Vasectomy Reversal

There are different reasons why a man may decide he would like to have his vasectomy reversed. Although a vasectomy is primarily considered to be a permanent method of sterilization, it is not uncommon for a man to find his situation in life change, thereby causing him to desire having children again. And with recent advances in microsurgical vasectomy reversal techniqes, the decision to become a father again has never been easier.

Vasectomy and Vasectomy Reversal
Every year, about 500,000 men in the United States choose to have a vasectomy in order to permanently prevent pregnancy. This simple, non-invasive procedure prevents sperm from making its way into your semen. As a result, no sperm is present in your ejaculate to fertilize an egg.

A vasectomy can be performed in a doctor’s office. During the procedure, the doctor cuts or blocks off each of the vas deferens. The vas deferens are the tubes that go from the testes to the seminal vesicles and act as a passageway for sperm to make its way out of the body. The procedure takes roughly about 30 minutes and men can usually return to work the same day, although they are likely to experience some minor pain and discomfort for a few days.

A vasectomy reversal, on the other hand, is more complex and requires surgery to reattach the vas deferens. Although the operation can be quite effective in helping a couple get pregnant (as much as 50% of men who undergo a vasectomy reversal are able to produce a pregnancy), it is not recommended that a man go into a vasectomy procedure expecting to get it reversed at a later time.

Types of Vasectomy Reversals
There are two different of vasectomy procedures: vasovasotomy and epididymosotmy. Which procedure is used will depend upon your health and how the original vasectomy was performed.

Two-thirds of all vasectomy reversals performed are done by vasovasotomy. This type of microsurgical vasectomy reversal requires the surgeon to use a microscope in order to locate the severed vas deferens. Sutures are then used to reattach the cut tubes. The entire procedure usually takes about two hours and is done in uncomplicated cases for men who have little scarring on their vas deferens. It is generally regarded as the most effective procedure.

The remaining one-third of vasectomy reversals are done by epididymostomy, which is only done when a vasovasostomy is not possible. Men who are not found to have sperm in their vas deferens likely have a blockage; therefore simply reconnecting the vas deferens would not be successful in restoring fertility. Instead, in this type of vasectomy reversal, the vas deferens are connected directly to the epidiymus in order to restore sperm flow. Unfortunately, this procedure tends to be less successful than a vasovasostomy as well as more complex, taking as much as five hours to complete.

Regardless of what type of vasectomy reversal you receive, the procedure for the surgery is relatively the same. Although a local anesthetic is possible, many men prefer to be given general anesthetic. Once the chosen type of anesthetic has taken affect, a vertical incision will be made on both sides of your scrotum in order to allow your surgeon access to your vas deferens.

The vas deferens will then be checked for any signs of scarring or blockage that may present a problem during the procedure or in your desire to get pregnant later on. In order to check for the presence of sperm in your semen, the fluid from the vas deferens will be drained and examined. So long as sperm in found in your vas deferens fluid and there does not appear to be any blockages, your surgeon will proceed with a vasovasostomy. If a blockage is indicated, your surgeon will likely go ahead with an epididymostomy.

Recovery
Although a vasectomy does need to be performed in a hospital (some fertility clinics may perform the surgery onsite), it usually doesn’t require an overnight stay. However, it is necessary to stay in the hospital until the anesthetic has worn off, usually a few hours. You will also be provided with a fitted athletic support garment, which you will need to wear for six weeks in order to help you heal.

After the surgery, it is best stay in bed for the first 48 hours. You should be able to return to work in a few days so long as it does not involve any strenuous physical activity, which should be avoided for at least three weeks. Sexual intercourse and ejaculation should also be avoided for four weeks so that no damage is caused to the vas deferens or incision site.

Complications of a Vasectomy Reversal
There is always the possibility of complications and side effects when you have surgery done. The most common side effect from the surgery is localized pain and swelling to the area for the first few days after the procedure. Painkillers can be prescribed to minimize this discomfort. It is also not unusual to experience nausea, constipation, headaches and muscles aches afterwards.

Complications of vasectomy reversal include infection and hematomas. Signs of an infection include pain, heat or redness around the incision area and require medical attention. Usually, antibiotics can take of the infection.

Hematomas occur when blood collects inside the scrotum and can result in a throbbing pain. Your doctor can drain the area to relieve the pain but it is possible for the hematoma to reoccur.

An unfortunate complication of vasectomy reversals is a decline in sperm count. Approximately 10% of men who have this surgery will have troubles conceiving for this reason. This complication usually occurs in men who had their reversal surgery performed two or more years after their vasectomy.

Vasectomy Reversal Success Rate
Your chances of conceiving after a vasectomy reversal depend greatly upon a number of factors, including the type of vasectomy reversal you received and the skill of your surgeon. Moreover, reported pregnancy rates after vasectomies do not take into account women who have fertility problems. If your partner has fertility problems as well, you may want to discuss with your fertility specialist whether a vasectomy reversal will actually increase your chances of getting pregnant.

Additionally, a vasectomy reversal will not instantly restore your ability to produce sperm in your semen. For men who have had a vasovasostomy, it can take up to six months before sperm is present in their semen while those who have had an epididymostomy may need to wait up to 18 months. Failure to have any sperm in your semen after this time indicates that the surgery did not work and that a repeat reversal may be necessary. By monitoring your semen samples, your fertility specialist will be able to determine the quantity, quality and motility of your sperm.

99% of men who receive vasovsostomies will have sperm travel through the vas deferens. However, only about 64% of men will be able to naturally conceive a child after the vasectomy reversal. Epididmyostomies have a lower success rate associated with them, with only 65% of men that receive this surgery able to pass sperm through the vas deferens and 41% being able to produce a pregnancy.

Vasectomy Reversal Costs
The cost of a vasectomy reversal will vary according to where you go for the procedure. In the United States, the average cost for this surgical procedure is about $10,000. It is not covered by medical insurance. In Canada, the average price of a vasectomy reversal is about CAN$5,000 but, again, the majority of insurance plans do not cover the cost.

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