Men who have had a vasectomy may wish to reverse the procedure for a number of reasons. Some remarry after a divorce or the loss of a wife and now wish to start a family. Others may want children after making an initial decision not to have a family or they want more children. Other men simply decide to restore their fertility. For a small percentage of men, a vasectomy causes pain in the testicle that may be relieved by a reversal. Almost all vasectomies can be reversed.
How is a vasectomy reversal performed?
A vasectomy is an operation that involves blocking the tubes (called the vas deferens) through which sperm pass into the semen. In the procedure, the vas deferens is cut and tied.
A vasectomy reversal is called a vasovasostomy. In it, a small incision is made in the scrotum to allow the surgeon to find the vas deferens and identify the blocked area or the site of the vasectomy. Scar tissue from both ends of the vas deferens is removed, leaving the two cut ends of the tube, which are aligned and sewn together. Once sewn together, the vas deferens is placed back into the scrotum and the incision is sewn closed.
In some cases, other sperm pathways that are blocked may be found at the time of the reversal. These pathways will need to be bypassed to restore fertility. One such area of blockage can be in the epididymis, the coiled tube that lies against the testicle where sperm cells mature. This type of blockage is more likely when the vasectomy has been performed many years previously. When a vasectomy is performed, sperm is still produced but because the vas deferens has been blocked, the sperm is absorbed by the body. Over time, more sperm may be produced than the body can absorb, increasing pressure inside the epididymis and vas deferens. This pressure can cause a rupture that can only be seen at the time of surgery. In such cases, a surgery to bypass the blocked epididymis can be done. This type of surgery, called a vasoepididymostomy, can be technically demanding, as tubules that make up the epididymis are even smaller and thinner than the vas deferens.
How long is the operation to reverse a vasectomy?
A vasovasostomy can take up to 4 hours to perform. It is done on an outpatient basis. The procedure is done under an anesthetic; either general, regional, or local, the choice of which is up to the patient and his surgeon.
What can I expect during the recovery period following a vasectomy reversal?
You may experience some pain for up to a week that can be relieved with oral medications. No heavy lifting or strenuous activity (running, jumping, etc.) for 1 week. You will have to refrain from sexual intercourse for 3 weeks. You’ll have to wear an athletic supporter for at least the first week.
When is the follow-up appointment after a vasectomy reversal operation?
You will have your semen collected and your sperm counted 6 weeks after surgery. You should abstain from ejaculation for 72 hours prior to that appointment.
What results can I expect from a vasectomy reversal?
Vasectomy reversals are generally more successful the sooner they are performed after a vasectomy. Success generally declines with time. In any event, pregnancy is achieved more often after a vasectomy reversal than it is with nonsurgical techniques such as intracytoplasmic sperm injection. (This procedure involves the direct injection of sperm into eggs obtained from in vitro fertilization.) A pregnancy is likely more than 50% of the time after a reversal but only about 30% of the time when the reversal is done 10 years or longer after the vasectomy.
The success rate for vasoepididymostomy depends on several factors, including the experience of the surgeon and the location of the blockage.
Sperm will appear in your semen within a couple of months after vasovasostomy. It can take longer—up to 15 months—after vasoepididymostomy.
How effective is reversal for men who have pain in the testicle following a vasectomy?
Pain can be resolved in more than 80% of men with a vasectomy reversal. Men who have a successful reversal report lower pain scores than those without a successful reversal.
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Kolettis PN, Sabanegh ES, D’Amico AM, et al. Outcomes for vasectomy reversal performed after obstructive intervals of at least 10 years. Urology 2002;60:885-888.
Myers SA, Mershon CE, Fuchs EF. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol 1997;157:518-520.
Nagler NH, Jung H. Factors predicting successful microsurgical vasectomy reversal. Urol Clin North Am 2009;36:383-390.
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