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Vasectomy reversal: Surgery to undo a vasectomyBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/vasectomy-reversal/MY00326
Vasectomy reversal is surgery to undo a vasectomy. It reconnects the tubes that carry sperm from the testicles into the semen. After a successful vasectomy reversal, sperm are again present in the semen and you may be able to get your partner pregnant.
Reported pregnancy rates after vasectomy reversal range from 40 to 90 percent. Many factors affect whether a reversal is successful, including the type of vasectomy you had, and the experience of the doctor doing the reversal surgery.
Why it's done
Men decide to have a vasectomy reversal for a number of reasons, including loss of a child, remarriage or improved finances making it feasible to raise a child. A small number of men have a vasectomy reversal to treat testicular pain that may be linked to vasectomy.
Almost all vasectomies can be reversed. However, this doesn't guarantee success in conceiving a child. Vasectomy reversal can be attempted even if several years have passed since the original vasectomy — but the longer it's been, the less likely it is that the reversal will work.
Vasectomy reversal rarely leads to serious complications. Risks include:
- Bleeding within the scrotum. This can lead to a collection of blood (hematoma) that causes painful swelling. You can reduce the risk of hematoma by following your doctor's instructions to rest after surgery. Ask your doctor if you need to avoid aspirin or other types of blood-thinning medication before and after surgery.
- Infection at the surgery site. This isn't common, but it is a risk with any surgery.
- Sperm granuloma. Sperm leaking into the scrotum can prompt your immune system to form an inflamed mass called a sperm granuloma. Granulomas may occur after surgery and can be a sign that a vasectomy reversal wasn't successful.
- Chronic pain. A minority of men have pain in the testicle area (scrotal pain) after vasectomy reversal.
How you prepare
When considering vasectomy reversal, here are a few of things to think about:
- Vasectomy reversal may be expensive, and your health insurance might not cover it. Find out about costs ahead of time.
- Vasectomy reversals are generally most successful when they're done by a surgeon who uses a surgical microscope (microsurgical technique).
- The procedure is most successful when performed by a surgeon who has done the procedure many times.
When choosing a doctor, don't be afraid to ask questions about how many vasectomy reversals the doctor has done, the type of techniques used and how often the vasectomy reversals have resulted in pregnancy. Also ask about the risks and potential complications of the procedure.
Before vasectomy reversal surgery, your doctor will likely want to:
- Take your history and perform a physical exam. Your doctor will want to make sure that you don't have health concerns that could complicate surgery.
- Check to see whether you can produce healthy sperm. For most men, having gotten a woman pregnant before is proof enough. If your doctor is unsure whether you are producing healthy sperm, you may need a testicular biopsy. In this test, a needle is used to remove fluid from your testicles to check for sperm.
- Confirm that your partner is capable of having a child. Your doctor will want to see whether your partner has any fertility problems, especially if she has never had a child or is older than age 35. This may require a gynecological examination and other tests.
Make sure you know what steps you need to take before surgery. Your doctor will probably ask you to:
- Stop taking blood-thinning medications. Two weeks before your vasectomy reversal, your doctor may tell you not to take pain relievers such as aspirin or ibuprofen (Advil, Motrin IB, others), because they can increase your risk of bleeding. Your doctor may also have you stop taking other medications.
- Bring an athletic supporter to wear after surgery. This will support your scrotum and hold bandages in place.
- Arrange for someone to drive you home after surgery. Surgery generally takes about two to four hours. You may need additional time to recover from anesthesia. Ask your doctor when you can expect to go home after surgery.
What you can expect
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Doctors usually perform vasectomy reversals at a surgery center or 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 tubes that carry sperm (vas deferentia).
- Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the the small organ at the back of each testicle that holds sperm (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, your 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. When sperm are present in the fluid, the ends of the vas deferens can be connected to re-establish the passageway for sperm.
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, your doctor may choose to perform a vasoepididymostomy.
Immediately after surgery, your doctor will cover the incisions with bandages. You'll put on an athletic supporter to hold bandages in place and to apply pressure to reduce swelling and limit movement.
You may be sore for several days. If your doctor places bandages after your surgery, ask when it's OK to take them off. Any stitches should dissolve in seven to 10 days.
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.
Your doctor may also give you the following instructions:
- Wear an athletic supporter for several weeks at all times, except when showering. After that, you'll need to continue to wear it during exercise.
- 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 two to 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.
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.
About six weeks after surgery, your doctor will examine your semen under a microscope to see if the operation was successful. To collect a semen sample, your doctor will have you masturbate and ejaculate into a container.
Your doctor may want to check your semen every two to three months. Unless you get your partner pregnant, checking your semen for sperm is the only way to tell if your vasectomy reversal was a success.
When a vasectomy reversal is successful, sperm usually appear in the semen after a few months, but it can sometimes take a year or more. Vasectomy reversal leads to pregnancy in about half of couples within two years.
If vasectomy reversal doesn't work
Vasectomy reversals sometimes fail if there is a sperm blockage that wasn't recognized during surgery, or if a blockage develops sometime after surgery. Some men have a second-attempt vasectomy reversal surgery if the procedure doesn't work the first time.
You may also be able to father a child through in vitro fertilization by using frozen sperm retrieved during your vasectomy reversal. If you didn't have sperm frozen or your frozen sperm aren't viable, in vitro fertilization may still be possible using sperm retrieved directly from your testicle with a needle.
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