Vasectomy Reversal

Vasectomy reversal is one way to obtain a pregnancy after vasectomy or injury to the vas deferens. A vasectomy reversal can provide a couple a method to conceive natrually with the use of Assisted Reproductive Technologies. There are many reasons why men persue reversal, such as loss of a child or new relationships.

 

There are other options for having children in the setting of vasectomy. Adoption and donor insemination are two options. If a couple desires to have biologically related children, then there are really 2 routes:

  1. Vasectomy reversal
  2. Assisted reproductive technologies (ART) with sperm retrieval combined with IVF/ICSI.

 

Which approach makes the best sense for a couple involves discussion of the risks and benefits of each approach in terms of: chance of success, risks associated with each approach and financial costs. There is no one 'best' options. Every couple must decide on their own which approach fits them best. Vasectomy reversal has several advantages and disadvantages.

 

Advantages Disadvantages

High chance of success if the obstructive interval is short.

 

The most 'natural' route to conception. Associated with the lowest rate of multiple gestation (twins, triplets, etc.).

 

No concerns have ever been raised regarding the potential for genetic abnormalities in the offspring.

 

If the procedure is successful, there are no additional costs for each additional 'try' - compared with IVF for which there will be expense associated with each separate attempt.

Success decreases with the time from reversal.

 

Time to return of sperm to the ejaculate may be weeks to months - typically longer if the obstructive interval is longer. This is mainly an issue if the wife is of advanced reproductive age.

 

While vasectomy is relatively safe and complications are uncommon, some men may experience bleeding, infection or other problems following surgery. Late stenosis (obstruction) can occur as a result of scarring.

 

Success Following Vasectomy

 

Success following a vasectomy can be defined in 2 ways:

  1. Technical success: return of sperm to the ejaculate
  2. Pregnancy

 

Note that the return of sperm to the ejaculate does not guarantee a pregnancy - the same is true for pregnancy with natural conception or with ART (IUI, IVF, ICSI, etc). Therefore, the technical success rate is always higher than the pregnancy rate. The factors that are most important in the chances of success are:

  1. Obstructive interval
  2. Wife's age
  3. Prior pregnancy history
  4. Quality of the fluid at the time of reversal

 

Obviously surgeon skill and experience make a large difference. Specialized training in vaso-epididymostomy and coordination with an infertility centre are pre-requisites to obtaining a good result. We have the ability to cryopreserve your sperm and the additional training and experience required to perform a vasoepididymostomy.

 

Figure: Technical success and pregnancy decrease with the time from vasectomy.

 

There are many reasons why sperm may not return to the ejaculate following vasectomy including upstream obstruction, scarring at the site of the anastomosis and decreased sperm production. While 90% of men have return of sperm to the ejaculate by 6 months after reversal, a few may take much longer. There have been cases where sperm may not appear for 2-3 years after reversal, but this is rare.

 

What is involved in vasectomy reversal?

 

The goals of vasectomy reversal are to achieve return of sperm to the ejaculate and insure against failure of the vasectomy by cryopreserving sperm at the same time. Not all reversals are successful and eliminating the chance of requiring another surgical retrieval by perserving sperm at the time of reversal is recommended in all men. Therefore, a vasectomy reversal is really a combination of procedures rather than one procedure.

 

  1. Vasovasostomy: reconnecting the two cut ends of the vas deferens
  2. Vasoepididymostomy: connecting the abdominal (distal) end of the vas deferens to an epididymal tubule
  3. Sperm retrieval and cryopreservation, usually directly from the testis.

 

The highest success rates for vasectomy reversal occur with vasovasostomy UNLESS there is upstream obstruction, in the epididymis, for example. The quality of the fluid in the testicular (proximal) end of the vas deferens at the time of reversal is key. If there is a concern regarding the quality of the fluid, then the epididymis can be inspected to get a sense if there is scarring and vasoepididymostomy performed if indicated.

 

The procedure usually takes between 45 and 90 minutes per side through small incisions in the scrotum. Because the sutures which are used to sew the ends together are much smaller than a human hair, an operating microscope and specialized instruments are necessary. It is very important that there is no movement during the procedure and therefore vasectomy reversal is usually performed under a general anesthetic

 

 


 

Preparation

 

  1. You must FAST before the procedure because it is done under a general anesthetic. This means nothing to eat or drink from midnight on prior to your procedure.
  2. Please make arrangements for someone you know to accompany you home. By law, you cannot drive for 24 hours after surgery.
  3. Stop any blood thinners or antiplatelet agents (such as coumadin/warfarin, aspirn or Plavix)
  4. Shave your scrotum prior to coming in.
  5. Bring an athletic support

 

FAILURE TO FOLLOW THESE INSTRUCTIONS MAY RESULT IN CANCELLATION OF YOUR SURGERY AND A CANCELLATION CHARGE

 

After Procedure

If you have questions that are not answered here, please contact us.

 

What to Expect

It will be normal for you to have some pain and bruising following your procedure (though many men will have no bruising).

 

Cautions

If you have significant scrotal swelling please contact us as you may be developing a hematoma. Some minor bruising is normal.

 

Diet

There are no dietary restrictions.

 

Activity

Avoid vigorous physical activity and intercourse for about 5 days after your procedure as it can produce post-operative bleeding. You may bathe any time after the procedure.

 

Medications

You may resume all of your regular medications after your vasectomy reversal. If you are on blood thinners, you urologist will give you specific instructions but, in general, antiplatelets and anticoagulants (e.g. aspirin, plavix and coumadin/warfarin) should be discontinued about 7 days before surgery and can be resumed 7 days after the procedure.

 

Follow-up

 

We will contact you for follow-up. You may resume having intercourse about 2-3 weeks after the procedure. You will receive a laboratory requisition to check your semen analysis every 1-2 months for return of sperm until your partner is pregnant.