Choosing to have a vasectomy is a big decision, and so is
deciding to have it reversed. Often, a man who has a vasectomy does
so because he is done having children or does not want to father children.
Later on, however, things may change—perhaps he has remarried, is restarting a
family after the loss of a child, or simply has had a change of heart. Whatever
the reason, a vasectomy reversal can be performed and, in most cases, end in
his fertility being restored.
During a vasectomy, the tubes that transport sperm from the
testes and out of the urethra (vas deferens) are severed then obstructed via
sutures or electrical cautery to prevent fertilization. In order to restore
fertility through a vasectomy reversal, the cut ends of the vas deferens tubes
are reconnected or are connected to the epididymis (the reproductive organ
where sperm matures). If successful, sperm will return to the ejaculate and
result in pregnancy.
Reversals are performed with general anesthesia and done in
an ambulatory surgery center or outpatient area of a hospital. After the
patient has been anesthetized, the surgeon (a urologist) will make a tiny
incision on both sides of the scrotum in order to access the vas deferens. Once
they have been pulled through the cuts and isolated from the scrotal sac, the
scarred ends of the vas that are blocked are removed. To see if the fluid
inside the end closest to the testicle contains sperm, the surgeon will take a
fluid sample. If sperm is present in the fluid, this means there is no blockage
between the testicle and the site in the vas from which the fluid was taken.
This too means that there is no blockage in the epididymis. With this
knowledge, the surgeon can perform a simpler type of vasectomy reversal, known
as vasovasostomy, whereby the cut ends of the vas can be reconnected to
reinstate a pathway for sperm. A microsurgical approach is considered best, as
it may result in the restoration of sperm to the semen in up to 95 percent of
patients and pregnancy in up to 75 percent of their partners.
If sperm is not found in the fluid sample, there may be a
break in the epididymal tubule, which is often due to a backup of sperm caused
by the original vasectomy. A break can result in a blockage, and this means the
surgeon will need to do a more complicated technique called an
epididymovasostomy, whereby the urologist must bypass the blockage by
connecting the upper end of the vas directly to the epididymis, but above the
obstruction. Success rates and pregnancy rates are lower with this technique
than they are with a vasovasostomy.
With either technique, however, though the vasectomy
reversal may be successful (meaning sperm has returned to the semen), pregnancy
rates differ and largely depend on the skill of the surgeon as well as the
length of time from the vasectomy until the reversal. For some who’ve had a
reversal, it may take only a few months for pregnancy to occur, but for others
it may take a year or more.
Following a reversal, your urologist will perform a semen
analysis every couple of months until your sperm count becomes stable or
pregnancy has been achieved. Sperm usually appears in the semen within a couple
of months, but for some it may take up to 15 months. The latter typically
occurs in men who’ve had an epididymovasostomy. Once sperm returns the semen,
the man can be fertile for many years.
About Ravi Kacker, MD
Featured Specialist for Vasectomy Reversal in Natick, MA
Call Now: (508) 603-9234 67 Union St #308Natick, MA 01760
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