A vasectomy is a form of male birth control that’s intended to be a permanent protection against pregnancy. With permanent being such a long time, it’s not uncommon for some men to have a change of heart or circumstance and want to be able to father children again. In fact, it’s estimated that over 30,000 men seek to have a vasectomy reversed each year.
Fortunately for these men, almost all vasectomies can be safely and effectively reversed.
This comprehensive guide is designed to introduce you to what a vasectomy is, how a vasectomy procedure is performed, and provide you with the most important and accurate information about vasectomy reversals and their success rates.
Introduction to Vasectomy
A vasectomy is a minimally invasive, outpatient surgical procedure performed on men and is intended to be a permanent form of contraception.
During a vasectomy, the vas deferens, which are the tiny tubes that carry sperm from the testicles to the urethra, are cut or blocked. This procedure permanently prevents sperm from being released during ejaculation, effectively making a man sterile.
Understanding Vasectomy Reversal
Although a vasectomy is intended to be a permanent form of birth control for men, a vasectomy procedure can often be reversed.
A vasectomy reversal is a more challenging and time-consuming surgical procedure than the initial vasectomy. Considering this, most vasectomy reversal procedures are completed by a microsurgeon during an outpatient procedure lasting between 3 and 4 hours.
The goal of a vasectomy is to restore sperm flow to the urethra by reconnecting the vas deferens, or the tiny tubes, that were originally cut during the original vasectomy.
The procedure involves making an incision in the scrotum to access the vas deferens. The surgeon then carefully examines the ends of the vas deferens to determine the best method for reconnecting them.
There are two main techniques used for reconnecting the vas deferens:
- Vasovasostomy. In this technique, the two ends of the vas deferens are reattached using microsurgical techniques. The surgeon uses a microscope to magnify the small structures and delicately sews the ends of the vas deferens together using very tiny sutures. Vasovasostomy procedures are typically 90%-95% effective.
- Vasoepididymostomy. When there is a blockage in the epididymis (the tube that stores sperm for maturation and transportation to vas deferens), or if the vas deferens are damaged or scarred from the initial vasectomy, the surgeon may need to bypass the blockage by connecting the vas deferens directly to the epididymis. This technique is more complex and requires specialized expertise. Because of this, the success rate of vasoepididymostomy procedures are typically between 65%-70%.
After reconnecting the vas deferens, the incisions are closed with sutures, and the patient is typically able to return home the same day.
Vasectomy reversal recovery time varies, but most men can resume normal activities within a week or two, although strenuous activities and sexual intercourse may need to be avoided for a few weeks to allow for proper healing.
It’s important to note that while a vasectomy reversal is generally successful in restoring the flow of sperm, the procedure itself does not always guarantee fertility.
The success of the procedure depends on a number of factors, including:
- Length of time since the original vasectomy. While nearly all vasectomies can be reversed, there is some research that demonstrates that there is less success associated with reversing vasectomy procedures conducted over 15 years ago.
- Current age. While men continue to produce sperm throughout their lifetime, research also indicates that male fertility naturally decreases with age.
- Overall health. A patient’s overall health has a direct effect on sperm production. Being overweight, smoking, abusing alcohol, and anabolic steroid use have all been associated with lower sperm count and decreased sperm movement.
- Presence of sperm antibodies. Nearly all men who’ve had a vasectomy produce antibodies to sperm. While these antibodies typically disappear after a vasectomy reversal, remaining antibodies could interfere with fertility.
Success Rates and Considerations
The goal of a vasovasostomy is to restore a path within the vas deferens to allow for sperm to once again be ejaculated. The tubes within the vas deferens are roughly one-third of a millimeter in diameter. Vasovasostomy procedures are typically 90%-95% effective in restoring sperm flow with actual pregnancy rates varying widely, usually between 30% to 70% success. Although, there is no guarantee success can be achieved.
The goal of a vasoepididymostomy is to restore sperm flow by connecting the vas deferens directly to the epididymis. The diameter of the epididymis is typically one-third to one-half the diameter of the vas deferens. The successful restoration of sperm flow resulting from vasoepididymostomy procedures is between 65%-70% with actual pregnancy rates between 10% and 55%.
