Every year, thousands of men undergo a vasectomy as a form of permanent birth control. When a man consents to the procedure, he is instructed that a vasectomy should be considered as permanent and irreversible. Prior to undergoing a vasectomy, a man should be as sure as possible that he does not desire to have children in the future. A vasectomy reversal is not 100% guaranteed to work and is a significantly more complex surgery than the original vasectomy. Nonetheless, 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 reversed.
What is a vasectomy?
A vasectomy is the surgical removal of a small portion of the vas deferens. The vas deferens is the narrow, muscular tube through which sperm travels to the urethra from the testicle. Once the sperm are produced in the testicles, they exit the testicle into the epididymis. The epididymis is a small, highly coiled tubule running along the back portion of the testicle, from the top of the testicle down to the bottom where it makes a u-turn, then progressively straightens out and grows more thick and muscular to become the vas deferens. The vas deferens continues upward through the scrotum and into the pelvis where it connects to the urethra within the prostate. When a man ejaculates, the walls of the vas deferens contract to propel sperm up to the urethra. In the urethra, other fluids from the prostate join the sperm prior to ejaculation out of the penis. When a vasectomy is performed, the doctor feels for the vas deferens and removes a small portion from each side. The ends are clipped, sutured, and then cauterized. The sperm is then blocked at this point.
What happens to the sperm after a vasectomy?
Sperm production never stops in a man, even after a vasectomy is performed. The vasectomy simply blocks the entry of the sperm into the urethra. The blocked sperm are eventually reabsorbed by the body once they are broken down. New sperm are constantly being produced. In a few cases, pressure can build up behind the vasectomy scar. An epididymal “blow out” can occur if pressure builds to a point where the epidiymis tubule ruptures. If this does happen, scar tissue will form at the rupture point forming a new level of sperm blockage. These blow outs are not painful or dangerous to a man’s health, but can play a large role in the success of a vasectomy reversal. If a rupture has occurred, the reversal must then be performed in a way that bypasses this blockage point.
What is the procedure for vasectomy reversal?
A vasectomy reversal is the process of rejoining the blocked tubes. If no epididymal blow out has occurred due to built up pressure, the portions of the vas deferens can be rejoined in a vaso-vasostomy. The surgery is challenging and is performed with an operating microscope. This microscope utilizes sutures that are finer than a human hair in order to correctly line up the inner passage of the vas deferens. These inner passageways are much smaller than the outer wall of the vas deferens, making a microscope necessary for correct alignment.
In cases where an epididymal blow out has occurred, the vas deferens north of the original vasectomy scar must be rejoined with the small epididymal tube south of the blow out scarring. This procedure is called vaso-epididymostomy and should only be performed by an experienced microsurgeon. The epididymal blow out is diagnosed during the surgery after examination of the fluid from the severed end of the vas deferens. This diagnosis is conducted during surgery, so patients are suggested to choose a skilled surgeon ahead of time who could perform this procedure correctly if it is necessitated. Vasectomy reversal is an out-patient procedure typically conducted under general anesthesia. Recovery time is relatively quick, with a full recovery in about three to four weeks. Patients are warned against participating in heavy-duty work, strenuous exercise and sex during this time period.
What are the success rates?
Success rates for a vasectomy reversal are very high and vary based on a variety of factors including the interval of time since the vasectomy, skill of the microsurgeon, and type of surgery performed. In cases where a vaso-vasostomyomy was performed on a man with a moderate time interval (less than 10 years), the success rates for sperm returning into the semen are as high as 95%. If the time interval is greater than 15 years, the success rate is about 75%. If a vaso-epididymostomy is required, the success rates are about 75%. Pregnancy rates after vasectomy reversal are lower, with 75% for vaso-vasostomy and 40% for vaso-epididymostomy. Pregnancy rates are lower than sperm return rates due to a variety of contributing factors including female infertility and other biological variables.
Are there alternatives?
As a general alternative to a vasectomy reversal, sperm retrieval is an option. This is a minimally invasive procedure, however the sperm cannot be used for artificial insemination. The sperm used in retrieval must be directly injected into a viable woman’s egg. This sperm can be used with Intracytoplasmic Sperm Injection (ICSI) as part of an In-vitro Fertilization (IVF) procedure. In cases where there is no female infertility factor and the time interval since the vasectomy was less than 15 years, a vasectomy reversal is the recommended procedure by the American Urological Association (URA) and the American Society for Reproductive Medicine (ASRM).
Disclaimer: This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician.
By FertilityProRegistry.com Staff
Updated: October 2, 2009