Vasectomy Reverse

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In recent years, vasectomy reverse procedures have increased in their effectiveness at helping men to regain their fertility. Where at one time vasectomies were believed to be a permanent form of birth control; today, having a vasectomy reversed is an outpatient procedure that produces impressive results.

A vasectomy reverse, or vasovasostomy, is a microsurgery that reconnects the tubes (vans deferens) which were cut in the original vasectomy procedure. The vans deferens are the tubes which carry sperm from the testicles to combine with the seminal fluids. A vasovasostomy is a delicate procedure that requires a surgeon specially trained in microsurgery.

Vasectomy Reverse Success and How Time Affects It

Contrary to popular belief, a vasectomy reverse can be performed regardless of how long ago one had their vasectomy. However, success rates can be affected by the length of time between the two procedures. This is due to both known and unknown factors. There is some gradual decline in sperm production that happens over time, but still millions of sperm continue to be produced. Most men form some level of antibodies to their sperm after the initial vasectomy, and for a small percentage of men the levels of antibodies are high enough prevent the sperm from working properly even though the antibodies have no other effect on the man's health. Because the male body continues to produce sperm, even after a vasectomy, the sperm will build up, eventually break down and be reabsorbed by the body. In some men, the congestion that builds up in the tubes between the testicle and the vasectomy blockage can become permanent so that even if the orgininal vasectomy blockage scar is removed, the sperm will not flow past this area of congested tube.

When this occurs, a different type of microsurgery called a vasoepididymostomy must be performed. In this complex procedure, the vans deferens is surgically connected directly to the epididymis. This kind of connection is technically more challenging. In the past when success rates were published many "experts" did not perform this procedure as frequently as they probably should have and therefore the lower rates of success that are published are likely lower than what can be achieved by those experts that are able to perform this kind of connection on a regular basis as needed. Because this connection is more delicate than a vaso-vasostomy, and because a portion of the epididymis is bypassed (the epididymis serves the function of getting the sperm moving and ready to do their job) the success rates when this kind of connection is required on both sides is a little lower.

How the Original Vasectomy Site Affects Success Rates

Another concern is where the vans deferens were cut when the original vasectomy was performed. If the original surgeon performed the vasectomy close to the testicle, it may be difficult to reconnect the vans deferens, thus requiring the vas deferens to be connected to a part of the tube called the convoluted vas which is much thinner, more bent and twisted, and more difficult to connect to. In some cases the vasectomy may be so close to the testicle that the surgeon must perform a vasoepididymostomy. Furthermore, the closer the vasectomy blockage is created to the testicle, the higher the chance of permanent congestion occurring in the tubes between the testicle and the vasectomy site because the closer blockage causes greater pressure in those tubes. If the permanent congestion occurs, the surgeon must perform a vasoepidymostomy. If the vasectomy site is farther away from the testicle, the vasectomy reverse procedure is much easier to perform and has a higher chance of success. Also, if the vasectomy site has a lump or nodule on it, this is an area where sperm have been able to leak around the original vasectomy site. This nodule is called a sperm granuloma. This almost always prevents permanent congestion and is a very good sign that a straight-forward connection will be possible with a successful result.

Other Health Conditions May Affect the Success of Vasectomy Reverse

Some men may simply be less fertile at the point in life that they seek a vasectomy reversal. This may be the result of other conditions affecting their sperm production that have occurred since their last child was conceived that that they may or may not be aware of. These conditions include trauma or infection of the testicles at some point after the vasectomy. Some men have varicoceles which are abnormal veins around the testicles that can gradually decrease fertility. Some men may have had illnesses that require medications that injure sperm production such as cancer and chemotherapy. Also some men may have been using testosterone which suppresses sperm production. Some men may have undergone surgery to the testicles or the pelvis subsequent to their vasectomy which results in additional damage to the tubes making a reconnection more difficult or impossible. For example, in a small percentage of cases, a herniea surgery can cause damage to the vas deferens at the level of the groin where the hernia repair id performed.

Indications for a Successful Vasectomy Reverse

Less time between original vasectomy and the reversal procedure
Vasectomy scar with a sperm granuloma
Good health practices such as healthy eating habits and proper exercise
Good fertility history prior to original vasectomy
Location of original vasectomy surgery, longer length of vas between the testicle and the scar

Risk factors for a Vasectomy Reverse Failure

One or both testicles appear smaller in size, damaged
Condition causing infertility that arose after the vasectomy
The length of the vans deferens, specifically if shorter
An enlarged, congested epididymis
Obstruction or blockage of sperm flow at another level other than the vasectomy