The benefits of a vasectomy reversal
- Ability to initiate a natural pregnancy
- Achieve pregnancy without artificial assistance
- Avoid expensive alternative reproductive techniques
- Allows family expansion
A vasectomy reversal means that a man can change his mind. While a vasectomy remains a common means of permanent male birth control, approximately 10% of men change their mind and request a vasectomy reversal. The most common reason for a change of mind is a divorce and remarriage, but some men request a vasectomy reversal due to loss of a child or due to a change in family planning by the couple. Fortunately, the vasectomy reversal can be done in an outpatient setting, requiring minimal loss of work and associated discomfort. The benefit of a vasectomy reversal is that a couple can initiate a natural pregnancy without resorting to assisted reproductive techniques. This allows men who have at one time made a decision to father no more children, to change their mind and proceed with initiating a biological pregnancy without the assistance of highly technological expensive artificial reproductive techniques. It is still possible to have a vasectomy following a vasectomy reversal, even though a previous vasectomy has been done. A repeat vasectomy is commonly done in the doctor’s office quite similar to the first vasectomy. A vasectomy should not be done, however, as a temporary mean of birth control, even though a vasectomy reversal is successful in over 50% of cases.
Successful Vasectomy Reversal Candidates include men with:
- vasectomy within the last 20 years
- wish to re-establish fertility
- little elapsed time since vasectomy
- young maternal age
- female infertility absent
- sperm granuloma” is present
- overall good health
Ideal Candidates for Vasectomy Reversal
Many men can benefit from vasectomy reversal surgery, but you must meet certain basic criteria in order to qualify for this procedure. You may be an ideal candidate for this surgery if:
You have undergone a vasectomy within the last 20 years. Your partner does not suffer from female infertility issues (if she does, you may need to utilize assistive reproductive technologies to conceive, in which case a vasectomy reversal will be unnecessary). A “sperm granuloma” is present at your vasectomy site, indicating that sperm continues to flow out of your cut vas from your testes (you are still eligible for this procedure if you do not have a sperm granuloma). You are in good overall health. At your initial consultation, Dr. Lipshultz will review your medical records, conduct a physical exam, and discuss your concerns to determine if you qualify for vasectomy reversal. Though it helps to have many of the above criteria, it is usually possible to undergo this procedure even if one or more criteria aren't met.
Men who do not wish to start or grow a family can undergo a vasectomy. During a vasectomy, the vas deferens, the testicular tubes that transmit sperm from the testes to the urethra, are disconnected and sealed. This procedure serves as a very effective contraceptive measure. However, due to relationship and lifestyle changes, many men who have undergone vasectomy later decide to restore their fertility. For these patients, Dr. Lipshultz can perform vasectomy reversal surgery.
Successful Pregnancy after Vasectomy Reversal
Some couples will have a better chance for a successful pregnancy after a vasectomy reversal depending on several factors.
There are increased success rates for men who have had less time elapsed between the initial vasectomy and attempted vasectomy reversal. Men who undergo vasectomy reversal shortly after vasectomy can often undergo a vaso-vasostomy (VV), as opposed to a epididymo-vastomy (EV). The details of these procedures are outlined here. Although it is impossible to tell for certain if a VV or an EV will be performed until after the operation is underway, there exists an application that can help estimate the relative chances of what operation will be performed. This ‘app’ is available free for the iPhone (Vas Reverse).
Advanced maternal age is also a factor to be considered when discussing options to re-establish fertility in the setting of a vasectomy. Sucessful pregnancies decrease as maternal age increases. The pregnancy rate for a typical fertile couple with a maternal age of 30 years is approximately 20% per ovulation. The chance of pregnancy decreases to 5% per ovulation for females age 40. Thus, even if a vasectomy reversal is successful, there is no guarantee of pregnancy. For couples where advanced maternal age is a consideration, surgical sperm retrieval and IVF can be discussed.
