Fertility After Vasectomy

Because of changes in your life or relationships, you may want a child even though you’ve had a vasectomy. In many cases vasectomies can be reversed. It’s important for men to have an honest discussion with their partner to decide if having a vasectomy reversal is the best choice for them.

If your female partner is older than 40, it may be harder for you and your partner to conceive naturally. In these cases, couples may be better served by having a procedure to extract sperm, which can be used for in-vitro fertilization (IVF).

Sometimes doing both a vasectomy reversal and sperm extraction at the same time is the best choice to optimize success of achieving pregnancy.

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Vasectomy Reversal Procedures

If you’ve had a vasectomy in the past, surgeons may be able to reconnect your vas deferens tubes by bypassing scar tissue around these tubes. There are various techniques for a vasectomy reversal. Your surgeon will discuss the differences between each technique.

Vasectomy reversals are done using general anesthesia. You also won’t need to stay in the hospital overnight to recover.

Vasovasostomy

Vasovasostomy is the most common technique for vasectomy reversal. During this three-hour procedure, your surgeon will sew the cut ends of the vas deferens tubes back together using a high power surgical operating microscope and sutures (stitches). These stitches are finer than a human hair and are so small that the naked eye can’t see them very well.

We use an operating microscope that magnifies 30–40 times. We want to make sure your tissue is handled extremely carefully.  

This technique reconnects vas deferens tubes that were previously severed during a vasectomy. Current studies don’t show that one technique is better than the other.

To reverse your vasectomy, your surgeon will perform several steps. Your surgeon will:

  1. Dissect your vas deferens tube,
  2. Identify where your tube is blocked from the vasectomy,
  3. Cut the vas deferens above and below this blockage, and
  4. Place six to ten very fine stitches to reconstruct your tube.

Before placing any stitches, your surgeon will examine the fluid coming from the testicular end of your vas deferens tubes under a microscope.

We will only perform a vasectomy reversal if fluid is still present in your vas deferens at the time of surgery. If you don’t have any fluid, we will perform an epididymovasostomy.

Vasoepididymostomy

Vasoepididymostomy is a more complex version of the vasovasostomy. This involves connecting one end of the vas deferens directly to the epididymis, which is a structure that stores sperm created in the testicle.

Surgeons will choose this procedure if your sperm is getting blocked in your epididymis. We typically use the intussusception technique, which involves placing two or three sutures in a tubule within the epididymis and then connecting them to the vas deferens before opening the tubule.

Epididymovasostomy

Epididymovasostomy is a more complex version of the vasovasostomy. Surgeons will choose this procedure if your sperm is getting blocked in your epididymis. This procedure is one of the most complex microsurgical procedures performed. We typically use the intussusception technique.

This technique involves placing two or three 10-0 sutures in the distended epididymal tubule and then connecting them to the vas deferens before opening the tubule. This makes the procedure much easier because your surgeon can place the sutures in the enlarged distended tubule rather than the open deflated tubule.

Once your surgeon places all the sutures, your surgeon will open the tubule with a microsurgical knife and then tie the sutures down.

Before & During Vasectomy Reversal

We will give you exact instructions to prepare for the vasectomy reversal. Please tell us about any medications you take, including aspirin. We may ask you to stop taking some or all of these.

On the day of your procedure, bring clean cotton briefs or an athletic supporter with you.

During the Procedure

You’ll receive medication to keep you comfortable. You may be awake and relaxed during the procedure or you may be completely asleep.

Once the medication takes effect, we will make an incision in your scrotum. Then we will lift out the cut ends of each vas deferens and examine them. We may need to remove a section of each cut end.

We will cut the end closer to the testicles until fluid flows freely. We may look at this fluid under a microscope to see if sperm are present. Then we stitch the two cut ends together. If needed, we can attach the vas directly to the epididymis (tube in the back of the testicle).

When we have reconnected both of the vas deferens, we will suture the incisions in the scrotum closed.

Vasectomy Reversal Recovery

Vasectomy reversals are performed under general anesthesia. You won’t need to stay in the hospital overnight to recover, and you can go home the same day. Patients typically have minimal pain.

Vasectomy Reversal Pain

For pain relief, take Ibuprofen 800mg every eight hours and Tylenol 650mg every six hours around the clock for three days. Take narcotic pain medication only if needed.  You can take antibiotics if we prescribe them.

To lessen the chance of swelling, stay off your feet as much as you can for the first 24 hours. Place an ice pack or bag of frozen peas (wrapped in a thin towel) on your scrotum for short amounts of time. This helps reduce swelling.

Wear snug cotton briefs or an athletic supporter for extra support. We will also give you instructions for showering and bathing.

After surgery, we ask that patients don’t have sex or masturbate for three weeks. We also ask patients to avoid lifting anything heavier than a gallon of milk for three weeks after the reversal.

Vasectomy Reversal Risks

With any surgical procedure in which we use anesthesia, there is always some risk. You could also possibly have:

  • infection (symptoms include fever, chills, drainage from the incision, or pain),
  • internal bleeding of the scrotum (symptoms include increasing pain, excessive swelling, a large black and blue area, or a growing lump), and/or
  • the procedure fails to restore fertility.

Vasectomy Reversal Cost

Typically, insurance doesn’t cover vasectomy reversal. The cost will depend on where you live, but usually costs $8,000 in total, including consultation, surgery, and anesthesia.

Vasectomy Reversal Vs IVF

Vasectomy reversals are much less expensive than IVF. Also, it is possible for you and your partner to have multiple pregnancies after a vasectomy reversal. With IVF, each cycle is designed to result in only one pregnancy and birth.

Vasectomy Reversal Success Rate

Vasectomy reversal surgeries are usually successful in the hands of fellowship-trained microsurgeons who regularly perform them.

Some men have no sperm or few sperm, even if their vas deferens tubes are successfully reconnected. Scarring, chronic congestion, or developing anti-sperm antibodies can cause men to have few or no sperm.

Several other factors can influence whether your vasectomy reversal is successful. These include:

  • procedure technique,
  • your surgeon’s skill level,
  • amount of time since your vasectomy,
  • the quality of your vasal fluid, and/or
  • whether you have any blockage in your epididymis.

If the vasectomy reversal worked, you will have sperm in your semen after the reversal surgery. If your vasectomy reversal fails, you will probably need IVF or an alternative reproductive technology.

Should I Store My Sperm in A Sperm Bank?

We also offer men the option of banking their sperm at the time of their vasectomy reversal. We can collect sperm during a vasectomy reversal by making a small incision (cut) in your testicle to remove some of the seminiferous tubules. This incision is then closed with very fine suture.

We will then take your tubules to the andrology lab to extract and freeze your sperm. Your sperm will be placed in liquid nitrogen and can stay in our lab for as long as you’d like.

Benefits of Banking Your Sperm

In rare cases, sperm may not return to your ejaculate after a vasectomy reversal. Your partner or spouse may also have infertility and need IVF. If either of these things happen, you won’t need to have another procedure to extract your sperm. We can extract and then store some of your sperm during your vasectomy reversal.  

Our Doctors on the Radio

Vasectomy Reversal—Answers for Your Questions: Jim Hotaling, MD, ESPN 700

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