Reverse Vasectomy

Can a vasectomy be reversed?

Vasectomy reversal is the most cost-effective way of achieving pregnancy after a vasectomy. Whether a couples desires more children in a relationship or the desire for children in a new relationship, vasectomy reversal offers the best chance of pregnancy.

There are over 35,000 vasectomy reversals performed annually in the United States. The most common reasons for this procedure include divorce/remarriage, desire for more children in a current relationship or death of a child. Occasionally, a vasectomy reversal will be performed simply because a man has changed his mind and wishes to restore continuity of his reproductive tract or he has developed pain after his vasectomy.

Can a vasectomy be reversed?

The success rate for vasectomy reversal is greater than 95% when sperm are identified at the time of surgery. The chances of finding sperm at the time of vasectomy reversal is determined by two important factors: the time elapsed since the vasectomy and the site of the vasectomy. When the time interval between the vasectomy and the vasectomy reversal is greater than 15 years, the chances of developing a secondary epididymal obstruction is approximately 70%. Also, when the vasectomy is performed low on the vas deferens then these chances are compounded. If sperm are not identified at the time of vasectomy reversal, an epididymovasostomy will be required to reverse your vasectomy. Vasectomy reversal success with epididymovasostomy is 65-70%. Regardless of the amount of time elapsed since the vasectomy, the success rate should be constant and only dependent on the type of surgery that is required.

How is a vasectomy reversal performed?

There are two different techniques for reversing a vasectomy: vasovasostomy and epididymovasostomy. Both techniques involve bypassing the obstruction in the reproductive tract. Vasovasostomy is the preferred method of vasectomy reversal when sperm are identified in the vas deferens at the time of surgery. Epididymovasostomy is the preferred method when sperm are not seen in the vas deferens.

Vasovasostomy

Vasectomy reversal performed by vasovasostomy is done using an operating microscope that provides magnification 25 times the normal image size. This is important since the size of the vas deferens is about the same as a piece of spaghetti and should be sewn in two-layers to offer the highest pregnancy rates. Microscopic suture (10-0 nylon) unseen by the naked eye is used during the vasectomy reversal. It is important to use this fine suture to prevent leakage of sperm and to minimize obstruction of the lumen of the vas deferens by the suture itself.

The initial step during a vasectomy reversal is to identify whether or not there are sperm in the testicular end of the vas deferens. If sperm are identified, then a vasovasostomy can be performed successfully using microsurgical technique. If sperm are not identified then a secondary epididymal obstruction has developed and re-connecting the vas deferens at the site of vasectomy will universally be unsuccessful. This occurs 30% of the time and is dependent on several factors such as the time since your vasectomy and the site of your vasectomy. If sperm are not seen then an epididymovasostomy will be required in order to reverse the vasectomy.

The next step in a vasectomy reversal is to re-approximate the ends of the vas deferens in a tension-free manner. The 10-0 Nylon suture provides a water-tight closure for the sperm to travel through the vas deferens. If larger sized suture is used, it can cause obstruction in the vasal lumen itself.

The typical appearance of the vasal lumen after it has been precisely sewn together using 10-0 nylon suture. The suture is made of the finest non-reactive material to prevent scarring of the lumen after the surgery.

An outer layer of 9-0 nylon suture is placed to reinforce the inner layer and to relieve tension from the important inner layer. Numerous interrupted sutures are placed around the outer layer ensuring a tension-free closure.

Epididymovasostomy

Epididymovasostomy is required during vasectomy reversal when there is absent sperm in the vas deferens. This signifies that a secondary epididymal obstruction has developed upstream from the vasectomy site. This situation is encountered in approximately 40% of individuals after a vasectomy. Epididymovasostomy can only be performed using a high powered operating microscope, under general anesthesia, by microsurgeons using the finest suture (10-0 nylon).

The epididymis is opened and a single tubule is isolated to bypass the obstruction that has developed.  The vas deferens is then attached to the epididymis using fine sutures (9-0 nylon). This attachment brings the vas deferens into close proximity of the single epididymal tubule.  The single epididymal tubule is sewn to the inner lumen of the vas deferens using microscopic sutures to create a water-tight closure, similar to vasovasostomy.  Additional fine sutures are placed in the outer layer of the epididymis to secure the vas deferens in place and to release tension off of the fine inner sutures.

Vasectomy Reversal Recovery & Healing

Patients always wonder what the recovery process is after a vasectomy reversal and what their incisions should look like after surgery. Fortunately, vasectomy reversal is not a very extensive operation regardless of which of the two surgeries are Patients always wonder what the recovery process is after a vasectomy reversal and what their incisions should look like after surgery. Fortunately, vasectomy reversal is not a very extensive operation regardless of which of the two surgeries are not getting on a plane for 3-4 hours or sitting in the car for an equal amount of time was not a problem as soon as the day after performed. The amount of time required for surgery and the need for general anesthesia should make patients think that surgery.

Your restrictions for activity after a vasectomy reversal are designed more for the actual healing process that is on-going inside the scrotum, than the actual discomfort a patient feels. The tiny microscopic sutures are all that is holding everything together after the vasectomy reversal and it is imperative that these sutures are not disrupted while allowing the surgical site to heal. There is no good medical justification to tell patients to “take it easy” for 2, 3, 4, or 6 weeks. These restrictions are quite arbitrary and usually based on a vasectomy reversal specialist’s own experience with the healing process. We feel that patients are able to resume all of their physical activities 2-3 weeks after surgery based on our surgical technique and experience.

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