Vasectomy reversal procedures include
- Vasovasostomy (VV)
- Epididymovasovastomy (EV)
- Require specialized microsurgical skills
- Are preformed based on patients needs
When thinking about getting a vasectomy reversal there are several facts that the patient needs to be aware of. Firstly, vasectomy reversal is an umbrella term for two separate surgical procedures: a vasovasostomy (VV) and an epididymovasovastomy (EV). Both procedures require specialized microsurgical skills beyond what would be obtained during a routine Urology training program. The physician performing the above procedure should have at least one year additional training beyond their Urology residency. This additional year allows the development of an additional skill set to diagnose and treat male infertility.
Vasectomy Reversal Procedures: Vasovasostomy
The most common technique for vasectomy reversal is the microsurgical vasovasostomy. During this procedure, Dr. Lipshultz will create a small incision through your scrotum so that he can access the underlying tissue. He will then reconnect the remaining portions of your vas deferens using microscopic sutures to ensure that these tubes are intact. To qualify for this simple and minimally invasive procedure, you must have fluid and sperm still present in your vas deferens at the time of your surgery. A microsurgical vasovasostomy can be performed on one or both testicles. The bilateral version of this procedure has a 95 percent success rate.
Vasectomy Reversal Procedures: Epididymovasostomy
For patients who during surgery are not found to have sperm and fluid in their vas deferens, and therefore are not good candidates for microsurgical vasovasostomy, Dr. Lipshultz can perform an epididymovasostomy. A lack of sperm and fluid in your vas deferens indicates that another portion of your vas deferens or testicular tissue is blocked. During an epididymovasostomy, Dr. Lipshultz will connect your severed vas deferens directly to your epididymis, a testicular duct that transmits sperm from the testis to the vas.
As with microsurgical vasovasostomy, this procedure can be performed unilaterally or bilaterally. When both testes require an epididymovasostomy, patients typically experience a 50 to 60 percent success rate. This is due to the fact that the epididymis is much smaller than the vas deferens and, therefore, more difficult to modify (although Dr. Lipshultz will use an operating microscope to better access and correct your blockage). Since the epididymovasostomy has a lower success rate than microsurgical vasovasostomy, Dr. Lipshultz often recommends that patients undergoing this procedure freeze their sperm in case the reversal is not as effective as planned.
As with microsurgical vasovasostomy, this procedure can be performed unilaterally or bilaterally. When both testes are adjusted, patients typically experience a 50 to 60 percent success rate. This is due to the fact that that epididymis is much smaller than the vast deferens and therefore more difficult to modify (although Dr. Lipshultz will use an operating microscope to better assess and adjust your tissue). Since the epididymovasostomy has a lower success rate than microsurgical vasovasostomy, Dr. Lipshultz often recommends that patients undergoing this procedure freeze their sperm in case the reversal is ineffective.
Given the combination of an increased number of people having vasectomies and high divorce rates, vasectomy reversal is becoming more common. While many physicians advertise that they perform reversals, the patient must do their homework to ensure that the physician is properly trained and has the necessary skill-set to do it properly – thus ensuring the best outcomes. It is also important that the physician offer the ability to sperm bank as an insurance policy if the VV or EV doesn’t work as expected. While there are few surgeons that offer this, the benefits or undergoing one surgical procedure and the proper preservation of sperm is essential.
Vasectomy reversal timeline
- Pre-Surgery appointment- physical examination and surgery details
- 7 days prior to surgery- no blood thinning medications
- Vasectomy Reversal Surgery- 3 to 4 hours
- 3-4 hours after surgery- return home
- 3-5 days after surgery- return to work
- 14 days after surgery- resume normal activities
At your initial appointment, Dr. Lipshultz will meet with you and your partner to discuss the details of a vasectomy reversal and to address your expectations. He will perform a focused physical examination to ensure that you are a good candidate for a vasectomy reversal and discuss the chances that the procedure would be successful.
