Vasectomy Reversal as a Male Infertility Option
What is a vasectomy reversal?
A vasectomy reversal re-establishes fertility by reconnecting the severed sperm duct (or vas deferens), which is located in each side of the scrotum. The procedure restores the passage for sperm to reach a female egg.
What are the different types of vasectomy reversals?
Vasectomy reversals are generally performed in an outpatient area of a hospital or in an ambulatory surgery center. The operation may be performed with local, epidural, spinal or general anesthesia. Once you are anesthetized, your urologist will make small incisions on each side of your scrotum in order to remove the scarred ends of the vas deferens (or vas) at the point of blockage created by the vasectomy. Then, the urologist will extract a fluid sample from the end closest to the testicle to see if it contains sperm. When sperm are present in the fluid, the passage can be reestablished by reconnecting the ends of the vas.
Urologists may choose to use a modified one-layer method or microsurgery to perform the reversal. During a modified one-layer method, a series of tiny stitches is placed through the entire thickness of the vas to join the ends. Once these stitches (the first layer) are tied, a second set (or layer) of stitches that only pierces the outer portion of the vas is placed between each adjacent pair of stitches. Urologists use microsurgery to produce better results using high-powered microscopes that can magnify structures from five to 20 times their actual size. An operating microscope allows the urologist to manipulate stitches smaller in diameter than an eyelash to join the ends of the vas.
Robot-assisted vasectomy reversals are becoming increasingly popular. With this technique, a surgeon uses a medical robot to perform the procedure. The medical robot offers the surgeon the ability to rotate instruments more than 360 degrees through tiny incisions and assist in technically precise maneuvers involved in advanced, minimally invasive surgeries, like a vasectomy reversal. The robot’s every move is controlled by the surgeon and instead of standing over the patient, the surgeon sits at a console in the operating room and looks at a large monitor. Major advantages of robotic technology to perform vasectomy reversals include:
3-D view: Conventional microscopic vasectomy reversals only allow a 2-D view. Depth perception is enhanced with the robotic platform, which is critical when operating in a field where sutures are finer than the human hair.
Angulation of the camera: It is natural to turn and turn and angle your head to get the best view of an area. In conventional surgery, the microscope only offers one, top-down view. With the robotic technology, the surgeon can easily change the angle of the camera to get a better view.
Scaling of movement: The robotic instruments can be scaled down in how much they move compared to the surgeon’s controls. This allows for extreme precision.
Some studies comparing robot-assisted procedures with microsurgical vasectomy reversals show that the medical robot may help surgeons have improved visualization, it may help eliminate any tremors, and it decreases surgeon fatigue. They also showed that the robotic procedure was faster than the conventional reversal because the robot allows the surgeons to use the instruments more efficiently. Sperm count for both procedures were about the same, but the robotic procedure resulted in a quicker return of sperm count.1
- J Reconstr Microsurg. 2012 Sep;28(7):435-44. doi: 10.1055/s-0032-1315788. Epub 2012 Jun 28.
Who is a candidate for a vasectomy reversal?
Vasectomies can be reversed, meaning healthy sperm can be restored to the ejaculate. Vasectomy reversals are performed when the personal circumstances of a couple have changed: remarriage, the loss of a child, or the desire for more children. Any man who has had a vasectomy and is interested in having more children is a candidate for a vasectomy reversal.
What is the success rate of a vasectomy reversal?
Vasectomy reversals are highly successful in returning sperm to ejaculate, with rates exceeding 98% in the first couple of years following a vasectomy.
Are there alternatives to the vasectomy reversal? What are the options if the vasectomy reversal fails?
With increasing time between the vasectomy and the vasectomy reversal, the success rate slightly declines but continues to remain high. In certain rare instances, the vasectomy reversal is not successful. The options in these circumstances are either to perform a redo-vasectomy reversal, undergo in vitro fertilization with sperm harvested using a procedure such as a microscopic epididymal sperm aspiration (MESA), or to use donor sperm.
Does a vasectomy reversal make financial sense compared to alternatives?
Numerous studies have been conducted to determine the cost-effectiveness of a vasectomy reversal compared to only harvesting sperm for an IVF procedure. These studies confirm common sense: a vasectomy reversal is a less expensive and simpler way to have more children rather than undergoing IVF with intracytoplasmic sperm injection (ICSI) in most cases.
Is the sperm quality different after a vasectomy reversal?
Some couples are curious about the quality of sperm following a vasectomy reversal. The quality and quantity of sperm generally return to the baseline characteristics which were present before the vasectomy. Furthermore, there is no evidence that children conceived following a vasectomy reversal have any issue with birth defects or developmental abnormalities, nor is there any evidence that there is an increased risk of miscarriages.
What is the overall step-by-step experience of getting a vasectomy reversal, from the first visit to the post-op phase?
The step-by-step process of proceeding with a vasectomy reversal is to meet with a urologist who has expertise in vasectomy reversals. The urologist will review your history, perform a physical exam, and assess for the distance between the two ends of the sperm duct on both sides. The examine of the male partner is also to make sure there are no abnormalities that could complicate a successful vasectomy reversal.
The vasectomy reversal surgery is outpatient. Patients are typically asked to abstain from sexual activity for one month following the vasectomy reversal. Light activity is acceptable following the procedure, but the patient should abstain from vigorous activity following the procedure for one month. Overall, the vasectomy reversal is a safe and effective method to restore healthy sperm to the ejaculate.
What are the risks of a vasectomy reversal?
Infection is extremely rare.
What is the infection rate?
The vasectomy reversal is a safe and effective procedure.
How much pain is there after a vasectomy reversal?
Pain is minimal and most patients can return to work in 2-3 days.
What can be expected after a vasectomy reversal?
Recovery from a vasectomy reversal should be relatively quick. Any pain that you might experience after surgery can be controlled with oral medications. You can usually resume your normal routine and light work within a week. Your urologist will probably advise you to refrain from heavy physical activity for about four weeks. You will also be advised to wear a jockstrap for support for several weeks, and you must refrain from sex for at least two weeks. On average, it takes one year to achieve a pregnancy after a vasectomy reversal. However, some pregnancies occur in the first few months after the reversal procedure.