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Medical News Today: Vasectomy reversal: What to expect

Vasectomy illustration
A diagram of a completed vasectomy.
A vasectomy reversal is a surgical procedure that reconnects the male reproductive tract after a vasectomy. A vasectomy is a minor surgical procedure that results in a male no longer being able to make a female pregnant.

A vasectomy involves cutting two tubes called the vas deferens, one on either side of the body, so sperm from the testes no longer become part of the semen. While a vasectomy is still considered a reliable and permanent form of contraception, advances in microsurgery have made it possible to reverse this procedure.

A vasectomy can be reversed even after a long time, in some cases, 15 or more years, as sperm are continually being produced and remain viable. Overall, around 6 percent of men who have had a vasectomy choose vasectomy reversal later.

Fast facts on vasectomy reversal:
  • A vasectomy reversal reconnects the van deferens that were cut in the vasectomy.
  • Vasectomy reversal is as safe as a vasectomy.
  • A vasectomy reversal does not affect sex drive, and men can typically resume having sex 3-4 weeks after the procedure.


Vasectomy and vasectomy reversal procedures

Many men may have cause to consider these procedures, to avoid conceiving a child, or because they want their fertility to return due to changes in their personal circumstances.

What is a vasectomy?

The rate of pregnancy after a vasectomy occurs in less than 2 out of 1,000 women, according to the Centers for Disease Control and Prevention (CDC). Vasectomy is the most effective form of birth control besides complete abstinence from having sex.

Vasectomy is an outpatient procedure that takes around 30 minutes. The man is awake the entire time. A small section of the vas deferens is removed from both sides and the ends are sealed.

It may take up to 3 months before all sperm are cleared from both vas deferens. During this period, doctors recommend a person uses other forms of birth control, to avoid the chance of an unwanted pregnancy.

What is a vasectomy reversal?

The reversal of a vasectomy is usually an outpatient procedure involving local or general anesthesia. General anesthesia may be necessary to ensure the patient remains still during the procedure.

The success rate for a reversal procedure is around 90 percent, according to a report in the Asian Journal of Andrology. This is based on the success of reopening the vas deferens and the presence of viable sperm.

The rate of pregnancy after a vasectomy reversal can be lower than before a vasectomy was done. The success of a vasectomy reversal in achieving pregnancy depends on a variety of factors, including:

  • experience and skill of the surgeon
  • age and fertility of a female partner
  • time since the vasectomy, reversal being harder the longer ago the vasectomy occurred
  • return of moving sperm

There are two types of vasectomy reversal techniques:

  • The vasovasostomy reconnects the two sides of the vas deferens.
  • The vasoepididymostomy reconnects the vas deferens to the epididymis, the area above the testes where sperm are stored.

It is important to say that a surgeon does not know if a man needs a vasovasostomy or vasoepididymostomy until he is on the operating table.


What to expect before vasectomy reversal

Doctor medical history
Before a vasectomy reversal, a doctor will check for other health problems and do a physical exam.

Doctors perform vasectomy reversals at a surgery center or hospital, but it is still an outpatient procedure with no need for an overnight hospital stay. Before the vasectomy reversal, the doctor will:

  • Take a medical history and do a physical exam – it is important to make sure there are no other health problems that may cause complications during or after surgery.
  • Confirm that healthy sperm can be produced – in most cases, evidence of having fathered a child before is sufficient, but if there is uncertainty, additional testing might be necessary.
  • Review the surgical history – it is important for the surgeon to know about any previous surgeries besides vasectomy or previous injuries that may interfere with the vasectomy reversal.
  • Consider blood tests – these are usually not necessary, but may be recommended for any men with issues of sexual function or an abnormal physical exam.

Once a person is in the operating room, he is often put to sleep with anesthesia.


During vasectomy reversal

During the vasectomy reversal, the surgeon will make a small cut on the underside of the scrotum to expose the vas deferens and free it from the surrounding tissues.

The vas deferens is then cut open to examine the fluid inside. Once it is established that there is sperm present, the vas deferens is reconnected to allow the passage of sperm.

If the fluid in the vas deferens is thick, it can be an indication of a blockage and that sperm are not flowing. At this point, the surgeon is likely to decide on a vasoepididymostomy as the more appropriate procedure.

Many experts believe that the procedure of connecting the vas deferens directly to the epididymis is one of the most challenging in the field of urology and male reproductive microsurgery. The difficulty is due to the small size of the vas deferens – narrower than a piece of angel hair pasta – the even smaller size of the epididymis tube, and the difficulty working on such a small scale.


Recovery after vasectomy reversal

three surgeons
After the surgery, rest for 48 hours is essential.

After a vasectomy reversal, the incisions will be covered with bandages and a person will be advised to wear a jockstrap for support for up to 6 weeks, only removing it when showering. Typically, wetting the surgical area should be avoided for 2 days after surgery.

Ice can help with soreness, which may occur for several days after the procedure. If present, stitches should dissolve within 2 weeks. A man should rest for the first 48 hours after the procedure and do as little as possible.

Once back home, a man will be advised to limit any activities that cause the testicles to move around too much, such as working out, jogging, or biking for up to 4 weeks after surgery.

Sexual intercourse should be avoided until a doctor has given the person the okay. Most men will need to wait at least 3 weeks after surgery. Semen samples are usually collected at 2, 4, and 6 months after surgery to check for presence of sperm. Typically, if no viable sperm are present after 6 months then further surgery may be recommended.


Risks and complications

While it is safe, there are risks to vasectomy reversal surgery. The most common risk is that full fertility does not resume. Other risks include chronic pain and infection, as well as:

  • inadequate sperm count
  • hematoma
  • bleeding
  • bruising and swelling
  • testicular atrophy, although extremely rare

The procedure of vasectomy reversal is safe overall. Complications are fairly unlikely, as long as the surgeon’s follow-up instructions are observed and recovery is managed properly.


Outlook

A person will not know how successful a vasectomy reversal is until their sperm evaluations have been done several months later. Once sperm counts return to adequate levels, the chances of conception improve.

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