Vasectomy Reversal Procedure

Introduction

Of the approximately 500,000 men who choose to have a vasectomy in the United States each year, up to 5-10% choose to reverse the vasectomy later. The reasons for vasectomy reversals include:

• a joint decision by the couple to have another child
• death of a child
• remarriage

Background
The Vasectomy Reversal Procedure
Success Rates

Background

The technical name for a vasectomy reversal is a "Vasovasostomy." This is surgically performed by reconnecting the previously cut ends of the vas deferens to rebuild an open vas channel (see illustration).

Occasionally, the original vasectomy has caused a blowout of the epididymis, a tube upstream from the blocked end of the vas deferens. In this case, a standard vasectomy reversal will not work. Instead, the surgeon must connect the vas end to the epididymis even further upstream from the blowout. This more complicated procedure is called an "Epididymovasostomy".

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The Vasectomy Reversal Procedure

The detailed work of a "Vasovasostomy" or "Epididymovasostomy" is usually peformed using magnification to adequately visualize and suture the vas and even smaller epididymis. The microsurgical technique of reconnecting the tubes is frequently performed with multiple layers of fine suture that are smaller than human hairs. A general or spinal anesthetic is usually used. The procedure can be performed on an out-patient basis with the patient returning home the same day as the procedure.

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Success Rates

The success rate of a vasectomy reversal depends on the

1. microsurgical skill and experience of the surgeon
2. patient’s tissue quality and time after the vasectomy.

There are clues before and during surgery to help predict the quality of the tissues and thereby the chances for success.

Clues During Surgery

An important predictor of success is the quality of the fluid coming from the vas end at the vasectomy site.

If the surgeon finds fluid with sperm cells coming from the vas, he or she can generally build an open channel by reconnecting the vas ends in greater than 90% of patients. The actual pregnancy rate, though, is less because the actual sperm may no longer be able to complete the process of fertilization. Nevertheless, pregnancies can result in greater than 60% of such cases.

If fluid without sperm is seen coming from the vas end, the surgeon can build an open channel through the vasectomy site in somewhat greater than 50% of patients. The actual pregnancy rate is frequently closer to 40%.

If the fluid is poor, the vas can be directly connected to the epididymis ("epididymovasostomy") and there is a further reduction in the success rate.

Clues Before Surgery

We can look at the time between the original vasectomy and the time of the vasectomy reversal to predict the success of the vasectomy reversal. In general, men who are less than 10 years out from their vasectomy have a better chance of success.

A study of over 1000 patients by multiple vasectomy reversal surgeons - the Vasectomy Reversal Study Group* - reported the following results:

* Belker AM, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. Journal of Urology 1991; 145(3):505-11.

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