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Vasectomy Reversal Candidates and Their Options

If you’ve had a vasectomy, it’s likely that your doctor told you that it was a permanent procedure.  More and more men, however, are asking their urologist whether their vasectomy can be reversed, most commonly because of remarriage and the desire to start a family, or because they simply changed their minds.  Fortunately, most vasectomies can be surgically reversed. If you are considering a vasectomy reversal, Dr. Larry Lipshultz can meet with vasectomy reversal candidates at his Houston practice to discuss the procedure. Contact his office today to schedule your appointment.

So what characteristics affect the chances that your vasectomy can be reversed successfully? 

First of all, men undergoing vasectomy reversal need to be healthy enough to tolerate the surgery, which is often done under general anesthesia and lasts several hours.  There are risks of having anesthesia, which are increased if your heart and/or lungs aren’t healthy, and making sure that your heart and lung health are optimized prior to your surgery is essential.  There are also other conditions that increase your risk of anesthesia, and these should be discussed with your doctor and optimized prior to surgery. 

Once we know you’re healthy enough to have surgery, there are two features of your prior vasectomy that help us predict what type of procedure you will need during surgery, and will help determine the likelihood of vasectomy reversal success.  These include:

  1. The number of years since your vasectomy – as this number increases, the likelihood of success decreases.   The longer the vas deferens is obstructed, the more likely a more complicated reversal will be necessary (see epididymovasostomy).
     
  2. Whether a “sperm granuloma” is present on exam – a sperm granuloma is a small lump along the vas deferens that occurs when sperm are able to escape from the end of the vas after vasectomy.  The presence of a granuloma increases the chances of vasectomy reversal success, because there is less pressure on the tiny ducts that drain the testicle.

Knowing the above facts will help your urologist predict whether the vasectomy reversal will require a vasovasostomy, which involves putting the ends of your vas deferens back together, or whether the surgery will involve an epididymovasostomy, a more complex procedure which attaches the end of your vas deferens to the epididymis, a sperm storage organ on your testicle.  Ultimately, however, your surgeon’s skill and what he or she finds during surgery will determine which procedure is done, and will influence the chances of success.  In the operating room, your surgeon will examine the fluid that flows from the testicular side of the vas deferens, and depending on its consistency and whether it contains sperm, will determine whether you need a vasovasostomy or epididymovasostomy.

For men who undergo vasovasostomy with a skilled surgeon, the chances of having sperm in the ejaculate approach 95%, with a 75% pregnancy rate.  Men who require epididymovasostomy have sperm in the ejaculate 50-60% of the time, and are able to achieve natural pregnancy in 45-50% of cases.

When choosing your doctor, make sure he or she discusses the likelihood of you needing one over the other type of procedure.  More importantly, your surgeon should be capable of performing the more difficult epididymovasostomy procedure, particularly since this decision is made during the surgery.