Considering the difference in diameter between the vas deferens and the epididymis, and the corresponding pregnancy success rate, a vasovasostomy procedure is the preferred method of vasectomy reversal.
Alternative Options
While nearly all vasectomies can be reversed, there are still a number of factors that could interfere with the ability to achieve pregnancy. Considering this, there are alternative options for fertility restoration to consider, including sperm retrieval for the purpose of in vitro fertilization (IVF).
There are a number of different ways that sperm can be collected from a man who’s had a vasectomy. In the case of IVF, the method of sperm retrieval is typically coordinated with the collection of the female’s egg retrieval.
In most instances, the male will undergo a testicular sperm aspiration (TESA). This procedure takes between 10 to 15 minutes, is performed under local anesthesia, and collects sperm by removing it from the testical with a needle. The sperm is then used as part of the IVF process or frozen (cryopreserved) for later use.
While both vasectomy reversal and IVF can help with achieving pregnancy, there are important factors to consider with both. Although it can take several months to become pregnant after the procedure, a vasectomy reversal appears to be a more effective procedure in younger couples looking to conceive naturally. On the other hand, IVF offers an effective option in achieving pregnancy for older men or for men who’ve had vasectomies over 15 years ago.
Post-Reversal Considerations
Post-operative recovery following a vasectomy reversal is quite similar to the recovery process you followed after your vasectomy.
Immediately after your procedure, and for at least the next 24 hours, it is very important to avoid all physical activities, and especially activities that involve lifting of any heavy objects.
To help reduce swelling and post surgical discomfort, it’s also important to apply ice to your scrotum right after surgery and continuing throughout the following day. To further alleviate pain and discomfort, make sure to take any pain medication as recommended by your doctor.
After your procedure, you will want to make sure you are providing the appropriate support to your scrotum. Most men find that wearing an athletic supporter or snug briefs for the first couple of weeks following the vasectomy reversal provides comfort and support while recovering.
Following a vasectomy reversal procedure, it’s important to avoid any activities that might pressure or stress the testicles or scrotum – this includes jogging, intense exercise, and heavy lifting, for at least six to eight weeks after surgery or until cleared by your doctor.
It’s also recommended that you refrain from sexual activity until your doctor gives you the ok. Until the area completely heals, ejaculation within the weeks following a vasectomy reversal has been known to strain the site of the incision and cause pain and discomfort in the testicles.
While there are very few serious complications associated with a vasectomy reversal, like an surgery, there is the risk of bleeding in and around the incision, infection, and chronic pain. Excessive bleeding, discharge, pain, swelling, redness or fever could be signs of a complication and should be reported to your doctor right away.
To alleviate frustration and disappointment, it’s important to be aware that it could take several months to become pregnant following the successful reversal of a vasectomy. Unfortunately, in some cases, you might not be able to restore fertility, even if the vasectomy itself is successful.
In these rare cases, you might consider the option of having sperm retrieved or frozen (cryopreservation) as a way to still be able to have children through a process such as in vitro fertilization.
Conclusion
Even though a vasectomy is a form of male birth control that’s intended to be permanent, the procedure can usually be reversed depending on the circumstances.
A vasectomy reversal procedure, or vasovasostomy, is an outpatient surgical procedure that reconnects the vas deferens that were separated as part of the original vasectomy. By reconnecting the vas deferens, sperm is once again able to travel from the testicles to the urethra and be released during ejaculation. In some cases, a vasectomy reversal could require a vasoepididymostomy, which is a more complex procedure completed as a way to bypass a blockage found in the vas deferens.
Depending on the type of vasectomy reversal procedure required, the procedure is successful in restoring sperm flow between 65% and 95% of the time. While reversing a vasectomy restores the ability to transport sperm to the urethra, it’s not a guaranteed way to assure a future pregnancy, other factors, including age, current health, and specific circumstances involving your partner could hinder the ability to conceive.
