Choosing to have a vasectomy is a big decision, and so is
deciding to have it reversed. Often, a man who has a vasectomy does
so because he is done having children or does not want to father children.
Later on, however, things may change—perhaps he has remarried, is restarting a
family after the loss of a child, or simply has had a change of heart. Whatever
the reason, a vasectomy reversal can be performed and, in most cases, end in
his fertility being restored.
During a vasectomy, the tubes that transport sperm from the testes and out of the urethra (vas deferens) are severed then obstructed via sutures or electrical cautery to prevent fertilization. In order to restore fertility through a vasectomy reversal, the cut ends of the vas deferens tubes are reconnected or are connected to the epididymis (the reproductive organ where sperm matures). If successful, sperm will return to the ejaculate and result in pregnancy.
Reversals are performed with general anesthesia and done in an ambulatory surgery center or outpatient area of a hospital. After the patient has been anesthetized, the surgeon (a urologist) will make a tiny incision on both sides of the scrotum in order to access the vas deferens. Once they have been pulled through the cuts and isolated from the scrotal sac, the scarred ends of the vas that are blocked are removed. To see if the fluid inside the end closest to the testicle contains sperm, the surgeon will take a fluid sample. If sperm is present in the fluid, this means there is no blockage between the testicle and the site in the vas from which the fluid was taken. This too means that there is no blockage in the epididymis. With this knowledge, the surgeon can perform a simpler type of vasectomy reversal, known as vasovasostomy, whereby the cut ends of the vas can be reconnected to reinstate a pathway for sperm. A microsurgical approach is considered best, as it may result in the restoration of sperm to the semen in up to 95 percent of patients and pregnancy in up to 75 percent of their partners.
If sperm is not found in the fluid sample, there may be a break in the epididymal tubule, which is often due to a backup of sperm caused by the original vasectomy. A break can result in a blockage, and this means the surgeon will need to do a more complicated technique called an epididymovasostomy, whereby the urologist must bypass the blockage by connecting the upper end of the vas directly to the epididymis, but above the obstruction. Success rates and pregnancy rates are lower with this technique than they are with a vasovasostomy.
With either technique, however, though the vasectomy reversal may be successful (meaning sperm has returned to the semen), pregnancy rates differ and largely depend on the skill of the surgeon as well as the length of time from the vasectomy until the reversal. For some who’ve had a reversal, it may take only a few months for pregnancy to occur, but for others it may take a year or more.
Following a reversal, your urologist will perform a semen analysis every couple of months until your sperm count becomes stable or pregnancy has been achieved. Sperm usually appears in the semen within a couple of months, but for some it may take up to 15 months. The latter typically occurs in men who’ve had an epididymovasostomy. Once sperm returns the semen, the man can be fertile for many years.
About Robert D. Oates, MD, FACS
Dr. Oates is one of the most experienced microsurgical vasectomy reversal surgeons in New England. It has been a main focus of his practice after completing a Fellowship in Male Reproductive Medicine and Surgery in 1988. He has authored numerous works on Male Infertility and stands committed to the highest level of microsurgical practice.
Featured Specialist for Vasectomy Reversal in Boston, MA
Call Now: (617) 638-1007 725 Albany StreetSuite 3BBoston, MA 02118