Making the Right Choice: Is a Vasectomy Reversal Right for You?

A vasectomy is a safe and effective birth-control method that was designed to be permanent. But at some point in the future, when life circumstances change, some couples may find themselves in a position to consider adding another (or a first) child to their family. When this happens, you and your partner will need to look at the options available and decide whether a vasectomy reversal is the right option for you.

Success rate factors

If you're considering a vasectomy reversal, the first thing to consider are factors that can contribute to or hinder the procedure's success. Some of the biggest ones include:

  • Time since original vasectomy: Studies have consistently shown that reversals have a higher rate of success when the procedure is performed closer to the original vasectomy. Time lapse between the vasectomy and reversal may result in the formation of scar tissue that blocks the sperm from flowing through the vas deferens. Additionally, a man's body can develop antibodies after a vasectomy that limit or reduce sperm production. These antibodies increase over time, reducing the likelihood of success for a reversal. Ideally, a reversal should be completed within six years of a vasectomy to ensure best results.
  • Type of procedure: There are two main types of reversal procedures—vasovasostomy and vasoepididymostomy. A vasovasostomy requires the surgeon to reconnect the severed ends of the vas deferens, whereas during a vasoepididymostomy the surgeon connects the severed end of the vas deferens directly to the epdidymis (the tube attached to the testicle where sperm mature). The vasoepididymostomy is more complex and typically employed when the vas deferens is damaged; it tends to have a lower rate of success than vasovasostomies.
  • Your choice of surgeon: The procedure is highly complex and is most successful when done by a board-certified urologist trained in reversal surgeries. Because the costs of a vasectomy reversal are typically not covered by insurance, the additional cost of having an experienced urologist trained in microsurgery perform the reversal may be a consideration for some patients. Vasectomy reversal costs may be lower if a less experienced urologist performs the procedure; however the success rate for the reversal may not be as high. (See Choosing a vasectomy reversal doctor for help finding a qualified surgeon in your area.)
  • Age: Although a vasectomy reversal is possible at any age, men under 45 have higher success rates. Men over 45 should consult their surgeon about the procedure's potential for success. (Your partner's age also plays a role, as a woman's fertility peaks at age 25 and begins to decline more sharply after age 35.)

Other options for conception

Vasectomy reversal is only one of a number of conception options for men who've undergone a vasectomy. Reversal tends to be the least expensive choice, but there are other procedures that a couple should consider. Assistive reproductive technologies (ARTs) such as in vitro fertilization (IVF) may be a better alternative if vasectomy reversal is not a viable option or if you don't want to undergo a second surgery. And unlike a reversal, the costs of IVF and other ARTs may be at least partially covered by insurance. But IVF may require several cycles before conception is achieved and has a lower overall success rate: About 30 percent of IVF procedures result in live births while the success rate of vasectomy reversal ranges between 40 and 75 percent. (See our article on alternatives to vasectomy reversal for more information.)

Making the decision

The decision to have a vasectomy reversal should be based on your needs and your specific circumstances. Talk with your doctor to determine if you are a good candidate for reversal and to better understand your options for conception.

References

Asch, A., & Marmor, R. (2008). From birth to death and bench to clinic: The Hastings Center bioethics briefing book for journalists, policymakers, and campaigns. Assisted reproduction. Chpt. 2. (pp. 5-10). Garrison, NY: The Hastings Center.

Graham, S.D., & Keane, T.E. (2009). Glenn’s urologic surgery. Philadelphia, PA: Lippincott Williams and Wilkins.

Pisipati, S., & Pearcy, R. (2010). The role of urological surgery in male infertility. Human Fertility, 13(4), 233-241.

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