Vasectomy Reversal

What is a Vasectomy Reversal?

Men undergo a vasectomy as a procedure to prevent them having any more children. A vasectomy is intended to be a permanent operation, however there are cases when men change their minds and want to have more children. In a man who has had a vasectomy procedure, a vasectomy reversal might be an option to enable them to conceive again.

Vasectomy reversal is more complicated than the original vasectomy procedure, and the process might not be successful. It is not usually available on the National Health Service. If you are considering a vasectomy it is worth remembering that it is intended to be a permanent sterilisation procedure, and that vasectomy reversal is not available or successful for everyone.

What Does the Vasectomy Reversal Procedure Involve?

During a vasectomy a tube known as the “vas deferens” is cut. Each man has two vas deferens, each one carries semen from a testicle to the penis, and during a vasectomy the vas deferens for both testicles are cut. This means that the man still produces sperm in the testicles but it does not flow to the penis when he ejaculates, and is instead reabsorbed by the body.

Reversing a vasectomy therefore involves reconnected the vas deferens tubes at the point where they were cut. Because the tubes are so small, less than half a centimetre across, this is a very delicate process. The testicles have to be opened and then the surgeon has to find each tube and determine where it has been cut.

When the break in the tube is identified, the broken ends are cleaned and any damaged edges are trimmed away. The part of the tube leading to the penis is flushed with water to check for blockages and to clear out any small particles that may have built up. If there is a permanent blockage in this part of the tube the sperm will not be able to reach the penis even if a reversal is performed.

The surgeon then draws up fluid from the tube leading to the testicle to check that sperm is still being produced. If there is a problem with this part of the tube it may be permanently damaged. The surgeon may attempt to join the tube from the penis directly to the testicle (a procedure known as epididymostomy) but this has much lower success rates than a procedure to connect the two parts of the tube.

If both parts of the tube are not damaged a very fine thread is used to reconnect the two parts of the tube. This procedure is known as a vasovasotomy. This process is carried out for both tubes.

What Are The Success Rates for Vasectomy Reversal?

The success of the procedure depends on a number of factors. The time between the initial vasectomy and the reversal operation can greatly affect success rates. This is because the longer it is since the vasectomy the more time there has been for the tissue to scar. Scar tissue increases the likelihood of blockages, and so the greater the length of time the lower the success rates.

There are different types of vasectomy procedures and the success rates of the reversal depend on what type of vasectomy was given in the first place.

Finally, the type of reversal procedure affects the success rates of the procedure. Reconnecting the two parts of the tube (vasovasotomy) has much higher success rates than connecting part of the tube directly to the penis (epididymostomy).

It is therefore crucial to discuss with your doctor your own chances of success based on your personal situation. It is important to recognise that there are two different measures of success that your doctor may discuss, and it is important to differentiate between the two.

Some doctors may discuss the success rate in terms of patency. This means what proportion of men will produce sperm when they ejaculate. These rates can be as high as 90%. However, following a vasectomy, many men’s sperm are affected. This means that even after a successful reversal where they produce sperm again, this sperm might be slower and less mobile than the sperm they produced before their vasectomy. For this reason, success rates for pregnancy are a lot lower than the success rates for patency. Whilst a high proportion of men will produce sperm again after a vasectomy reversal procedure, between around 30% and 60% will successfully conceive.

It is therefore important to discuss with your doctor what the likelihood is of a successful outcome, but also to clarify what the doctor is defining patency or pregnancy rates as a successful outcome.

What are the Risks Associated with the Vasectomy Reversal?

There are common side-effects associated with the procedure, such as pain, bruising and swelling around the operation site. These are usually temporary, and treatment such as ice-packs and painkillers can be helpful. Men are often advised to refrain from strenuous activity for up to four weeks following the procedure. This is to allow time for the tissue to heal. Your doctor will advise you of any recommendations to help your recovery.

The surgery can occasionally have complications, such as build up of blood or fluid inside the scrotum. If this occurs, you may need an additional procedure to drain the tissue. There is also a possibility that nerves or blood vessels may be damaged during the surgery. If blood vessels are damaged this can affect the blood supply to one or both testicles leading to permanent damage. If the nerves are damaged this may cause chronic pain in the testicles and may require further surgery. It is important to discuss with your doctor the likelihood of these risks.

Are There Any Alternative Options?

If the vasectomy reversal doesn’t work, or if you would like to consider a different approach, there are other options that may be considered. These are other types of fertility treatment such as In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI). These both involve removing sperm directly from your testicle and using them to fertilise an egg. Your doctor will be able to discuss these different options with you.

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