Vasectomy reversal: What you should know

Vasectomy reversal: What to expect

By Lana Barhum 
Reviewed by Judith Marcin, MD
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 reversal


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.

Before
reversal

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


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.
SOURCE: MEDICAL NEWS TODAY
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.