A vasectomy, though thought to be a permanent form of birth control, can be reversed. Unexpected events in men’s lives can lead them to change their mind. Reasoning ranges from the desire to have another child, tragic loss of a child, or a new marriage and family opportunities. Regardless of the circumstance, a vasectomy can be undone.
That said, vasectomy reversal is not 100 percent guaranteed to work and is a significantly more complex surgery than the original vasectomy.
How is a vasectomy reversal performed?
Your doctor will usually perform your vasectomy reversal at a surgery center or a hospital on an outpatient basis, which means you won’t need to stay overnight. You may be given general anesthesia to make you unconscious during the procedure, or you may be given a local anesthetic that doesn’t make you sleep, but keeps you from feeling pain.
During the vasectomy reversal, your surgeon will:
- Make a small cut on the bottom of the scrotum to expose the testicle
- Cut open the vas deferens in order to examine the fluid inside
- Decide which type of vasectomy reversal method to use
- Connect the ends of the vas deferens, or connect the vas deferens to the epididymis
What kinds of vasectomy reversals are done?
There are two types of vasectomy reversals that your doctor may use:
- Vasovasostomy — During this procedure, your doctor connects the two cut ends of your vas deferens in order to restore the flow of sperm.
- Vasoepididymostomy — With this method, your doctor connects the cut end of the vas deferens with the epididymis. This procedure is more complicated, and is generally done only when vasovasostomy won’t work.
It is impossible to know before the operation which one is best for you. Your doctor will decide during the vasectomy reversal. If sperm are present in the end of the vas deferens that is connected to your testicle, the surgeon will usually do a vasovasostomy.
If sperm are not present in that fluid, the surgeon will look at other factors, including the consistency of the fluid or the presence of scar tissue. This will help him decide which method to use.
If a blockage is seen in the epididymis—in a few cases, pressure can build up behind the vasectomy scar, leading to an epididymal “blow out” if pressure builds to a point where the epidiymis tubule ruptures—then a vasoepididymostomy will be needed. In this case, the vas deferens will be connected to the epididymis in order to bypass the blockage.
Recovery after a vasectomy reversal?
Recovery time is relatively quick, with a full recovery in about three to four weeks. Here’s what you should expect after your vasectomy reversal procedure:
- You will be able to go home on the day of your procedure, but will need to arrange for a ride after having anesthesia.
- It is normal to feel some pain and cramping. This will get better after a few days to a week.
- The stitches used to close the skin should dissolve in 7 to 10 days. Your doctor will let you know when you can remove the bandages.
For the fastest recovery, follow these steps:
- Wear an athletic supporter in order to keep the bandages in place and prevent the testicles and scrotum from moving too much. You should wear this all the time for several weeks, except when showering.
- Apply and ice pack to your scrotum to help relieve pain or swelling.
- Avoid getting the surgery area wet, including swimming and bathing, for two days after the procedure.
- Take it easy for several weeks. This includes avoiding heavy lifting and sports.
- If your job isn’t that strenuous, you should be able to go back to work a few days after your surgery. If your job involves physical labor or lots of driving or walking, ask your doctor when you can start working again.
- You may need to avoid having sexual intercourse or ejaculating for two to four weeks after surgery.
Risks associated with a vasectomy reversal
Following a vasectomy reversal, some common, occasional and rare complications may occur.
- Sperm may come back to semen, but doesn't ensure pregnancy
- Sperm may not return to semen
- Scrotal bruising
Occasional complications include bleeding that requires more surgery. Rare complications include long-term testicular pain and infection or swelling of the epididymis or testes.
Vasectomy reversal success
Success rates for vasectomy reversals are measured in two ways:
- Presence of sperm in the semen
- Ability to achieve pregnancy with your partner
The success of a vasectomy reversal partially depends upon the type of procedure:
- Vasovasostomy (macrosurgery): When done without the use of high-powered microscopes (macrosurgery), vasectomy reversal results in sperm showing up in the semen of about 80 percent of men, with 20 to 40 percent of their partners able to get pregnant.
- Vasovasostomy (microsurgery): Using high-powered microscopes during surgery (microsurgery) results in sperm returning to the semen in 85 to 90 percent of men. The pregnancy rate, though, is higher—between 50 and 70 percent of the partners became pregnant.
- Vasoepididymostomy: This type of vasectomy reversal showed that sperm returned to the semen in 58 to 85 percent of men, with 11 to 56 percent of men able to get their partner pregnant.
Pregnancy rates are lower than sperm return rates due to a variety of contributing factors, including female infertility and other biological variables.
Many other factors can affect the success of a vasectomy reversal as well, including:
- The experience of your surgeon: specifically, doing the type of procedure called for
- Time since the original vasectomy: success decreases the longer you wait, possibly due to increasing damage to the testicles or the need for the more complicated vasoepididymostomy procedure—in one study, when a vasovasostomy was done 15 years after the original vasectomy, the presence of sperm decreased to 71 percent and the pregnancy rate dropped 30 percent; compared to 97 percent and 76 percent, respectively, if the procedure was done within three years of the vasectomy.
- Presence of scarring in the vas deferens or epididymis:this can make it more difficult to restore the flow of sperm
- The age of your partner: pregnancy rates drop as a woman ages
- Having a child with your partner before: this improves your chances of getting your partner pregnant after the procedure
Vasectomy reversal alternatives
Vasectomy reversal is not the only way to restore your fertility after having a vasectomy. Your doctor can remove sperm directly from the testicle or epididymis, either with surgery or using a needle (aspiration).
The sperm removed in this way, however, cannot be used for artificial insemination—a procedure in which sperm are inserted directly into a woman’s uterus, fallopian tubes or cervix. Instead, the sperm will be used with in vitro fertilization (IVF) methods.