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Vasectomy Reversal

Vasectomy reversal surgery restores fertility in most men. Find out what to expect and how to prepare. Of the half a million men who have a vasectomy each year, 2 percent to 6 percent of them — 10,000 to 30,000 men — later decide to have the vasectomy reversed. This surgery reconnects the ducts that carry sperm from the testicles into the semen. After successful vasectomy reversal, sperm are present in your semen again and you may be able to get your partner pregnant.

Who is it for?

Men decide to have the surgery to restore fertility for a number of reasons, including loss of a child, remarriage or improved finances. A small number of men have a vasectomy reversal to treat testicular pain.

Before having vasectomy reversal surgery to restore fertility, your doctor will want to make sure you can produce healthy sperm. For most men, having gotten a woman pregnant before is proof enough. If your doctor is unsure whether you are producing enough healthy sperm, you may need a testicular biopsy. Your female partner also needs to be tested to make sure she doesn't have fertility problems.

Vasectomy reversal can be effective regardless of how long it's been since the original vasectomy. However, if more than 15 years have passed since the original vasectomy, you may have a lower chance of having enough healthy sperm in your semen to father a child.

Vasectomy is a straightforward surgery and an effective form of birth control — but surgery to undo a vasectomy is more involved and doesn't always work. The cost for a vasectomy reversal can range from $5,000 to $12,000 or more, and this procedure isn't usually covered by insurance.

How do you prepare?

Doctors usually perform vasectomy reversals at a surgery center or at a hospital. It's a delicate, microsurgical procedure that can be done using a few different surgical techniques.

How is it done?

Vasectomy reversal

The surgery is more difficult than the original vasectomy because the tube that carries sperm from each testicle to your semen (vas deferens) must be sewn back together or attached to the epididymis. The surgery usually is done on an outpatient basis — without an overnight stay at the surgery center or hospital. Doctors can perform this surgery in one of two ways:

What can you expect during the procedure?

You may have general anesthesia to make you unconscious during the surgery. Or, your surgeon may use an epidural, spinal or local anesthetic. In any case, your anesthesia will need to keep you completely still because the surgery is so delicate. It's done using a microscope that magnifies the surgery area five to 20 times, and any movements are magnified by the operating microscope.

The surgeon will make a cut on the underside of your scrotum, expose the testicle, and release it from surrounding tissues. Next, he or she will cut open the vas deferens and examine the fluid inside.

Fluid assessment

Once the vas deferens has been opened, the surgeon will do a naked-eye inspection of the fluid that comes out as well as examine a drop of the fluid under a microscope. This is an important part of the operation because it helps your doctor determine what type of surgery you need to restore the flow of sperm.

Freezing sperm

If your doctor finds sperm during the surgery, you may choose to have some frozen in case your vasectomy reversal doesn't work. If after vasectomy reversal you're not able to father a child through sexual intercourse, your frozen sperm may be injected directly into an egg. This is a type of in vitro fertilization called intracytoplasmic sperm injection (ICSI).

After Surgery

Immediately after surgery, your doctor may cover the incisions with bandages. You'll put on your jockstrap to hold any bandages in place and apply some pressure to reduce swelling and movement. You'll need to rest with an ice pack placed on your scrotum to reduce swelling. As the anesthetic wears off, you may have some pain and cramping that can be relieved with acetaminophen. For most men, the pain isn't severe and gets better after a few days to a week.

After you return home, take it easy. You may be sore for several days, which you can treat with acetaminophen or, if your doctor prescribes it, acetaminophen plus codeine. You may also have bruising, but the discoloration should lighten and disappear after about two weeks. Any stitches should dissolve in seven to 10 days.

Results

In successful vasovasostomy, sperm usually appear in the semen after a few months. After a vasoepididymostomy, it takes longer — from three to 15 months. Vasectomy reversal leads to pregnancy in about 52 percent of couples within two years. While some pregnancies occur within a few months after a vasectomy reversal, the average is about a year after the procedure.

Sometimes problems with conception are due to female infertility. When the female partner doesn't have fertility problems, couples are more likely to conceive a child after a vasectomy reversal.

Your surgeon will want to examine your semen after surgery to see if the operation was successful. Unless you achieve pregnancy, a sperm count is the only way to tell if your vasectomy reversal was a success.

If vasectomy reversal doesn't work

Vasectomy reversals sometimes fail if there is a sperm blockage that wasn't recognized during surgery, or if a blockage develops sometime after surgery. Some men have a second-attempt vasectomy reversal if the procedure doesn't work the first time.

Experts are investigating whether anti-sperm antibodies — proteins that develop after a vasectomy — might interfere with fertility after vasectomy reversal. Research shows anti-sperm antibodies can inhibit the function and movement of sperm, but experts are still not sure about their effect on fertility after a vasectomy reversal.

Risks

Risks of vasectomy reversal include:

Call your doctor if you develop any of these signs and symptoms:

Looking Ahead

Different surgical techniques can be used to perform vasectomy reversal. Experts are evaluating the outcomes of various surgical techniques to determine which ones are most successful. While surgeons can apply research about the best techniques to their own practice right away, other developments are on the horizon that will take longer before they are commonly used:

Experts are investigating the use of new methods to replace stitches, including glue, use of lasers and biological tissue. They think that once developed, methods other than stitching may decrease surgery time and provide better results.

To watch videos of our international patient’s testimonials: Click here

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