Vasectomy Reversal is a procedure in which the effects of male sterilization are reversed. During a sterilization procedure known as vasectomy, the vasa deferentia, (ducts that carry the sperm from the testicles), are cut, tied or cauterized (burned or seared). When a vasectomy reversal is done, it creates an opening between the disjoined ends of each vas deferens so that the sperm can enter into the semen before ejaculation.
Purpose
The purpose of a vasovasostomy is to restore a man's fertility, whereas a vasectomy or male sterilization, is performed to provide reliable contraception (birth control). Research indicates that the level of effectiveness in preventing pregnancy is 99.6%. Vasectomy is the most reliable method of contraception and has less risk of complications and a faster recovery time than female sterilization methods.
Most cases of vasectomy can be reversed. This reversal though, does not guarantee a successful pregnancy. The longer a man has had a vasectomy done, the more difficult the reversal would be and lower the success rate. The rate of sperm return if a vasovasostomy is performed within three years of a vasectomy is 97%; this number decreases to 88% three to eight years after vasectomy, 79% by nine to 14 years, and 71% after 15 years. Other factors that can affect the success rate of a vasovasectomy are age of the female partner, her fertility potent, the method of reversal used and the surgeon’s expertise in performing the operation.
Vasovasostomies are also performed in men who are sterile because of genital tract obstructions rather than prior vasectomies. A vasovasostomy may also be performed on occasion to relieve pain associated with post-vasectomy pain syndrome.
Demographics
An estimated 5% of men who have had a vasectomy later decide that they would like to have children. Some reasons for wanting a vasectomy reversal include death of a child, death of a spouse, divorce or experiencing a change in circumstances so that having more children is possible. One study found that divorce was the most commonly reported reason for a vasovasostomy and that the average age of men requesting a vasovasostomy is approximately 40 years.
About 7.4% of infertile men have primary genital tract obstructions caused by trauma, gonorrhea or other venereal infections or congenital malformations of the vasa deferentia. Many of these men are good candidates for surgical treatment of their infertility.
Most surgeons prefer to have the patient given either a continuous anesthetic block or general anesthesia because of the length of time required for the operation. A vasovasostomy generally takes two to three hours to perform, depending on the complexity of the surgery and the experience of the operating physician. More complex surgeries may take as long as five hours. The advantage of general anesthesia is that the patient remains unconscious for the duration of the surgery, which ensures that he remains comfortable. Regional anesthesia, such as a spinal block, allows the patient to remain awake during the procedure while blocking pain in the area of the surgery.
After anesthesia is administered, the surgeon makes an incision from the top of one side of the scrotum, sometimes moving upward as far as several inches (centimeters) into the abdominal area. Another incision, similar to the earlier one, is made on the other side of the scrotum. The vasa deferentia will be identified and isolated from surrounding tissue. From the testicular end of each vas deferens the fluid is removed and analyzed for presence of sperm. If sperm are found, then the ends of the vasa deferentia that were previously cut in a vasectomy will now be connected. If no sperm are found, a more complex procedure called a vasoepididymostomy or epididymovasostomy (in which the vas deferens is attached to the epididymis, a structure in which the sperm mature and are stored) may be more successful in restoring sperm flow.
There are two techniques that may be used to reconnect the cut ends of the vasa deferentia. A single-layer closure involves stitching the outer layer of each cut end of the tube together with a very fine suture thread. This procedure takes less time but is often less successful in restoring sperm flow. A double-layer closure, however, involves stitching the inner layer of each cut end of the tube first, and then stitching the outer layer. After reconnection is established, the vasa deferentia are returned to their anatomical place and the scrotal incisions closed.
Diagnosis/Preparation
Before a vasovasostomy is performed, the patient will undergo a preoperative assessment, including a physical examination of the scrotum. This evaluation will allow the surgeon to determine what sort of vasectomy reversal should be performed and how extensive the surgery might be. A medical history will be taken. The physician will review the patient's medical records in order to determine how the patient's vasectomy was performed; if large portions of the vasa deferentia were removed during surgery, the vasectomy reversal will be more complicated and may have a lower chance of success. The patient's partner should also undergo a fertility assessment, including a gynecologic exam, to assess her reproductive health.
Some surgeons prefer to give the patient a broad-spectrum antibiotic about half an hour before surgery as well as a mild sedative.
Usually complications can occur after vasovasostomy. These include swelling, bruising and symptoms related to anesthesia (nausea, headache, etc.). If the operation is inadequately done or scarring partially blocks the channel inside the vasa deferentia, there would be a risk of low sperm count. In rare cases, there can be other risks of infection or severe hematoma (collection of blood under the skin). The most serious potential complication of a vasovasostomy is testicular atrophy (wasting away), which may result from damage to the spermatic artery during the procedure.
After the procedure the patient will be transferred to a recovery room where he will remain for approximately three hours. The patient will be asked to void urine before discharge. Pain medication is prescribed and usually required for one to three days after the procedure. Antibiotics may be given after the procedure as well as beforehand to prevent infection. Ice packs applied to the scrotum will help to decrease swelling and discomfort. Heavy lifting, exercise, and sexual activity should be avoided for up to four weeks while the vasovasostomy heals.
Patients are usually allowed to return to work within three days. They may shower within two days after surgery, but should avoid soaking the incision (by taking a tub bath or going swimming) for about two weeks. The surgeon will schedule the patient for an incision check about a week after surgery and a semen analysis three months later.
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