Vasectomy reversal: Overview, success rate, alternatives and more

Although the number of vasectomies carried out each year has decreased, the number of men requesting reversal of the sterilization procedure has increased substantially. An estimated 3 to 6 percent of vasectomized men will seek reversal at a later date.¹

If you are considering a vasectomy, you should view it as permanent sterilization and not as a temporary method of contraception. Sperm banking is available, but if you are considering this as an option, then it may indicate that you aren’t entirely sure about getting a vasectomy, and should take a little more time to consider your decision. Mentioning sperm banking to a Doctor during your pre-vasectomy consultation may signal that you have doubts.

What is a vasectomy reversal?

Vasectomy reversal is a surgical procedure that restores the flow of sperm in the male reproductive tract after a vasectomy. An experienced microsurgeon will reconnect the two ends of the vas deferens that deliver sperm into semen. There are two types of vasectomy reversals:

Vasovasostomy

A vasovasostomy is the surgery of choice for vasectomy reversal and the operation most frequently performed. The surgeon will make an incision in the scrotum, locates the spermatic cords, and reconnects the two cut ends of the vas deferens.

Vasoepididymostomy

During the surgery, the fluid from the vas deferens is analyzed. Sperm may be blocked from getting to the vas deferens due to excessive inflammation or scarring in the epididymis. If a blockage has occurred, and sperm is absent, vasoepididymostomy will be necessary to bypass the blockage.

A vasoepididymostomy is performed by connecting the vas deferens directly to the small organ at the back of each testicle (epididymis).

There is no way to know ahead of time which procedure is needed. In most cases, the surgeon decides during the operation which technique will work the best after examining the quality of the vasal fluid.

Who has a vasectomy reversed?

Men most likely to have a reversal are those who are with a different partner from the one when they had a vasectomy, in fact, the strongest predictor of request for reversal is a change in marital status.² A significant factor is the age of the man at the time of vasectomy. One study published in 1999 finds that vasectomy reversal occurred 12.5 times more often in men who underwent a vasectomy in their 20s than in men who were older.³

Is it possible to get pregnant after this procedure?

Although the patency rate (percentage of men that doctors are able to re-establish sperm flowing through the vas deferens) tends to be high – typically 90% plus, the actual rate of pregnancy is usually quoted around the 60% mark.¹

An important predictor of reversal success is the time since vasectomy, as the longer, the amount of time that passes, the less likely successful reversal becomes.⁴ There are many other factors involved as well. Antisperm antibodies (in both men and women) is one potential issue. About 60% of men have an increase in detectable anti-sperm antibodies after their vasectomy. This may affect the ability to get your partner pregnant post-reversal. Age of the woman and time since reversal are also factors that may have an influence. One study published in 2003 found that “Microsurgical vasectomy reversal may have higher success rates when performed for the same couples getting back together”.⁵

Is pregnancy possible without a vasectomy reversal?

Should a vasectomy reversal fail, there are other options to father a child. Traditional artificial insemination methods like in vitro fertilization (IVF) are available if the man banked sperm before his vasectomy. If he didn’t take this step, artificial insemination may be possible with the help of ICSI (Intracytoplasmic Sperm Injection). While artificial insemination may be a good option for couples who are experiencing severe fertility issues, most doctors agree that a vasectomy reversal is ultimately the better choice.

Reasons to choose artificial insemination

Even though doctors may steer couples towards the vasectomy reversal option, there are a handful of reasons why artificial insemination may be a good choice.

• Vasectomy reversals are not always successful, with failure rates ranging from 10% to 20%. While additional reversal operations may result in the restoration of a man’s fertility, the idea of multiple procedures may be unappealing to some men.
• Overall success rates of vasectomy reversals decline with time. According to one source, vasectomy reversals are most likely to succeed when performed three years after vasectomy and are only 30% successful when performed 10 years after.¹
• If a man only wants one additional child, he may wish to remain sterile after the child is conceived. Artificial insemination can allow a couple to have “just one more” without undoing the man’s vasectomy.

Post-vasectomy artificial insemination methods

There are two primary methods available to couples in which the man has had a vasectomy:

Intrauterine insemination (IUI)

Intrauterine insemination involves injecting a man’s sperm directly into his partner to produce a pregnancy. IUI is only possible if a man banked sperm before his vasectomy. If banked sperm is available, then intrauterine insemination may be possible after a vasectomy. Otherwise, IVF (in conjunction with ICSI) must be used.

In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), often written as IVF/ICSI

In vitro fertilization involves directly fertilizing a woman’s egg outside of her body then placing it back into her uterus. IVF was traditionally performed with sperm collected from the sample provided by the man, but this is obviously not possible for a vasectomized man.

A technique known as ICSI (intracytoplasmic sperm injection) allows doctors to obtain viable sperm from a man even after a vasectomy. This sperm can then be used for IVF (in-vitro fertilization) to help a woman become pregnant.

The concept behind IVF/ICSI is fairly simple, although the process itself requires cutting edge technology and highly trained fertility professionals. In ICSI, sperm are extracted from the man’s testicle or epididymis through a process known as sperm aspiration (aspiration is simply the medical term for “removal”). Using a microscope, a single sperm is injected into the donor woman’s egg. This fertilized egg is then implanted into a woman’s uterus, which will often result in a pregnancy.

ICSI success rates

The Infertility Center of St. Louis Fertility Clinic, which helped pioneer ICSI, reports that an ICSI/IVF cycle results in a fertilized embryo in most cases and produces a pregnancy 46% of the time.⁶ There are numerous factors that can affect the success rate of ICSI, including female fertility conditions and the experience of the clinic performing the procedure.

Some couples may wonder if sperm extracted via aspiration (as in ICSI) can be used for IUI. Sperm extracted from a man’s testicle or epididymis is not mature and is generally unable to penetrate and fertilize the wall of a woman’s egg. This is why it must be directly injected into a woman’s egg via IVF.

Summary

Although almost all vasectomies are reversible, the success of the procedure depends heavily on the man’s age, years since his vasectomy, and other factors. Vasectomies can technically be reversed multiple times. But the success rate may decrease with each operation.