Advances in microsurgery have made a reversal procedure more common and available than in the past. Some people are better candidates than others, but the chances for success are good to excellent for many patients.
Your original decision to have a vasectomy was probably based on a clear understanding that it was to be a permanent procedure. Hopefully, you considered all your options, and you came to a well-informed conclusion that having a vasectomy was the proper course for you and your spouse at that time in your life. And, when you decided on the procedure, you were aware that a vasectomy is highly effective, in part, because it is meant to be lasting.
Things change.
In contrast, circumstances change. Life and living situations can shift significantly. As a result, of all the men who have had a vasectomy each year, a growing number of them eventually have good and valid reason to change their mind. While about 600,000 men undergo a vasectomy annually in the United States, many will consider having a reversal procedure (vasovasostomy) in order to allow them to father a child after some major turn in their life.
Perhaps the most common reason that 50,000 or more men annually have a reversal is that they remarry, and that the new couple would now like to have children in their family. Regardless of their motivation, this is a step that should be considered carefully… with as much information as needed to make an informed decision.
Is a reversal possible?
The answer is generally 'yes,' but some people are better candidates than others. Rejoining the cut ends of the vas deferens is technically possible, but it is a significantly greater challenge than the vasectomy. Advances in microscopic surgery have made this extremely delicate surgery more common and more available than in the past.
During a vasectomy, the vas deferens are cut, and a portion of may have been removed, so that these two tiny tubes no longer carried sperm from the testicles and epididymis to the penis during sex. By interrupting the flow of sperm, men become sterile, although ejaculations and sexual climax are otherwise exactly the same.
Stitching tiny tubes.
Disconnecting this miniature pipeline (the vas) is easier, obviously, than stitching it back together again. The vas itself is about the diameter of a round shoelace. The inner channel, which must be aligned, is one third of a millimeter in diameter. The surgical thread (suture material) that a surgeon needs to knit the two ends together is finer than a human hair, and nearly invisible. This microsurgery must be done under a powerful microscope.
The work of the surgeon is to reconnect the previously cut ends of the vas deferens in order to rebuild an open vas channel. In some cases, if part of the vas is damaged, the surgeon must connect the vas end to the epididymis even further upstream from the damage. This more complicated procedure is called a vasoepididymostomy.
Will this work for me?
Chances for success depend on many factors. These include the microsurgical skill and experience of the surgeon and the condition of the patient's tissue after the original vasectomy. Assuming an experienced surgeon, there are clues before and during the surgery, which help predict the condition of the tissues and thereby help predict the chances of success.
A key question, according to most surgeons, is how long ago the vasectomy was performed. In general, men who are less than 10 years out from their vasectomy have a better chance of success. If the vasectomy was performed less than three years ago, the statistical likelihood of reopening a vas channel is 97 percent. But if 15 years or more have passed, the chances drop to 71 percent (See chart below.)
While these percentages seem good, the passage of time also reduces the chance of a pregnancy resulting because the actual sperm may no longer be able to complete the process of fertilization. The following table is based on a study of over 1,000 patients by multiple vasectomy reversal surgeons*.
| Years since vasectomy | Chance of rebuilding an open vas channel | Chance of pregnancy |
| Less than 3 years | 97 % | 76 % |
| 3 to 8 years | 88 % | 53 % |
| 9 to 14 years | 79 % | 44 % |
| Greater than 15 years | 71 % | 30 % |
* Belker AM, et al.Results of 1,469 microsurgical vasectomy reversals by
the Vasovasostomy Study Group. Journal of Urology 1991; 145(3):505-11.
Clues during surgery.
An important predictor of success is the quality of the fluid coming from the vas end at the vasectomy site. If the surgeon finds fluid with sperm cells coming from the vas, he or she can generally build an open channel by reconnecting the vas ends in greater than 90 percent of patients (refer to the Belker Study data).
However, if only fluid without sperm can be seen coming from the vas end, the surgeon can build an open channel through the vasectomy site in somewhat greater than 50 percent of patients. The actual pregnancy rate is frequently closer to 40 percent.
If the fluid is poor and sperm are absent, the vas can be directly connected to the epididymis (epididymovasostomy), but there is a further reduction in the potential success rate.
Every case is unique.
Because a vasectomy is intended to be a permanent change, there are no guarantees about the success of a reversal. The time that has passed since the vasectomy can be an important factor. Commonly, the chances of success can range from good to excellent. However, each individual is different, and a couple should discuss success factors with an experienced doctor before reaching an informed decision.
In Summary:
- A vasectomy is intended to be a permanent procedure.
- Over 50,000 men have a reversal each year.
- A reversal is technically possible, and is becoming more common and available.
- Reconnecting the cut ends of the vas deferens is delicate microsurgery.
- Success factors include the skill of the surgeon, the condition of tissue and the time that has passed since the original vasectomy.
- A major study found that chances of rebuilding a vas channel range from 71 percent up to 97 percent, depending on the years since vasectomy.
- The same study found the chance of pregnancy to range from 30 percent up to 76 percent (see chart above).
- Individual cases will vary and it's important to discuss success factors with a doctor.
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