Introduction

This Web page is designed to provide general information to men who are considering restoring their fertility through vasectomy reversal. The female partners of men who are considering vasectomy reversal may also find this information helpful. Spouses / significant others should have an evaluation by an obstetrician/gynecologist to ensure fertility before making a decision to have a vasectomy reversal.

Approximately 600,000 vasectomies are performed in the United States each year. 1 - 6% of the men will eventually want to restore their fertility by means of a vasectomy reversal. The most common reason for restoring fertility is to father a child after remarriage following divorce. Sometimes a death of a child or simply a change of mind prompts a man to have a vasectomy reversal.

Basic Anatomy

An understanding of the basic male anatomy is helpful for understanding what is involved in a vasectomy and/or vasectomy reversal. Figure 1 illustrates the male reproductive anatomy.

Figure 1

The testicle continually makes sperm that is stored in the epididymis. During ejaculation (expulsion of semen from the penis), sperm are transported from the epididymis and travel down the vas deferens then into the prostate. Fluids from the prostate and seminal vesicles mix with the sperm in the ejaculatory duct to make up the ejaculate (semen).

What is Vasectomy?

A vasectomy is a surgical procedure that blocks the vas deferens thus preventing sperm from flowing to the prostate, as illustrated in Figure 2. Obstruction of the vas is usually accomplished by removing a small segment of the vas deferens and placing a suture or small metal clip on the end of the vas.

Figure 2

Vasectomy Reversal

A vasectomy reversal is a surgical procedure that re-approximates the cut ends of the vas deferens, restoring the flow of sperm from the testicle to the prostate. This procedure generally requires an experienced microsurgeon using an operating microscope to achieve the best success rates. A vasectomy reversal can be accomplished in two ways: a vasovasostomy or vasoepididymostomy.

Figure 3a/3b illustrates the two types of vasectomy reversals.

Figure 3a	Figure 3b

A vasovasostomy, Figure 3a, is the most common way to re-approximate the cut ends of the vas deferens. The ends of the vas are sewn together using sutures that are finer than human hair. For some men, 20 - 30%, scarring in the epididymis after vasectomy prevents sperm from getting to the vas deferens. In this setting, reconnecting the two ends of the vas will not be adequate to restore fertility. A vasoepididymostomy, Figure 3b, is then performed to bypass the blockage in the epididymis.

Success Rates

Without the use of microsurgical techniques, vasectomy reversal is successful in only 40 - 50% of cases. Success is defined as the presence of sperm in the ejaculate. The use of microsurgical techniques allows for more precise approximation of the ends of the vas deferens and results in higher success rates.

As the next section discusses, the time from the vasectomy does play a role in the overall success of vasectomy reversals. The more years that have passed since the vasectomy was performed the higher the chance that a vasoepididymostomy will need to be performed, thus decreasing the chance of success. However, most patients do not require vasoepididymostomies no matter how long out the vasectomy has been. Vasectomies that are 30 years old have been successfully reversed.

Dr. Schow's personal statistics for patency rates (defined as more than one million sperm in the ejaculate) after vasectomy reversals based on review of the last 1000 patients are:

• 97% if Dr Schow performs a bilateral vasovasostomy (no matter how long it has been since your original vasectomy)
   
• 95% for all patients including redo procedures and patients up to 38 years from the vasectomy

Fifty percent of the patients in this group achieved a pregnancy within one year of the vasectomy reversal, some as soon as one month from the surgery. Dr. Schow performs about 6 - 8 vasectomy reversals per week.

Who is a Candidate for Vasectomy Reversal?

Essentially any man who has had a vasectomy is a candidate for vasectomy reversal. The advent of microsurgical techniques makes possible vasectomy reversal at any time after vasectomy. It is rare that a vasectomy reversal cannot be accomplished. A recent study by one of the largest research groups on vasectomy reversals, 1,247 men, reveals that successful pregnancies can be achieved even when the vasectomy has been performed 20 years previously, Figure 4. As can be seen from this study, the sooner the vasectomy is reversed, the better the results. For these reasons, couples that are considering vasectomy reversal should not delay the surgery.

Figure 4

Expectations Before, During And After Surgery

No specific testing is required before surgery. A pre-operative health assessment by your primary doctor along with some basic lab tests will need to be performed before surgery. Men over the age of 50 years old usually will need to have an EKG performed.

Spouses / significant others who have concerns regarding their fertility status should have an evaluation by an obstetrician/gynecologist before making a decision to have a vasectomy reversal.

Vasectomy reversals take place at the MMHC Surgery Center. See the Visiting MMHC's National Vasectomy Reversal Center for a description of the typical visit.

Dr. Schow is able to perform the surgery with either intravenous sedation and local anesthesia or general anesthesia. The CRNA will review the differences between the two types of anesthesia and together you will make a decision as to which method works best for you. Under Dr. Schow's care vasectomy reversals typically require 1 ½ to 2 hours to complete. Either type of anesthesia provides sufficient patient comfort during the procedure.

Patients are usually discharged to home 15-30 minutes after the surgery. Discomfort is quite variable but typically is not much more severe than the original vasectomy. Pain medication will be prescribed. Most of the discomfort is usually resolved within 3 to 4 days. Strenuous activity such as lifting more than 10 pounds, running or jogging is not recommended for 4 weeks after surgery. Sexual activity can be resumed four weeks after surgery.
 

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