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Vasectomy Reversal
This is an abbreviated version of the complete article.*
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| Basic Facts |
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A vasectomy reversal is a procedure that reconnects the vas deferens. |
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To reverse a vasectomy, a man may undergo a vasovasostomy; in some cases, the man may need a more involved procedure call a vasoepididymostomy. |
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A vasoepididymostomy is performed when there is a blockage in the epididymis or vas deferens that will not allow sperm to pass through. |
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A vasectomy reversal is a procedure that reconnects the vas deferens to allow sperm to mix with seminal fluid and become ejaculate. By reversing a vasectomy, a man may again biologically father children.
If a man has a vasectomy and decides later to have children, he may be able to reverse the vasectomy with a vasectomy reversal. Typically a man may undergo a vasovasostomy; in some cases, the man may need a more involved procedure called a vasoepididymostomy. A vasovasostomy reconnects the vas deferens; a vasoepididymostomy connects the vas deferens directly to the epididymis to bypass a blockage.
The possibility of reversal should never be assumed. The procedure is difficult but succeeds in restoring sperm activity in more than 90 percent of patients. However, only 67 percent achieve a pregnancy after a vasectomy reversal.
PRE-PROCEDURE GUIDELINES
Prior to the procedure, the physician may order one or more of the following tests:
- Semen analysis to assess semen volume;
- Transrectal ultrasound (TRUS) to look for a blockage;
- Serum and antibody tests, which are collected through blood tests;
- Follicle stimulating hormone (FSH) serum test; and
- Additional hormone studies and/or a biopsy.
Prior to the procedure, the physician may instruct the patient to:
- Stop taking aspirin up to 10 days prior to the procedure;
- Wash the genital and scrotal area thoroughly;
- Bring an athletic supporter to the procedure to wear home; and
- Instruct the patient to shave the area on the front and sides of the scrotum.
At the clinic or physician's office, the physician will ask the patient to change into a hospital gown. If the physician has not already instructed the patient to shave the scrotal area, it will be cleaned and shaved.
WHAT TO EXPECT
In a vasovasostomy, the surgeon reconnects the cut ends of the vasa deferentia to allow movement of sperm.
To perform a vasovasostomy, the surgeon makes an incision in the scrotum directly over the area where the vasectomy was performed. The surgeon will expose the vas deferens through the incision and place clamps directly above and below the site where the vas deferens was separated. The surgeon then creates "clean cuts" in the vas deferens by trimming small parts above and below the original cut. Using a microscope tool to see the ends, the physician then sutures the ends together. The procedure can take 2 to 3 hours and requires local anesthesia.
In a vasoepididymostomy, the surgeon must make a larger incision (slightly longer than the testicle) in the scrotum. The surgeon will expose the vas deferens through the incision and place a clamp directly above the site where the vas deferens was separated. The surgeon then creates a "clean cut" in the top vas deferens by trimming small parts above the original cut. The surgeon cuts into the epididymis and using gentle pressure pushes a single epididymal tubule through the incision. The surgeon cuts a small hole in the tubule and then sutures the open end of the vas deferens to the open part of the epididymal tubule. A vasoepididymostomy can take up to 4 hours while the patient is under general anesthesia or is given an epidural.
Private or governmental insurance programs do not cover most reversal procedures and in general do not cover any type of service that is deemed related to infertility.
POST-PROCEDURE/TREATMENT GUIDELINES
Following a vasectomy reversal, the physician will instruct the patient to:
- Stay home from work for at least 3 days;
- Avoid strenuous exercise, lifting heavy objects, and athletic activities for 3 weeks; and
- Avoid sexual intercourse or ejaculation for 1 month.
The physician will schedule a follow-up appointment with the patient approximately 7 days after the surgery to examine the incisions. At 3 months, and possibly quarterly for 1 year, the patient will be scheduled for a semen analysis to see if the sperm are moving through the reconnected vas deferens.
POSSIBLE SIDE EFFECTS AND COMPLICATIONS
Complications for vasectomy reversal are rare; however, if they occur, they may include:
- Sperm antibodies;
- Testicular discomfort;
- Bleeding and bruising; and
- Testicular atrophy.
In some cases, the reversal may not be successful and the man may need to have a second surgery or to consider other options such as sperm aspiration for in vitro fertilization of one of his wife's eggs.
Medical Review Date: July 10, 2008
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