A vasectomy can be reversed. The process is called vasectomy reversal. However, the chances of becoming fertile again depend on various factors.
Microsurgery is required to reverse a vasectomy. The vasectomy reversal procedure is much more complicated than the sterilization itself – and so is the healing process. The operation takes up to three hours and the patient usually has to spend a day or two in the hospital.
Procedure for vasectomy reversal
During vasectomy reversal, the doctor works with a microscope or magnifying glasses. He first exposes the vas deferens and frees the scarred or stuck ends so that they become permeable again. Then he sews them back together. If he finds during the operation that no more semen is getting into the vas deferens via the spermatic cord, he places a kind of bypass from the epididymis to the vas deferens. However, this procedure is very complicated and should only be performed by very experienced doctors.
Successful reversal depends in part on the skill of the surgeon, but also in part on how long ago the vasectomy that is being reversed was performed: the longer the surgery and the older the scarring, the less likely it is to success. Men often develop autoantibodies against their sperm after sterilization if sperm components get into the blood during the vasectomy.
Success rates for vasectomy reversal
Below are estimates:
- 75% if you have your vasectomy reversed within 3 years
- up to 55% after 3 to 8 years
- between 40% and 45% after 9 to 14 years
- 30% after 15 to 19 years
- less than 10% after 20 years
When the woman is 40 or older, chances for fertilization are minimal.
Frequently asked questions about vasectomy reversal
- What is the recovery process? Recovery is variable and can take anywhere from 5 to 14 days. It is recommended to avoid heavy lifting and sexual intercourse during the first 4 weeks after this surgery.
- Does insurance pay for vasectomy reversal? The cost of the surgery, as well as whether or not it is covered by insurance, is variable, and dependent upon where the surgery is performed and the patient’s individual insurance policy.
- What is the typical cost of vasectomy reversal? Cost can vary widely, depending upon the surgeon, the type of practice where it is performed, and what part of the country the patient lives in.
- Who is not a good candidate for vasectomy reversal? There are certainly some patients who are better candidates than others; time from the vasectomy is not necessarily a reason not to have a reversal. However, in the case of a couple where the woman has, for instance, had a tubal ligation, surgical sperm retrieval combined with in-vitro fertilization is probably a better choice than performing vasectomy reversal followed by tubal ligation reversal.
- What are side effects of vasectomy reversal? Side effects are typically minimal and usually would include swelling, pain or bruising; however, the vasectomy itself and the reversal should not have any effect upon potency or urinary function.
- What is the effective rate of reversal? The success rate varies based on several factors. Time from the vasectomy certainly helps to predict how likely it would be to be able to put the two ends of the vas deferens back together; however, getting return of sperm into the ejaculate does not guarantee pregnancy, so pregnancy rates typically vary from 30 to 70 percent, whereas patency rate, that is the return of sperm, can be as high as 95 percent.
- What are other fertility options? The only other option to a reversal that would allow use of a man’s sperm with the woman’s egg would be surgical sperm retrieval (through either extraction or aspiration) combined with in-vitro fertilization. The sperm removed from the testicle can be injected directly into the eggs that have been retrieved from the woman after she has been stimulated with hormone injections. This is a very effective but expensive treatment with relatively good success rates. However, it is not possible to remove enough sperm from the man’s testicle to inseminate the woman.
- How do post procedure antibodies affect pregnancy rates? There is some debate about the effects of antibodies on pregnancy rates after vasectomy reversal. Approximately 70 to 80 percent of men who have had vasectomies will have antibodies to their sperm. However, these antibodies rarely prevent the sperm from fertilizing the egg. Therefore, patients should know that it is usually unnecessary to routinely test for antibodies, as they rarely will have a bad effect upon the success rate.
- Is cancer risk increased with the reversal? There was a report several years ago stating that men with vasectomies had a higher rate of prostate cancer. This report has since been challenged and, for the most part, disproven. There is also no evidence to show that reversal of the vasectomy would have any effect upon risk of cancer.
- How many times can a reversal be done? There is no maximum number of times that a man can have a reversal, although the success rate may decrease with increased number of reversals. However, there is good data to show that “redo-reversals” can have as high a success rate as first-time reversals. The more surgery is performed, the greater the likelihood of scarring in the scrotum, making subsequent surgeries more difficult.
- What if there is no sperm in the vas at the time of surgery? If the surgeon is experienced in doing vasectomy reversals, they should be able to find the blockage, which is likely to be in the epididymis, and perform the bypass above that point. However, if the surgeon is not able to perform this bypass, then the best thing to do is reattach to two ends of the vas and hope for the best. That is why it is important that prior to surgery, the patient question the surgeon regarding their experience in vasectomy reversals to determine if they would be able to perform both types of reconstruction.
- Six weeks post vasectomy reversal, is scarring a concern? Scarring can occur at any time after a vasectomy reversal although it typically occurs within the first six months. Therefore, even if there was sperm in the ejaculate after six weeks, it is possible that scarring could occur later on.
- How would I find a good surgeon for the procedure? It is important to choose a surgeon who performs reversals on a regular basis, preferably someone with fellowship training or other special training in male infertility. Patients should ask the surgeon how often they perform the procedure, what their own personal success rate is, both in obtaining sperm and pregnancy rates, and if they have the ability to perform both types of reversals.
- Does a vasectomy reversal effect sperm quality? The sperm quality should return to normal 3 to 6 months following a reversal as it takes that long for the testicles to make new sperm. However, the count and the motility may be lower after reversal due to partial blockage or scarring.
- Is a vasectomy safe/healthy for an 18-year-old? Vasectomy reversals do not always work and in someone who is both young and never fathered children, it is probably not a good idea. This patient should reconsider having a vasectomy. Prior to a vasectomy, the patient and his partner should be absolutely sure that they are done having children.
- How does one prepare for the vasectomy or the reversal? Prior to a vasectomy, the patient and his partner should be absolutely sure that they are done having children. There are no special preparations in terms of abstaining from ejaculation prior to either the vasectomy or the reversal. The patient should be aware that a vasectomy reversal is a more expensive procedure than the original vasectomy and likely will take longer to recover.
- What is the recovery for a vasectomy and the reversal? Most men will recover from a vasectomy in a couple of days. It is typically recommend taking it easy for 2 days, using ice packs and scrotal support, and then going back to work 2 or 3 days later. However, vasectomy reversals tend to take longer, depending on the type of work that the patient does. While some men can return to a desk job in 3 or 4 days, it is recommended that heavy construction and lifting should be avoided for 4 weeks after a vasectomy reversal.
- What is the age limit for a reversal? The success of the reversal is related more to the age of the female rather than the male. Therefore, there is no age limit for a reversal.
- What are psychological/emotional problems related to a vasectomy? A report on psychological factors prior to a vasectomy has suggested that most men are not worried about having a vasectomy, but they are a little concerned regarding the recovery of a vasectomy. Very few men have reported serious psychological or emotional problems following their vasectomy.
Some content in this article is copyrighted material used with permission of the author, University of Iowa Hospitals & Clinics, uihc.org.