Vasectomy Reversal

Vasectomy is a common method of male sterilisation and approximately 500,000 men undergo a vasectomy each year. About 2% to 6% of men who have had a vasectomy will request a vasectomy reversal.

Vasectomy reversal entails reconnection of the two severed ends of the vas deferens. The operation usually takes between two and three hours to perform.This procedure is generally performed through a scrotal incision and under a general anesthetic. The ends of the vas are identified and scar tissue is removed. The freshly cut ends of the vas are then reconnected fine non-absorbable suture material and under magnification.

Vasectomy reversal can be performed as a day case or with a one night stay and then a few days (up to a week) off of work may be required. Sexual intercourse and ejaculation is not permitted for 4 weeks post operatively. If oozing occurs at the time of surgery, a small drain may be left in the incision and removed one or two days later. This will prevent blood from accumulating inside the scrotum. Significant complications as bleeding and infection occur in only 1-2% of patients.

At Follow-up the first post-operative semen analysis will be performed at four to six weeks. A minimum of three ejaculations should occur before obtaining a sample. Additional analyses will be performed at three monthly intervals thereafter as required.

After a successful vaso-vasostomy, one can expect to see sperm in the semen at between six and twelve weeks. Absence of sperm in the semen six months post-operatively invariably means failure. Following a vaso-epididymostomy, sperm usually return to the semen during the three-to-six month interval, but may not be seen for up to one year. Again, absence of sperm at one year usually means failure.

The results of a vasectomy reversal are measured by the patency rate (sperm seen in semen sample) and pregnancy rate. A vaso-vasostomy has a patency rate in excess of 85% and pregnancy rate of 40-75%. Following a successful vasectomy reversal the probability of pregnancy will be most influenced by the fertility status and age of the female partner. A gynecological evaluation for all women whose male partners intend to undergo a vasectomy reversal is necessary in parallel. In normal women, fertility declines with age such that the chances of pregnancy for a woman less than 35 years old is 70 to 75%, and for women between 35 and 39 years old is 60%. There are no data to indicate an increased incidence of fetal abnormalities occurring in children conceived following a vasectomy reversal.

Although the process is approached with a positive outlook results are not guaranteed. The decision to proceed with a vasectomy reversal is should be made only after careful consideration of many factors, including a realistic appraisal of chances for success, financial resources, and available options for assisted reproduction.

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