid physical exertion (exercise, physical labor) for 2 weeks, and abstain from sexual activity for 1 week. Men who work primarily at a desk may be ready to return to work as soon as 3 days after surgery.
If men have history of testicular disorders, low testosterone or are currently taking testosterone therapy, additional testing may be recommended. Men taking testosterone should stop testosterone 3 months prior to undergoing vasectomy reversal. Otherwise, most men require no additional workup beyond a history and physical exam.
All patients go home the same day of their surgery, and typically need prescription-strength pain medicine for 3-4 days after surgery. Pain is typically localized to the incisions, and men who are able to have bilateral vasovasostomy may have a faster recovery. Most men will then continue to have some soreness for 1-2 weeks, and may need NSAIDS (Tylenol/ibuprofen) after surgery. All men are encouraged to wear scrotal support to reduce discomfort for 2 weeks. We instruct our patients to avoid physical exertion (exercise as well as work activities) for 2 weeks after surgery. Men who have non-physical work duties may return to work within 1 week of surgery. Otherwise most men can resume unrestricted work activities at 2 weeks. We ask men to hold off on resuming sexual activity for at least 2 weeks after surgery. Couples may be able to achieve pregnancy almost immediately after a successful vasectomy reversal, and are encouraged to start trying once the 2-week recovery period has passed. A semen analysis is obtained at 6, 12 and 24 weeks after surgery if vasovasostomy is performed, and at 6 and 12 weeks if vasoepididymostomy is performed.
If vasovasostomy is performed, the success rate of returning sperm to the ejaculate is 90-95%. If vasoepididymostomy is performed, the success rate is 60-70%. Pregnancy rates after successful vasectomy reversal range from 30-70%, depending on several factors including female partner age.
Scarring may occur at the site of the vasectomy reversal, resulting in new blockage and infertility. Men who have had a prior vasectomy reversal and found to have zero sperm in the ejaculate may consider undergoing a re-do vasectomy reversal. As an alternative, we offer patients a procedure called testicular sperm retrieval, in which sperm are obtained directly from the testicle and can be used for in-vitro fertilization.
Why choose Washington University?
Success after vasectomy reversal is dependent on the ability of your surgeon. By choosing to work with our Washington University physicians, you can be assured you are receiving passionate and expertise care from specialists dedicated to their patients.
Dr. Johnson is a board-certified, high-volume microsurgeon who has fellowship training in vasectomy reversal surgery. As a male infertility specialist, he is dedicated to using his expertise in reproductive medicine and surgery to help couples achieve pregnancy. Medical care, and the area of reproductive medicine especially, can be complex and sometimes overwhelming. Dr. Johnson is dedicated to guiding couples through this process to find the fertility treatment plan that’s best for them.