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Doctors usually perform vasectomy reversals at a surgery center or at a hospital. The procedure is generally done on an outpatient basis — without an overnight stay.
Your doctor may use general anesthetics to make you unconscious during surgery. Or, your surgeon may give you an anesthetic that keeps you from feeling pain, but doesn't put you to sleep — such as an epidural, spinal or local anesthetic.
Vasectomy reversal is more difficult than vasectomy. It requires specialized skills and expertise. Doctors can perform this surgery in one of two ways:
- Vasovasostomy (vas-o-vay-ZOS-tuh-me). With this procedure, the surgeon sews back together the severed ends of the tube that carries sperm (vas deferens).
- Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the coiled tube at the back of each testicle (epididymis). A vasoepididymostomy is more complicated than a vasovasostomy and is generally chosen if a vasovasostomy can't be done or isn't likely to work.
You probably won't know ahead of time which technique is needed. In most cases, the surgeon decides during the operation which technique will work best. Sometimes a combination of the two surgical techniques is needed — a vasovasostomy on one side and a vasoepididymostomy on the other.
During the procedure
During surgery, the doctor will make a small cut (incision) on the underside of your scrotum. This will expose the testicle and release it from surrounding tissues. Next, the doctor will cut open the tube that carries sperm (vas deferens) and examine the fluid inside. Ideally, this fluid will contain healthy, moving sperm and plenty of clear fluid. If the fluid is thick or pasty, or if it contains no sperm or partial sperm, scar tissue may be blocking sperm flow. In this case, a vasoepididymostomy may be the best option.
After surgery
Immediately after surgery, your doctor will cover the incisions with bandages. You'll put on a jockstrap to hold bandages in place and to apply pressure to reduce swelling and movement.
After you return home, take it easy. Periodically using an ice pack on your scrotum will help reduce swelling. As the anesthetic wears off, you may have some pain and cramping. For most men, the pain isn't severe and gets better after a few days to a week.
You may be sore for several days. You may also have bruising that will disappear after about two weeks. Any stitches should dissolve in seven to 10 days.
- For the first two days after surgery, avoid anything that might get the surgery site wet, such as bathing or swimming.
- Refrain from sports and heavy lifting for at least three weeks.
- If you have a desk job, you'll probably be able to return to work a few days after surgery. If you perform physical labor or have a job that requires much walking or driving, talk to your doctor about when it's safe to go back to work.
- Don't have sexual intercourse or ejaculate until your doctor says it's OK. Most men need to refrain from sex for two to four weeks after surgery.
- You'll need to wear a jockstrap for several weeks at all times, except when showering. After that, you'll need to continue to wear a jockstrap during exercise.
- Bandages can generally be removed after a few days. Ask your doctor when it's OK to take them off.
Freezing sperm
If your doctor finds sperm during surgery, you may choose to have some frozen in case your vasectomy reversal doesn't work (cryopreservation). If you're not able to father a child through sexual intercourse, your frozen sperm may be injected directly into your partner's egg. This is a type of in vitro fertilization called intracytoplasmic sperm injection (ICSI). Talk to your doctor about whether freezing sperm may be an option for you. Ask about the possible benefits and cost of the procedure. It isn't always available, and doctors have differing opinions about its effectiveness.
- Lipshultz LI, et al. Surgical management of male infertility. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-7216-0798-6..50022-4&isbn=978-0-7216-0798-6&sid=1092403583&type=bookPage§ionEid=4-u1.0-B978-0-7216-0798-6..50022-4&uniqId=229285861-3#4-u1.0-B978-0-7216-0798-6..50022-4. Accessed Dec. 6, 2010.
- Practice Committee of the American Society for Reproductive Medicine. Vasectomy reversal. Fertility and Sterility. 2008;90(suppl):S78.
- Vasectomy reversal. UrologyHealth.Org. http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=154. Accessed Dec 6, 2010.
- Lipshultz LI, et al. Techniques for vasectomy reversal. Urologic Clinics of North America. 2009;36:375.
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