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Vasectomy Reversal

Although a vasectomy is carried out for permanent contraception (birth control), it is not unusual for a man to request its reversal.

Sperm flows from the testicles into a long thin tube (epididymis) which coils up around the back of the testis. Close to the bottom of the testis the tube becomes thicker, more muscular, and straightens to become the vas deferens. The vas deferens then runs to the urethra (urinary passage) and conducts sperm at the time of ejaculation.

Vasectomy is a minor procedure in which the vas deferens on each side of the scrotum (the "sac") is divided and blocked. When the vas deferns is blocked after a vasectomy, the ejaculation fluid (semen) is free of sperm and the egg produced by the woman cannot be fertilized to start a pregnancy.

After a vasectomy, the testicles continue to produce sperm. The unused sperm degenerate and are absorbed by the body. A vasectomy reversal (also known as a vasovasostomy) aims to reconnect the two ends of the vas deferens so that sperm can once again be mixed to the semen. Achieving a pregnancy after a vasectomy reversal may be more difficult than before the vasectomy due to a number of factors. In some cases, scarring of the vas deferens or epididymis, or changes in sperm quality may occur after the vasectomy. The longer the interval from the vasectomy to its reversal, the less likely a pregnancy can be achieved.
Success rates for vasectomy reversal vary depending on many factors, including your partner's fertility and time from vasectomy. Your urologist has discussed the potential of recovering your fertility. The ability to restore sperm in your semen is very high after a vasectomy reversal and the pregnancy rates are good when the reversal is done within 3 years of the vasectomy. However, the success of the procedure drops significantly after 9 years.

Vasectomy reversal is not normally covered by health insurance companies. The discussion with your urologist will have included information about success rates and costs. As well, there are alternatives to vasectomy reversal including adoption, use of donated sperm and assisted reproductive techniques (ART). ART may involve sperm being taken from the testis and injected into an ovum (egg) taken from the ovary of your partner. The costs of ART may be considerable with modest success rates.

The procedure

The vasectomy reversal will be carried out as a day case procedure. The surgery is often done under general anaesthesia and the patient is asked to have nothing to eat for six hours before your surgery.
In the operating room one or two incisions will be made in the scrotum or the suprapubic area. The incision is usually longer than the original vasectomy incision in order to expose both cut ends of the vas deferens to adequately rejoin them. During the surgery the urologist will determine if the vas deferens is in satisfactory condition to permit adequate flow of sperm through the rejoined tube. The two healthy ends of the vas above and below the obstruction will be joined. The procedure can take 2-4 hours given its intricacy and the common use of magnification.

Occasionally, the vas deferens is too scarred to permit effective sperm flow. In this case, the urologist may need to bypass this scarred part of the tube and connect one end of the vas deferens directly to the epididymis. This type of surgery, called a vaso-epididymostomy is more technically challenging, with a lower success rate.

After the procedure

One should be accompanied home after your vasectomy reversal and you should not drive for 24 hours until the anaesthetic has completely worn off. One should avoid strenuous physical activity, heavy lifting, or exercise for about one week. Any strain may cause bleeding or swelling of the scrotum. Application of an ice pack intermittently after the procedure will minimise pain and swelling. Pain is usually adequately controlled with over-the-counter pain killers (neurofen). One may need a prescribed painkiller that can be used as required for a few days after the surgery.

Most men have no problem after a vasectomy reversal. There is a small risk of infection requiring treatment with antibiotics. Occasionally, men have scrotal pain that persists for a few weeks or months. Over time, this usually resolves completely without specific treatment. Normally, a small lump will persist at the site of the vasectomy reversal. A vasectomy reversal should not affect your sexual function nor will you notice any change in your semen.

Sexual activity should be postponed for several weeks after the vasectomy reversal. Sperm may return to the semen immediately after the procedure. The urologist will advise the optimal timing of intercourse to achieve a pregnancy. This occurs around the mid-point of your partner's menstrual cycle, when ovulation (egg release) occurs.

There is often a significant delay in the appearance of large numbers of sperm in the semen after a vasectomy reversal. If the semen tests show large numbers of healthy sperm, the possibility of pregnancy is good. Unfortunately, restoring sperm to the semen after vasectomy reversal does not always result in a pregnancy.

Many couples have achieved pregnancy following vasectomy reversal.