What to know about a vasectomy reversal

Each year, more than 500,000 men in the U.S. choose vasectomy for permanent birth control. This form of sterilization prevents pregnancy better than any other method of birth control, except for abstinence. Only 1 in 2 women out of 1,000 will get pregnant in the year after their partners have had a vasectomy.

Even though at the time a man decides to undergo the procedure to have a vasectomy, about 5-10 percent of these men may change their mind later down the road to have it reversed. This change of heart may stem from a new marriage, a couple deciding they want a child or from the unfortunate experience of losing a child.

What is a vasectomy reversal?

A vasectomy reversal is a safe procedure with few risk of bleeding or infection that is becoming an increasingly common and doable surgical procedure with generally good results. The goal of a vasectomy reversal is to restore a man’s fertility. This microsurgical procedure, which takes about 2-5 hours, is performed to restore the ability of the vas deferens to transport sperm from the testicles to the penis, where it exits after ejaculation. Men who have this procedure done should be able to go home the same day. Generally, most men can go back to work in a day or two, if they have a desk job. Men with a more strenuous, physical job may need to wait to return to work for three or four days.

There are two ways a vasectomy reversal can be done:

·      Vasovasostomy, which involves reconnecting the two cut ends of the vas deferens to the epididymis in order to bypass a blockage above the vasectomy site. This procedure is performed in 70% to 80% of vasectomy reversals as it is easier to perform and tends to have a higher success.

·      Epididymovasostomy, in which the surgeon must suture the ends of the vas deferens to the epididymis in order to bypass a blockage above the vasectomy site.

How successful are vasectomy reversals that result in a pregnancy?

The success of a vasectomy reversal depends on several factors.  If a man waits a long time to pass between a vasectomy and a vasectomy reversal, there is a reduced likelihood of achieving pregnancy. For men who undergo a vasectomy reversal within about ten years of a vasectomy, can expect a higher success rate of their partner becoming pregnant. Men who wait more than 15 years, have about a 70% success rate of a pregnancy occurring.

The testicles keep producing sperm even after a vasectomy

This good news is that even if a man has a vasectomy, the testicles will continue to produce sperm, it just no longer has a way out of the body. Once a man has a vasectomy reversal, his normal fertility is restored. After this procedure, men need to refrain from sex for about 3 weeks in order for healing to occur. Keep in mind, it may take as long as 12 months for a man’s fertility to return.

How long does it take for a man’s fertility to return?

Typically, it takes several months and in some cases, more than a year, before fertility returns. A vasectomy reversal can result in a pregnancy in about 40% to 75% of cases. The best way to tell if a man’s fertility has returned is to test the sperm count. This can be done at a urologist office where the semen can be tested every 2 to 3 months until the sperm count holds steady or your partner becomes pregnant. Sperm often appear in the semen within a few months after a vasovasostomy but may take from 3 to 15 months after a vasoepididymostomy. In either case, men should stay fertile for many years. 

Does having a vasectomy reversal have a negative effect on a man’s sex drive or his ability to get an erection?

The answer to this is no.  A vasectomy reversal does not involve any structures that have an impact on a man’s sex drive or his ability to achieve an erection.

Does insurance cover a vasectomy reversal?

The answer to this is it depends on what type of insurance you have, but generally, most insurance do not cover a vasectomy reversal. This will be a factor for a couple to consider as they will likely have to pay out-of-pocket for this procedure.

How to find a qualified surgeon who does vasectomy reversals

Like with any surgical procedure, a couple considering a vasectomy reversal should do their homework.  Look for a surgeon who has a lot of experience performing this microsurgical procedure, has an excellent success rate, and can perform an epididymovasostomy if required. Ask your family physician or urologist for referrals.

Once possible candidates are found, arrange for a consultation to ask questions such as the following:

·      What is the doctor’s educational background? Did they complete a fellowship?

·      What is the doctors’ vasectomy reversal success rate?

·      How many vasectomy reversals have they performed?

·      What complications have they encountered when performing vasectomy reversals?

·      Can they bank sperm?

·      What other alternatives are there if the procedure is not successful?