At the time of the physical exam, attention will be paid to the site of the vasectomy and whether or not a “granuloma” (distinct thickening on the vas) is present. A granuloma represents a “leakage” of sperm from the testicular vas i.e. the vas below the vasectomy site. This “leakage” is actually a good finding – it means the vas is “decompressing” below the vasectomy site. This “decompression” prevents the build up of intra-vasal pressure, which can disrupt or “blow-out” the delicate epididymal tubule leading from the testis to the vas. If this “blow-out” occurs, then the vas cannot be connected directly to the vas at the vasectomy site (vasovasostomy). The latter procedure has a 95% return-of-sperm at our institution. If there is no granuloma and if an epididymal blow-out has occurred, then I will have to connect the vas to the epididymis, resulting in a 70% return of sperm. Consequently, a lot can be learned form the physical examination.
If you wish to bank sperm at the time of vasectomy reversal, please notify us when you schedule and again on the day of the surgery. We will ask you to sign a sperm banking consent form, and you will need to have blood tests for 5 communicable diseases (HIV, RPR, Hepatitis antibody).There is an additional fee to the Sperm Banking Laboratory.
We would like you to ask questions at this visit or afterwards to ensure that you are completely comfortable with the vasectomy reversal procedure.
Seven Days Prior to Surgery
We expect that you not take any blood thinning medications such as aspirin, ibuprofen-containing medications such as Aleve, Motrin or Naprosyn one week prior to surgery. If you have a headache or pain, acetaminophen (Tylenol) is recommended. We will provide you with an information packet that contains additional detailed information about the surgery.
Avoid Smoking and Reduce Alcohol Consumption
Smoking and alcohol consumption can impair your body's ability to heal. It's important in the weeks leading up to surgery that you quit smoking and drastically reduce your consumption of alcoholic beverages in order to achieve ideal health conditions.
Avoid Using Aspirin and Certain Other Medications
Aspirin, blood thinners, and other medications that make it harder for your blood to clot should not be taken in the week or possibly weeks leading up to surgery. This helps prevent delayed healing and problems with bleeding in the days after the vasectomy reversal has been performed.
Run Errands Ahead of Time
Rather than rush around after the surgery is performed or the day before the procedure, it's a good idea to run any errands that you need to in the days leading up to surgery. Buy groceries, fill prescriptions, do laundry, purchase the recommended support garments, and clean around the house ahead of time. This will allow you to concentrate on healing after your surgery is performed rather than stress about minor things.
Arrange for a Loved One to Be with You for Recovery
In the first few days after surgery, it's helpful to have a loved one with you. Not only will this person help you get to the surgical facility and back, but he or she will also be available to help around your home. Having someone there to run basic errands and touch base with the practice in case of pressing needs can be crucial for ensuring surgical success.
Prepping In the Day Before Surgery
The day before surgery, be sure to keep the following in mind:
- Do not eat or drink after midnight on the night before surgery
- Shower thoroughly with antibacterial soap the night before and morning of surgery
Arrive at the surgical facility relaxed and calm, wearing loose-fitting, comfortable clothing.
Why These Pre-Op Instructions Are So Important
Healing really begins before a surgery is even performed. Pre-operative instructions are in place to ensure that patients are in optimal conditions for healing free from complications. Following all instructions for surgical care closely means faster healing as well as reduced severity and duration of side effects.
Most men seeking vasectomy reversal undergo microsurgical vasovasostomy. During this procedure, Dr. Lipshultz reconnects the vas deferens. This surgery can only be performed when men have adequate fluid and sperm on the testicular side of the vas deferens. Vasectomy reversal usually takes from 3 to 4 hours, followed by a few more hours for recovery from the anesthetic.
You can expect to go home the same day. Pain may be mild to moderate. You should be able to resume normal activities, including sex, within 2 weeks and can usually return to work in 3-5 days.