A vasectomy reversal is a surgical procedure performed to restore fertility in men who have previously undergone a vasectomy.
Vasectomy is one of the most effective forms of birth control available. While vasectomy is a permanent form of birth control, some men might wish to have a vasectomy reversed.
Vasectomy reversal (also called vasoepididymostomy) reconnects the vas deferens. This makes it so that sperm returns to the ejaculate.
Although vasectomy reversal is possible, men should be sure they do not want to have biological children before having a vasectomy. About 5% of men who have had a vasectomy choose to have it reversed.
Learn more about vasectomy reversal, including its definition, indications, candidate criteria, the surgical process, post-operative care, and potential risks and complications.
Men’s health experts at WashU Medicine
Urologists specializing in men’s health at WashU Medicine see patients at Barnes-Jewish Hospital, one of the top hospitals in the nation, as well as convenient locations across the region.
What is vasectomy reversal?
A vasectomy reversal is a microsurgical procedure that aims to re-establish the continuity of the vas deferens, the tubes that carry sperm from the testicles to the urethra, allowing sperm to be present in the ejaculate. This procedure is sought by men who wish to regain fertility following a vasectomy, often due to changes in life circumstances or the desire to expand their family.
Learn more about vasectomy>>
Why would I have my vasectomy reversed?
There are a few reasons a person might decide to have a vasectomy reversal. The decision to have a vasectomy reversed might be due to a desire to regain fertility or to relieve pain after a vasectomy.
- Change in family plans: Couples deciding to have more children.
- New partnership: Men entering a new relationship and wanting to conceive with their partner.
- Chronic testicular pain: In rare cases, men seek vasectomy reversal to alleviate chronic pain that may be associated with the previous vasectomy.
Who is a candidate vasectomy reversal?
Before having a vasectomy reversal, it’s important to talk with a urologist about the process. This will help you understand the chances of a successful vasectomy reversal and achieving a pregnancy after the procedure.
Your urologist will talk with you about several factors, including:
- Health evaluation: Candidates should be in good general health and free from conditions that would contraindicate surgery.
- Reproductive history: Details of the original vasectomy procedure, including the time elapsed since the vasectomy and any complications, will be considered.
- Female partner’s fertility status: Assessment of the female partner’s reproductive health to ensure there are no significant barriers to conception.
- Physical examination: Examination of the scrotum and testicles to assess the condition of the vas deferens and surrounding tissues.
- Semen analysis: Conducted if needed to evaluate sperm count and quality in cases of previous vasectomy reversal.
The vasectomy reversal process
Preoperative preparation
- Consultation: Detailed discussions with a urologist or reproductive specialist about the procedure, benefits, risks, and alternatives. Evaluation of the individual’s and partner’s reproductive health.
- Medical optimization: Managing any underlying health conditions and stabilizing the patient’s health before surgery.
- Informed consent: Obtaining consent after explaining the procedure, risks, benefits, and potential outcomes.
Surgical steps
- Anesthesia: The procedure is typically performed under general anesthesia or spinal anesthesia to ensure the patient is comfortable and pain-free.
- Incision and access: Small incisions are made in the scrotum to access the vas deferens.
- Vasovasostomy or vasoepididymostomy:
- Vasovasostomy: Directly reconnecting the severed ends of the vas deferens using microsurgical techniques and very fine sutures. This procedure is chosen when sperm is present in the fluid from the testicular end of the vas deferens.
- Vasoepididymostomy: Connecting the vas deferens directly to the epididymis (the coiled tube where sperm matures) if there is a blockage or absence of sperm in the vas deferens fluid.
- Microsurgical techniques: Use of a high-powered microscope to perform the delicate reconnection of the vas deferens, ensuring precise alignment and minimal tissue damage.
- Closure: The incisions are closed with sutures, and a bandage is applied.
The procedure typically takes between 2 to 4 hours, depending on the complexity and whether a vasovasostomy or vasoepididymostomy is performed.
Post-operative care and recovery
Immediate postoperative care
- Monitoring: Close monitoring in a recovery area until the patient is stable and the effects of anesthesia have worn off.
- Pain management: Administration of pain relief medications to ensure comfort during the initial recovery period.
- Wound care: Instructions on keeping the surgical site clean and dry to prevent infection.
Recovery at home
- Activity restrictions: Avoiding heavy lifting, strenuous activities, and sexual intercourse for several weeks to allow proper healing.
- Ice packs: Applying ice packs to the scrotum to reduce swelling and discomfort during the first 48 hours.
- Follow-up appointments: Regular check-ups with the surgeon to monitor the healing process, remove sutures if necessary, and address any complications.
Semen analysis
- Sperm presence: Semen analysis is typically performed several weeks to months after surgery to evaluate the presence and motility of sperm, indicating the success of the reversal.
- Regular monitoring: Additional semen analyses may be needed to monitor changes in sperm count and quality over time.
Potential risks and complications
Surgical risks
- Infection: Risk of infection at the surgical site.
- Bleeding: Risk of bleeding during and after surgery.
- Hematoma: Formation of a blood clot in the scrotum causing swelling and pain.
- Chronic pain: Persistent pain in the testicles or scrotum.
Long-term considerations
- Scarring and blockage: Scar tissue formation can lead to re-blockage of the vas deferens, affecting the success of the reversal.
- Sperm quality: Semen quality may not return to pre-vasectomy levels, and fertility may still be compromised.
- Need for additional surgery: In some cases, a second reversal or assisted reproductive techniques may be needed.
Impact on quality of life
The outcome of the procedure and the potential for changes in fertility status can affect emotional well-being. Support and counseling may be needed to manage the stress and anxiety associated with the process.
Success rates
- Time since vasectomy: The length of time since the initial vasectomy can affect success rates. Generally, reversals performed within 10 years of the vasectomy are more likely to be successful.
- Surgical technique: The skill and experience of the surgeon in performing microsurgical techniques can influence outcomes.
- Partner’s fertility: The overall fertility potential of both partners affects the chances of achieving pregnancy.
Vasectomy reversal is a complex procedure that requires careful consideration, skilled surgical intervention, and diligent post-operative care to restore fertility. Understanding the causes, symptoms, diagnostic methods, and treatment options is essential for making informed decisions. If you are considering vasectomy reversal, consulting with a specialized urologist or reproductive specialist will help develop a personalized care plan tailored to your specific needs and circumstances.
Frequently asked questions about vasectomy reversal
It is possible to have a vasectomy reversal. Vasectomy is meant to be a permanent form of birth control, but can be surgically reversed. Men who have a successful vasectomy reversal are once again capable of achieving pregnancy naturally. Once a vasectomy has been reversed, couples have a pregnancy rate somewhere between 30-70% in the following 1-2 years after surgery. Roughly 5% of men who have had a vasectomy choose to have it reversed.
For men who have had a prior vasectomy reversal and were found to have zero sperm in the ejaculate, there are other options. Some men may consider undergoing a re-do vasectomy reversal. Urologists at WashU Medicine also offer a procedure called testicular sperm retrieval, in which sperm are taken directly from the testicle. These sperm can then be used for in-vitro fertilization, so that couples still have the opportunity to achieve pregnancy.
No, a successful vasectomy will not reverse itself. Once a man has a proven negative semen analysis, the vasectomy is permanent unless surgically reversed. It is not possible for the vas deferens to re-align or reverse itself.
