Overview
Vasectomy reversal is a surgery to undo a vasectomy. After successful vasectomy reversal, sperm are present in your semen again and you may be able to get your partner pregnant. A more complicated surgery than vasectomy, vasectomy reversal re-connects the tubes that carry sperm from the testicles into the semen. Vasectomy reversal can be attempted even if a long time has passed since you had your vasectomy. However, only about half of vasectomy reversals are successful.
Why it's done
Men decide to have the surgery to restore fertility 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.
Risks of Vasectomy Reversal
Major complications following vasectomy reversal are rare. Risks of vasectomy reversal include : -
- Bleeding within the scrotum. This may lead to a collection of blood (hematoma) that causes painful swelling. You can reduce this risk by avoiding aspirin before and after surgery and following your doctor's instructions to rest after surgery.
- Infection at the surgery site. This isn't common, but is a risk with any surgery.
- Inflammation. Sperm leakage into the scrotum can prompt your immune system to form an inflammatory mass called a sperm granuloma. Granulomas usually occur sometime after surgery and can be a sign that a vasectomy reversal wasn't successful.
- Damage to nerves and blood vessels. In some cases, this reduces fertility after a vasectomy reversal.
- Fever
- Swelling that worsens or won't go down
- Difficult urination
- A marble-sized lump in your scrotum
- Bleeding from an incision that continues after you've pinched the site between two gauze pads for 10 minutes
How you prepare for Vasectomy reversal
Before having vasectomy reversal surgery to restore fertility, your doctor will want to make sure 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 enough 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. Your female partner also needs to be tested to make sure she doesn't have fertility problems. It's a good sign if your partner has been pregnant in the past. Her doctor will want to know if she has regular menstrual cycles, and will do a pelvic exam. The doctor may recommend other tests to make sure your partner's fallopian tubes aren't blocked and that she's producing eggs (ovulating).
What you can expect
A vasectomy reversal reconnects the severed vas deferens, the tube that carries sperm from each testicle. One of two surgical procedures may be used to reverse a vasectomy. A vasovasostomy reattaches the severed ends of the vas deferens to one another. A vasoepididymostomy attaches the vas deferens directly to the epididymis, the coiled tube on the testicle where sperm matures. The point where the vas deferens is reattached is called an anastomosis.
Vasectomy reversal is a technically challenging operation that requires specialized skills and expertise. The surgery is more difficult than is the original vasectomy. The tube that carries sperm from each testicle to your semen (vas deferens) must be sewn back together or attached to the epididymis. The epididymis is the coiled tube on the back of each testicle where sperm matures. The surgery usually is done on an outpatient basis - without an overnight stay at the surgery center or hospital.
- Vasovasostomy (vas-o-vay-ZOS-tuh-me). With this procedure, the surgeon sews the severed ends of the tube that carries sperm (vas deferens) back together. However, sometimes this isn't possible and a more complex surgery is needed to restore the flow of sperm.
- Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the epididymis. This surgery is used when sperm flow is blocked and a vasovasostomy won't work.
You probably won't know ahead of time which technique is needed. In most cases, the surgeon makes the decision during the operation. You may need a combination of the two surgical techniques - a vasovasostomy on one side and a vasoepididymostomy on the other.
During the procedure
You may receive general anesthetics to make you unconscious during the surgery. Or, your surgeon may use an epidural, spinal or local anesthetic. In any case, your anesthesia will need to keep you completely still because the surgery is so delicate. It's done using a microscope that magnifies the surgery area.
The surgeon will make a cut on the underside of your scrotum, expose the testicle and release it from surrounding tissues. Next, he or she will cut open the vas deferens and examine the fluid inside.
Fluid assessment
Once the vas deferens has been opened, the surgeon will inspect the fluid that comes out. This is an important part of the operation because it helps your doctor determine what type of surgery you need to restore the flow of sperm. If the fluid contains sperm and plenty of clear fluid, surgery to re-connect the ends of the vas deferens - a vasovasostomy - is likely to work. Fluid below the vasectomy site that is thick or pasty, or that contains no sperm or partial sperm, can be a sign that there is scar tissue blocking the flow of sperm. In this case, attaching the vas deferens directly to the epididymis - a vasoepididymostomy - may be the best option.
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