What is a Vasectomy Reversal?
Vasectomy reversal is surgery to open the vas deferens, the ‘pipe’ that carries sperm and is intentionally obstructed by vasectomy.
Vasectomy reversal involves identifying undamaged vas deferens (‘pipe’) above and below the vasectomy site, cleanly cutting open the vas deferns at those sites and rejoining the upper and lower vas deferens (‘pipes’) using tiny sutures (placed with the aid of an operative microscope). This bypasses the vasectomy or block point. If successful a vasectomy reversal results in passage of sperm through the vas deferens and return of sperm to the ejaculate.
How Successful is Vasectomy Reversal surgery?
Following vasectomy reversal surgery rates of patency (sperm passing) are as high as 90%. For most men real success of a vasectomy reversal is pregnancy – success rates vary mainly due to female partner age.
Main factors influencing success of a vasectomy reversal:
- Time between vasectomy and vasectomy reversal (better patency rates with shorter times)
- Age and fertility of female partner (younger better, previous fertility better)
- Surgeon experience and training (high case numbers better)
It is prudent to consider the female side to fertility – both to manage expectations and decide if vasectomy reversal or IVF with surgical sperm retrieval is clearly a better option for a given couple. For this reason, if vasectomy reversal is being considered for fertility restoration, we recommend you and your partner consult a Fertility Specialist.
What are the risks?
Vasectomy reversal is a low risk surgery that rarely results in serious complications.
Complications that can occur include:
A bleed after surgery into the scrotum can produce a painful swelling. You can reduce the risk of a haematoma after your surgery by limiting physical activity, wearing supportive underwear and applying ice packs. Medications that thin the blood also increase the risk of a haematoma. If you take these medications your doctor will advise you on the risk/benefit of ceasing them around the time of surgery.
You will have some postoperative pain but it generally settles significantly in the days after surgery and is usually completely resolved within weeks after surgery. If you have severe or persistent pain post operatively you should call your surgeon.
Infection is rare after vasectomy reversal but, as with any surgery, there is a risk. It is more common in men who develop a haematoma. If you suspect infection inform your surgeon.
What should you expect from the surgery?
Before the surgery
Your surgeon will confirm your medical history to help determine chance of success of vasectomy reversal, your risks and whether there are likely to be other fertility factors.
Physical examination may be indicated.
If you are having a vasectomy reversal to achieve pregnancy it is prudent for your partner to be reviewed – to optimise her health before conception, exclude or identify some fertility problems, guide you on the choice of vasectomy reversal or IVF with surgical sperm retrieval and to understand chance of success – not just patency or sperm passing but also chance of pregnancy.
During the surgery
Vasectomy reversal is usually day surgery (discharge same day as surgery) or overnight stay.
Most patients have a general anaesthetic (fully unconscious) but some surgeons use local anaesthesia +/- sedation.
The surgery involves either a midline scrotal incision or an incision on either side of the scrotum. Tissue is dissected to identify then expose the vasectomy site. The vas deferens (‘pipe’ that was obstructed at the vasectomy) is followed above and below the vasectomy until normal tissue is reached. The two ends are then cleanly cut and the two now open ends of the vas deferens are brought together, bypassing the vasectomy. The two ends are rejoined using tiny sutures placed with the aid of an operating microscope. This is called a vasovasostomy – joining the vas deferens back together).
Sometimes the testicular end of the vas deferens (the lower end of the pipe) has been significantly damaged. In this case your surgeon may need to go lower down this pipe to find healthy ‘pipe’ including to where the ‘pipe’ narrows significantly (the much narrower ‘pipe’ is called the epididymis, but it is actually a continuation of the vas deferens). In these cases the vas deferens at the top is joined to the epididymis below (vasoepididymostomy). This surgery is more technically challenging (big pipe to small pipe join) and has a lower success rate.
Usually your surgeon can only determine whether vasovasostomy or vasoepidymostomy is appropriate during the operation so it is ideal that your surgeon has experience with both techniques – so they can make this decision intraoperatively and know how to perform the more challenging surgery if needed.
After the surgery
To optimise chance of success of a vasectomy reversal and to minimise the risk of complications it is important that you follow your surgeon’s post operative instructions.
Most will recommend supportive, ‘sung’ underwear in the days after surgery and minimal physical activity for a week after surgery. Beyond that most surgeons recommend limited activity for a few weeks. Your return to work will depend on the physical nature of your job. Your surgeon will advise you. Most men return to normal activity about a month after surgery.
Your surgeon will also advise refraining from sexual intercourse and/or ejaculation for at least a few weeks after surgery.
How long does it take to restore fertility?
After a vasectomy reversal it can take a few months for sperm to return to the ejaculate.
Most surgeons recommend a semen analysis about three months after surgery to confirm patency (sperm passing).
Your surgeon will inform you when they recommend you start trying to conceive and when, if your partner does not conceive, they recommend further assessment.
Alternatives to Vasectomy reversal
Even after a vasectomy your testes will continue to make sperm. It is just the outflow tract that has been blocked by the vasectomy. Given this it is possible to retrieve sperm from your testes (surgically – usually a needle aspiration). There will not be enough sperm retrieved for intrauterine insemination – but there are usually enough for IVF (with ICSI – injection of a single sperm into each egg).
So some couples choose to proceed with IVF using surgically retrieved sperm for fertilisation instead of vasectomy reversal.
If vasectomy reversal has been unsuccessful (no sperm passing) IVF (with surgical sperm retrieval) or a repeat reversal (lower success rates) become options.
Likewise if vasectomy reversal has succeeded in terms of sperm passing but not pregnancy over time it may become evident that IVF (using ejaculated sperm) is your best chance. And equally some couples try IVF first and if that is unsuccessful proceed with vasectomy reversal.
Which option you choose first and when you might consider switching to ‘plan B’ is an individual decision best discussed with your Fertility Specialist. Factors including your and your partner’s age, how long ago you had your vasectomy, how many children you hope to have and accessibility of IVF treatment will all influence that advice and your decision.
Are there any health rebates that cover the cost of vasectomy reversal?
Yes, there are Medicare rebates to cover some of the cost of vasectomy reversal.
Additionally if you are a member of a private health fund you may be eligible for further rebates – this will depend on your insurance policy.