Vasectomy Reversal

More than 250,000 American men have vasectomies each year, and 10% of them will at some point be reversed.  A vasectomy is a procedure that cuts the vas deferens, which is the tube that carries sperm from the testicles to the penis.  It is the most common form of birth control in the world.  Although men with vasectomies will continue to make sperm, the path outside the body is disrupted, so the sperm is not able to get out.  Many men make a decision to have a vasectomy after they have children, and then find that in some way their life circumstances have changed and they would like to have more.  While men with vasectomies can still contribute sperm for intercytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF), the primary advantage of a vasectomy reversal is that it can result in a natural pregnancy with less stress, time and cost.  The disadvantage is that in some cases the reversal may not work, and that most insurance companies will not cover the cost of the reversal procedure.

How is it done?

To reverse a vasectomy doctors have to stitch together a tiny opening that is between one-seventieth and one-hundredth of an inch in diameter – that’s about the size of a pinpoint.  Making the connection itself is not that difficult for an experienced doctor, but there can be complications along the way.  Since the testicles continue to make sperm, which are essentially trapped inside, many men experience a “clog” or “blowout” in the epididymis, from the pressure of the sperm building up.  The number of men who experience epidydimis blockage has recently been increasing, but fortunately there is a procedure that allows the blockage to be bypassed. 

Another complication is the length of the vas deferens, which is removed during the original vasectomy.  While it’s recommended that the vas deferens is simply cut, some urologist will remove several inches on both sides so the ends cannot simply be reconnected.  While this makes a reversal more difficult, it doesn’t make it impossible.  The vas deferens is very long, and actually extends into the abdomen, before it descends back down into the penis.  If part of the vas deferens is removed during vasectomy, it can be pulled down from the abdomen into the scrotum to be reconnected.  This may, however, require a larger incision.  While the incision for a normal reversal is just a small opening in the scrotum, the cut may need to be extended into the abdomen to release the extra length of the vas deferens. 

After the Reversal

Some men may experience a reduction in sperm count after a vasectomy reversal because of the scar tissue formed after surgery.  It normally takes about 3 months for the reversal to heal and sperm production to increase to normal levels, although in some men it can take over a year. 

There are doctors who disagree about how effective a vasectomy reversal can be.  Some doctors argue that if done correctly there should be no lasting infertility problems in most men; while others suggest that pregnancy rates after vasectomy reversal are only 50-60%.

Another point of disagreement is anti-sperm antibodies, which are found in 50-70% of men with vasectomy reversals.  When your blood comes in contact with something foreign, like bacteria or viruses, it produces antibodies that are designed to kill a specific invader.  The idea is that once antibodies for an invader are produced, the next time you are exposed to that particular bacteria or virus your body already has the tools to destroy it.  Antibodies are the reason most people only get chicken pox once, even though they might be exposed to it on several occasions.  If sperm enter the blood stream, which is common during both vasectomy and reversal, the immune system will see them as foreign, and produce anti-sperm antibodies to destroy them.  Many doctors believe this attack on sperm will lower sperm count and reduce motility; while other doctors have found it plays a small role in fertility after reversal, and that it’s the quality of the reversal itself that has the biggest impact on sperm count.  Most doctors do agree, however, that there are fewer complications and a shorter recovery time, if the vasectomy has been done within the last 10 years.

Vasectomy Reversal vs. IVF

Men going through vasectomies and vasectomy reversal can and should have sperm removed and frozen, in case ICSI or IVF is needed in the future.  While the procedures do not stop a man from producing sperm, it’s more convenient to remove sperm during a reversal instead of undergoing an additional procedure later.  Vasectomy reversal is a much more simple procedure, than the more invasive IVF. Yet, if a man’s partner is older there may be a time advantage in moving straight to ICSI or IVF, instead of waiting for his sperm production to recover.

Vasectomy reversal is becoming more common and more effective.  New techniques have improved fertility rates and allowed couples to have children with natural pregnancy instead of infertility treatments.  Finding an experienced doctor who is confident in his or her abilities to perform vasectomy reversal, even when there are complications, will help improve the outcomes of the procedure.  Having children after a vasectomy is not only possible, but can be relatively simple.