Vasectomy Reversal (Vasovasostomy)
Vasectomy is a male birth control method. This and female tubal ligation techniques are considered as permanent birth control methods. Vasectomy reversal connects the both ends of previously ligated and cut vas deference (tubes). Since the tubes are very small, this require microsurgical techniques and an operating microscope or a powerful loop.
Vasectomy reversal is an procedure. Patients should expect to leave the clinic/hospital in 1-3 hours after the surgery. Generally local anesthesia is sufficient, but during the microsurgical part of the operation, patients should stay still, therefore, general anesthesia may be needed. Sometimes, the surgery can start with a local anesthesia and if required, general anesthesia can be applied if the patient has outpatient difficulty to stay still.
The success rate of vasectomy reversal depends on many variables. The patients expectation is achieving a pregnancy after a reversal surgery, not only the appearance of sperm in ejaculate. The vasectomy can be reversed, but the couple may not achieve pregnancy eventually. Therefore the vasectomy reversal candidates and their partners should be evaluated with respect to their fertility potential as couples. We offer one free IVF cycle with testicular sperm if patient does not have any sperm in the ejaculate 3 months after the surgery.
WHO IS THE CANDIDATE FOR A REVERSALVasectomy reversal is done naturally on men who want to gain their fertility. However, patients should remember that they need time and a fertile partner to achieve a pregnancy. Therefore, before deciding a reversal, their partner should have a thorough examination by a fertility specialist. For example, a female partner over 36 years old with a poor ovarian reserve may not be pregnant after a successful vasectomy reversal. Although some patients have sperm in their ejeculate 3 months after surgery, they should expect to achieve a pregnancy within one or two years. This means that female partners should have a good fertility potential at the time of the surgery and 2 years after surgery. If the surgery fails or no pregnancy happens in 2 years even if the surgery is a success with respect to the patency of tubes, they should still have a good chance with IVF treatment. Otherwise, IVF may be a better first step treatment. Of course when one chooses between a reversal or IVF/ICSI with testicular sperm, the cost of the treatment is important as well.
In summary, the indication for vasectomy reversal should be discussed with the patient very carefully. The couple should have a very good chance 1-2 years after the surgery. If an expert opinion shows that the pregnancy chance will be jeopardized if an IVF/ICSI trial is needed and is delayed for 2 years. If the couple want to have more than one child, then having a patent vas (open tube) can give them a more economical way to have children after the vasectomy reversal. The idea is to reduce to cost of per child. Of course, here, the price of IVF/ICSI with testicular sperm and the cost of reversal should be compared. We offer patients meeting these criteria one free IVF+TESE/TESA if vasectomy fails which means no sperm in the ejeculate 3 months after surgery or no pregnancy one year after surgery. The drugs for ovulation induction is not included.
The female partner should be less than 36 years old at the time of the surgery The female partner should have an examination before the reversal and have a good chance for fertility. The uterus, endometrial cavity should be normal. Ovarian reserve should be fine.
Male partner should have a proven fertility before vasectomy or a good quality sperm at the time of surgery. This can be done with TESA (Testicular sperm aspiration). TESA can be done before surgery to evaluate the fertility potential with IVF if reversal fails.
Although, some men develop antibodies to their own sperm if vasectomy is done 8 or more years ago, we do not consider this possibility as poor fertility potential for IVF success. So the duration of obstruction is not a criteria for the eligibility for this program.
After SurgeryThe surgery usually takes 1-4 hours, then 3-4 hours after surgery for recovering from the anesthetics. Then the patient may go home. If there is no complications, then patients should expect to return their routine daily activities, including sport and sex, in 3 weeks.
Reversals are more successful during the first 10 years after vasectomy.
In general, vasectomy reversal :
- Pregnancy rates of greater than 50%.
- Biggest chance occurs within 3 years of the vasectomy.
- If the reversal is done 10 years after vasectomy, the pregnancy chance in one year is about 30%.
RisksRisks of vasectomy reversal include:
- Infection at the site of surgery.
- Fluid buildup in the scrotum (hydrocele) that may require draining.
- Injury to the nerves in the scrotum.