Approximately 4 - 10% of men who have a vasectomy request a reversal. Most men seeking information about a vasectomy reversal are in a new relationship and are interested in having children with this new partner. Approximately 20% of patients seek a reversal to have children with the same partner.
Many factors influence the chance for success after a vasectomy reversal. The chance for patency (sperm returning to the semen) is influenced by:
- the time since the vasectomy
- the appearance of the fluid seen from the vas deferens at the time of surgery
- whether or not an obstruction is present in the epididymis
- surgical technique and experience
The chance for pregnancy is influenced by:
- the time since the vasectomy
- the appearance of the fluid seen from the vas deferens at the time of surgery
- whether or not an obstruction is present in the epididymis
- surgical technique and experience
- any female fertility factors
In the most widely quoted study on vasectomy reversal, the Vasovasostomy Study Group1 demonstrated that the chance for success after a vasectomy reversal decreased with increasing time between the vasectomy and the reversal.
This study also demonstrated that the appearance (clear, cloudy, or thick and pasty) of the fluid from the vas deferens and whether sperm were seen at the time of surgery also affect the chances for success. If no sperm are seen in the vas deferens fluid and the time between the vasectomy and reversal is long then a secondary obstruction in the epididymis may exist. In these cases, the more complex vasoepididymostomy (connection between the vas deferens and the epididymis) may be required.
Surgical experience and technique are also important. A surgeon who performs the procedure regularly will likely have higher success rates than one who performs the procedure only occasionally. While a vasectomy reversal can be performed with or without a special operating microscope, most specialists agree that microsurgical procedures have a higher success rate and most studies show significantly higher success rates with microsurgery.
Any female fertility factors which are present can also affect the chance for pregnancy. Therefore it is important that the female partner receive regular gynecologic care and discuss attempting a pregnancy with her gynecologist before a vasectomy reversal is performed.
A vasectomy reversal can be performed with local, regional (spinal or epidural) or general anesthesia. The choice of anesthesia is based on surgeon and patient preference. The procedure can be performed as an outpatient with the patient going home on the day of surgery. For three weeks after surgery, activity is restricted both to minimize discomfort and to reduce the risk of jeopardizing the delicate microsurgical anastomoses (connections between the vas deferens and/or epididymis). A patient may also have work restrictions, depending on the type of work he does. Specific questions about work and postoperative activity should be discussed with the surgeon.
There are other options for having children after a vasectomy. A couple can choose adoption or donor insemination using sperm from a sperm bank. Another option which can allow a man to have his own biological children is sperm retrieval with in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Many factors determine which of these options is most appropriate for a couple including the expected chance for success, cultural or religious beliefs, and financial considerations.