Vasectomy reversal or vasovasostomy, is a procedure to reconnect the vas deferens to allow sperm to enter the ejaculate like they would prior to a vasectomy. The procedure aims to restore male fertility.
Things to consider before surgery
Before proceeding with vasectomy reversal surgery, you and your partner should be investigated for possible causes of post-surgical infertility. You should be evaluated for benign or malignant disease of the lower urinary tract by your urologist, including a careful history, physical examination and appropriate investigations. Your partner’s fertility should be assessed by a female fertility specialist.
Even if you and your partner are otherwise healthy, the results of the operation are not guaranteed. Three factors are predictive of success:
- The interval since the vasectomy was performed
The best results are achieved when reversal surgery is performed within 10 years, with 97% patency rates and 76% pregnancy rates reported when reversal surgery was performed three years post-vasectomy. A vasectomy interval exceeding 15 years may result in patency rates of 71% and pregnancy rates of 30%
- Surgical technique
Surgical experience is important and the best results are obtained with surgeons trained in microsurgical technique.
- The presence of sperm and the quality of the fluid from the testicular end of the vas deferens seen during surgery
Even if sperm are absent from this fluid, 60% of men will ejaculate sperm post-operatively, especially if clear fluid is present rather than a thick opalescent paste. This cannot be assessed prior to the operation, but will give you some early idea of how likely it is that the procedure will be successful.
Vasectomy Reversal: The Operation
The operation is performed under general anaesthetic, through two small incisions in the scrotum. The two ends of the cut vas deferens are then identified and prepared for reattachment. The two ends of the vas deferens are then sewn together using very small, very fine sutures.
Before reattachment, fluid is retrieved and examined for the presence of sperm; sperm may not immediately be present on microscopy however a copious clear discharge is a good prognostic sign and indicates a greater chance of long-term restoration of fertility.
What to expect post-operatively after Vasectomy Reversal
For six weeks, you should abstain from vigorous physical activity and sexual intercourse. The scrotum should be well-supported.
The first post-operative sperm count is performed at six weeks and then every three months for up to 2 years after surgery.
If after 2 years sperm have not returned to the ejaculate, the operation is considered a failure. At this point, you should reassess your options, which may include revision surgery or assisted fertilisation using sperm extraction.