Definition and Overview

Vasectomy reversal is a microsurgery that reconnects the pathway of the sperm and removes blockages, to allow men to ejaculate the sperm and hopefully fertilize an egg for pregnancy.

To understand the role of both vasectomy and its reversal to male sexual health, it’s important to know the reproductive system. Males produce sperm cells in their testicles. It then goes into the epididymis, which looks like a coiled tube, where the cell matures and is stored, ready for union and fertilization. Once it matures, it develops the ability to travel or “swim” from the epididymis through a long tube called the vas deferens, which is connected to the penis, so the cell comes out during ejaculation.

In a vasectomy, the normal pathway for the sperm cells is impeded. The vas deferens may be cut, clipped, or coiled. Any of these procedures prevents the sperm cells from combining with the ejaculate.

However, some males want to revert the process to become fertile (capable of siring children) once again. In such cases, the surgeon performs any of the two popular techniques to either connect the vas deferens (vasovasostomy) or to establish a link between the vas deferens and the epididymis (vasoepididymostomy), especially when there’s already a blockage in the epididymis.

Either of the procedures doesn’t affect the ability of the patient to have sexual intercourse and obtain satisfaction from it. Both simply relate to fertility. Moreover, the body doesn’t stop producing sperm cells even after vasectomy. In fact, a man can still be fertile for the next three months after the procedure.

Who Should Undergo and Expected Results

Naturally, males who have had a vasectomy before are the ones who undergo the procedure. It’s either they have found new partners or they develop the desire to grow their family. Based on a study, around 10% of males who have had vasectomy elect to have it reversed later on in life.

The outcome of the procedure, however, doesn’t guarantee a high success rate in siring children. Many factors can affect it. One is the duration between vasectomy and the intended reversal. The longer the time has passed, the lower the chances of getting pregnant. This is because blockages may already form in the epididymis, which can then act as more complicated barriers for the sperm cells to travel. Experts suggest that reversal should be performed within 3 to 10 years after vasectomy. Otherwise, the pregnancy rate drops to only 30%.

The quantity and quality of sperm cells also have an impact. The passage of time and the many years of vasectomy may lead to lower sperm motility.

As to the procedure, reversal is more complicated than a vasectomy. While the latter takes less than an hour to complete, the former may require one to 4 hours. It’s extremely important that the reconnection is precise and that there are no barriers or leakage that can affect the way the sperm cells travel. Nevertheless, it’s treated as a day surgery, so no confinement is needed.

Adding to the complication is the fact that surgeons are unable to tell which technique is better until they have seen the physical condition of the reproductive system. Although most of them prefer vasovasostomy since it’s much easier to do, complex obstructions may eventually force them to switch to vasoepididymostomy.

It takes at least two weeks for the patient to fully recover from the surgery.

How Does the Procedure Work?

General anesthesia is often recommended to patients as it’s a microsurgery. It’s essential that the doctors are precise; the patient must also lie very still throughout the operation as even small movement can have a direct impact on the result of the procedure. A local numbing agent will also be applied in the upper section of the scrotum, where the incision is going to be made. The vas deferens is exposed in the scrotum and is cut to determine whether there’s still sperm collecting in the area. If there is, the vas can just be reconnected to the other end of the vas. This technique can still be performed even if the sperm no longer has tails or the cells have become nonmotile.

However, if there is fluid with no sperm or there is no fluid at all, a reconnection of the vas to the epididymis is carried out since it’s assumed there is already blockage or obstruction in the latter. Very fine sutures are then used to connect the parts, and the reconnection is carried out under a high-quality microscope designed for surgery.

After the reversal is complete, the vas is placed back to its correct position and the incisions are closed using absorbable sutures.

Possible Risks and Complications

It’s possible that males will develop antibodies against sperm. This means the body’s immune system attacks the sperm cells, killing them eventually, resulting in infertility.

Since it’s a surgery, infection can occur, so doctors often provide antibiotics.

Sometimes too the procedure itself fails due to the body’s inability to create quality sperm or enough sperm to increase the chances of fertilizing an egg.

References:

  • Roncari D, Jou MY (2011). Female and male sterilization. In RA Hatcher, et al., eds., Contraceptive Technology, 20th rev. ed., pp. 435–482. New York: Ardent Media.
  • Speroff L, Darney PD (2011). Sterilization. In A Clinical Guide for Contraception, 5th ed., pp. 381–404. Philadelphia: Lippincott Williams and Wilkins.
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