Vasectomy reversal: An overview

Are you getting a vasectomy?
Plan ahead and get some cold packs on Amazon and a 3 pack of jock straps for a comfortable post-surgery recovery!

Although reversal techniques are improving, if you are considering a vasectomy you should not consider it as a temporary method of contraception – you should consider it as permanent sterilisation.

Sperm banking is available, but if you are considering this as a option, then it may be that you aren’t totally sure you want a vasectomy and should take a little more time to consider your decision. Mentioning sperm banking to a Doctor during pre-vasectomy counselling will signal to him that you have doubts.

Members of the medical profession, including those who perform reversals will tell you that you should consider vasectomy to be permanent.

When was the first vasectomy reversal performed?

Back in 1907, would you believe! Parlovechoi first attempted to reverse an accidental vasectomy that occurred in a hernia operation. Later authors describe the technique under the names of Vasorraphy or vasovasal anastomis.

Read more in our comprehensive article on the history of vasectomy.

Who has a vasectomy reversed?

In the main, the men most likely to have a reversal are those who are with a different partner from the one when they had a vasectomy, those for whom circumstances have changed, and those who didn’t consider it fully or regret it due to being pressured into it in the first place. A major factor is age at time of vasectomy. One study published in 1999 finds that “Vasectomy reversal occurred 12.5 times more often in men who underwent vasectomy in their 20s than in men who were older”.

How successful is it?

Success rates vary. Some of the factors that have an effect are the age of the man, and the time elapsed since vasectomy. Although it is quite common to hear success stories of older men having a reversal many years after their vasectomy and becoming fathers again, generally speaking the younger the man is, and the shorter the interval between vasectomy and reversal, the better the success rate is. The generally quoted averages are about 60% of men post reversal are able to get their wives pregnant.

If I have a reversal, does that mean my wife will get pregnant?

Not necessarily. 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.

There are many factors involved here. Antisperm antibodies (in both men and women) being one potential issue. About 60% of men have an increase in detectable antisperm antibodies after their vasectomy. This may affect the ability to get your wife 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 couples with the same female partner”.

If reversal fails, are there other options to father a child?

The option here is ICSI – Intra-Cytoplasmic Sperm Injection. The technique is to remove sperm from the epidermis by a process called aspiration, and fertilise an egg by selecting one sperm and injecting it into the egg. The fertilised egg is then implanted using conventional IVF techniques. The technique does offer a chance to father a child, but the whole process is expensive, and IVF does not have a 100% success rate. One study published in 2004 that makes a comparison between reversal and ICSI/IVF to father children post-vasectomy concludes that the success rates are similar, but recommends reversal as the first choice due to the risk of multiple pregnancies of the ICSI/IVF technique.

An excellent site from infertile.com describes the technique and success rates in detail.

Are there any vasectomy techniques that lend themselves to easier reversal?

For those considering a vasectomy, it’s a good idea to point out that the operation technique used may have a bearing on how reversible the procedure is. The two most common forms of incision are bilateral and midline. “Bilateral” is where two small incisions are used – one for each vas deferens, and “Midline” is where one incision is used to gain access to both vas deferens.

Medical opinion is bound to vary between doctors, but some specialists feel that the bilateral version may be more reversible than the midline version because a midline scrotal incision places the vasectomy low down towards the convoluted vas, and that vasectomy reversal success is proportionate to the length of the ‘distal remnant’. Some reversal specialists feel that the best way forward is to use the no scalpel technique to approach the vas then perform an open ended vasectomy – but using high bilateral incisions to leave long distal remnants.

There is a new device called Vasclip on the market with currently limited availability that may offer easier reversal than conventional techniques. At the present time information is limited as the device is new. Vasclip do not make any claim that the device is more reversible than conventional techniques, but in the past vasectomy clips have been trialled with easier reversal being the purpose. Time will tell! As of the end of July 2007, the Vasclip site is down, and I’m not getting any response to my enquiry emails from Vasclip.

The above is NOT intended to be used as medical advice, but discussion points between you and your doctor when discussing what procedure is the most suitable for yourself. The links below give more detail about reversal techniques and success rates.

Links to websites covering reversal surgery

Fertilityforums.info

Discussion forum dealing with vasectomy reversal, and all matters relating to fertility.

Maleinfertility.com

This is a really great site from Cornell University with much detail about vasectomy reversal and other fertility techniques. Contains narrated mini-videos of procedures.

Infertile.com

Selection of media and technical video and audio clips on infertility treatments and vasectomy reversal.

Infertile.com

Sperm aspiration – how it’s done. The technique is used to collect sperm for IVF/ICSI.

Infertile.com

Microscopic Vasectomy Reversal – comparison of techniques.

Infertile.com

Comparison on the success rates of reversal and sperm aspiration/ICSI to get pregnant (vasectomised men).

The patients guide to vasectomy reversal

Excellent site from Columbia University.

Well connected

“Well connected”. Panel comprising of experts from Harvard medical school and Massachusetts general hospital. Deals with all aspects of vasectomy, physical and psychological. Highly recommended reading. Has a section on reversal, with alternatives if reversal is unsuccessful.

Vasectomy.com

VASECTOMY.COM General article about reversal surgery.

UK reversal information

UK vasectomy practice website page on the reversal procedure. Explores the main reasons for regretting a vasectomy, suitability for the surgery and discusses the procedure. Information provided here is of use to anyone searching for this information – not just UK residents.

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