Vasectomy Reversal

Introduction

Vasectomy, also referred to as male sterilization,  is a permanent method of birth control in men. It is a minor surgical procedure in which the vas deferens, the thin tube that stores and transports sperm, is cut and sealed. This prevents sperm from entering the urethra to cause fertilization in a woman when a man ejaculates during sexual intercourse.

Vasectomy reversal is a surgical procedure where the ends of the sperm-carrying tube, the vas deferens, that were cut and sealed during vasectomy are joined back together to enable reproduction. Your chances of getting your partner pregnant following vasectomy reversal  can range from 30 to 90 percent.

Indications

An individual may have several reasons for reversal of a vasectomy, including:

• Change of mind
• Loss of a child
• A new marriage or relationship
• A couple wanting to have more children
• To treat post-vasectomy chronic testicular pain

Preparation for Vasectomy

Pre-procedure preparation for vasectomy reversal may involve the following steps:

• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements that you are taking or any medical conditions you have that may complicate the procedure.
• Your doctor may ask you to  refrain from certain blood-thinning or anti-inflammatory drugs for a defined period.
• You will be asked to take a shower on the day of surgery and wash your genital area thoroughly with an antibacterial soap.
• You will also be asked to shave the area around the penis and scrotum entirely.
• Arrange for someone to drive you home to avoid pressure or movement on the operated area caused by driving yourself.
• A signed informed consent form will be obtained from you after the pros and cons of the procedure have been explained.

Procedure for Vasectomy Reversal

Vasectomy reversal is a sophisticated procedure that can be achieved by two different surgical approaches depending on the location of the original vasectomy:

• Vasovasostomy: In this procedure, the cut ends of the vas deferens, the sperm carrying tube, are reconnected.
• Vasoepididymostomy: This approach involves the connection of the detached vas deferens to the epididymis, a tube that lies at the back of each testicle.

Vasectomy reversal is generally carried out as a day procedure under general anesthesia. Your surgeon makes a small incision in the skin of the scrotum, the sac that contains the testes. The surrounding structures are retracted to expose the testicle. The vas deferens is carefully cut and inspected for fluid and the presence of sperm. When your surgeon confirms the presence of sperm with motility, the tubes are reconnected to enable the transport of sperm.

In cases where there is no seminal fluid or fluid is present but has no sperm, a vasoepididymostomy would be performed in a similar manner to connect the detached vas deferens to the epididymis.

The operation is performed under a surgical microscope to allow precise approximation and suturing of the vas deferens.

Postoperative Care and Recovery

As vasectomy reversal is typically a same-day surgery, you will be discharged home after a few hours of observation in the recovery room with the following instructions:

• Apply ice packs over the scrotum to reduce post-operative swelling.
• Your doctor may prescribe medications to help alleviate pain and make you feel comfortable.
• Wearing an athletic supporter at all times for the first four weeks helps support the testicles and reduces swelling and movement.
• Keep the surgical area clean and dry.
• Recreational activities, such as sports and lifting heavy weights, are restricted for a few weeks.
• Return to work depends on how well you are healing and the type of work or activity level you perform.
• Sexual activity can be resumed after about six weeks following surgery.

Key Features of Vasectomy Reversal

The chances of vasectomy reversal success depend on how much time has passed between the vasectomy and the reversal. Over time, additional blockages can form, and some men may develop antibodies to their own sperm. The positives of the vasectomy reversal procedure include:

• It leads to overall conception rates of greater than 50%
• Has the greatest chance of success within 3 years of the vasectomy
• Leads to conception only about 30% of the time if the reversal is done more than 10 years after the vasectomy

Risks and Complications of Vasectomy Reversal

Some of the risks and complications of vasectomy reversal may include:

• Pain or redness around the surgery site
• Bleeding within the scrotum
• Surgical site infection
• Swelling or bruising around the scrotum
• Fever of over 100 degrees Fahrenheit
• Loss of sensation around the scrotum
• Insufficient sperm count
• Testicular atrophy, although very rare

Summary

Vasectomy reversal is a simple outpatient operation with high success rates. However, in some instances, a vasectomy reversal can be unsuccessful if factors such as low sperm count and motility, and your partner’s age lessen the chances of becoming pregnant.

Speak to your physician about any factors that may affect your ability to father a child.