Side effects
Vasectomy reversal side effects
- bleeding below the skin’s surface (hematoma)
- infection
- fatigue after surgery
- swelling after surgery
- excessive pain after surgery
However, these two postoperative complications are very rare and can be successfully treated. The man who wants to go through vasectomy reversal is told to refrain from sexual intercourse for 2 weeks following surgery to allow the delicate vas deferens to heal. However, following the 2 weeks’ abstinence period, regular intercourse is encouraged to promote the flow of fluid through the newly formed microscopic connection. A semen analysis is usually obtained at 6 to 8 weeks following surgery to check if sperm are present. In the majority of the patients, sperm will be seen at this time period post vas reconstruction. As with vasectomy, a vasectomy reversal is not associated with any sexual dysfunction, e.g., erectile dysfunction or change in ejaculation pattern. In fact, since less than 5% of the ejaculate actually comes from the testes, there should be little noted change in ejaculate volume either following a vasectomy or, likewise, following a vasectomy reversal.
Although a vasectomy reversal should be considered a permanent form of male birth control, in reality, in a large percentage of men a vasectomy can be successfully reversed. This requires a microsurgical procedure that is done as an outpatient, requiring minimal loss of work and associated discomfort.
What is a hematoma?
A scrotal hematoma (also known as a hemoscrotum) refers to the substantial accumulation of blood within the scrotum following trauma to the genital and groin region or as a side effect to surgery, such as a vasectomy or a vasectomy reversal.
Signs and Symptoms of Hematoma
The most common signs of scrotal hematoma following a vasectomy reversal include the following:
- Swelling
- Discomfort
- Discoloration
Interestingly, the above signs and symptoms of a scrotal hematoma are also common side effects that patients naturally experience after vasectomy reversal. It's important to keep this in mind yet to remain cautious with regard to your health and wellness as you recover from surgery.
How common is a hematoma after vasectomy reversal?
Thankfully scrotal hematomas are somewhat rare and are relative easy to address and treat. Vasectomy reversal is a generally safe and complication-free procedure for many patients, and special care is taken to minimize any kinds of post-surgical risks. It's important that patients remain attentive to any undue discomfort or swelling that seems especially excessive as they heal.
Treating a Hematoma Following Vasectomy Reversal
Treatment for a hematoma following vasectomy reversal may not be necessary if there is just a limited amount of bleeding and blood accumulation. Should the issue be more serious, surgical drainage is performed in order to remove the blood and improve the overall health and wellness of the patient in the process.
Tips for Preventing a Hematoma After Surgery
The best way for patients to prevent a scrotal hematoma from occurring is to follow their surgeon's pre-op and post-op instructions to the letter. While the healing experience for each patient is different, these surgical instructions help ensure ideal conditions for recovery and optimal rest time.
Is bruising normal after vasectomy reversal surgery?
Yes, bruising of the scrotum and testicular area are common side effects after vasectomy reversal surgery. The same is true of soreness and swelling. These are all just signs that your body is responding to surgery and it is all part of the natural healing process.
How long will the bruising last?
This can vary a fair amount from patient to patient simply given the different responses that a person's body may have to surgery. The bruising as well as swelling tend to last for a few days, sometimes becoming more pronounced before eventually subsiding.
For the most part, patients tend to experience bruising for roughly five days to a week.
How can I deal with the post-surgical bruising?
Urologists will often recommend that patients get a lot of rest after their surgery in order to promote faster and more effective healing. Taking recommended pain medications and using ice packs as needed are both ideal options for reducing the bruising and swelling after the vasectomy reversal.
What should I do if the bruising persists?
If the bruising lasts for more than a week after you undergo vasectomy reversal, be sure to contact your urologist right away. This is especially true if your notice a fever, increased swelling, or any odd discharge from the scrotum.
How common is swelling after vasectomy reversal?
Swelling is one of the most common side effects after vasectomy reversal surgery, along with bruising and discomfort. It is normal to experience some degree of swelling as this is simply a sign of your body responding to surgery and healing.
How pronounced can the swelling get?
The swelling following vasectomy reversal surgery can be quite pronounced and noticeable, but it's generally manageable. Some patients will notice more swelling than others, with the size of the scrotum becoming quite large. In general, patients should not feel alarmed about the swelling so long as it's not accompanied by severe pain and bruising.
How long does the swelling last after vasectomy reversal?
The swelling after vasectomy reversal surgery will last for a few weeks, though the most pronounced swelling will occur during the first week. By the end of the first week, most patients will notice a reduction in swelling. Patients will usually be asked to wear a support garment or a certain kinds of undergarments for roughly two weeks.
Tips for Managing Post-Operative Swelling
In order to ensure the best possible healing experience, it's important that patients spend the first day or so in bed getting plenty of rest. Cold compresses can be used on the scrotal area four roughly 20 minutes at a time, with roughly 40 minutes in between the applications of the cold compress. This will help address the swelling and discomfort.
All sexual activity should be avoided for at least 10 days, and other forms of vigorous physical activity (e.g., running, heavy lifting) should be avoided for at least 10 to 14 days.
Keep in Touch with Your Urologist As You Recover
By the end of the first week, you will have likely been back to the practice for a follow-up visit or two, but be sure to keep your surgeon posted about any occurrences that seem troubling to you. This goes for any instances of persistent bruising, major swelling, or extreme pain and discomfort. By notifying your surgeon sooner rather than later, you can receive the care that you need when it is needed most.
Is fatigue common after vasectomy reversal?
Fatigue does tend to be a common side effect following vasectomy reversal. This is a given, however, simply considering the nature of the surgery.
Why does fatigue occur after surgery?
Vasectomy reversal surgery is performed under anesthetic. Sometimes local or regional anesthetic may be used, while other times general anesthesia may be recommended. As patients come out of anesthetic, a certain amount of grogginess and fatigue are to be expected.
In the days that follow surgery, patients can also expect sensations of grogginess and exhaustion to occur as they deal with other symptoms, such as soreness, bruising, and swelling.
How long will sensations of fatigue last?
Overall, patients should notice some sensations of fatigue that accompany other symptoms, but the fatigue itself should only last a few days to a week. Residual feelings of tiredness or weakness may persist as patients continue to heal, however, and ought to fade as other symptoms abate.
Patients are encouraged to discuss any issues with energy level and other matters with their surgeon during their follow-up visits. This will allow any pressing concerns to be addressed in a timely fashion.
Easing Back Into Your Daily Routine
One way to address fatigue and other symptoms of vasectomy reversal is to take it easy when returning to your normal daily activities and routine. It's important to take time off to relax and recovery. Overexerting yourself too early can make your recovery process far more troublesome, extending the amount of time you feel fatigued or sore.
Surgical Recovery Is a Process That Takes Time
It's important that prospective patients understand that the recovery time following vasectomy reversal is often greater than the recovery time after the initial vasectomy. By understanding that, patients also tend to understand the importance of being fully rested after surgery in order to improve the overall recovery process.
Other Matters to Consider with Regard to Vasectomy Reversal
Many patients ask how successful vasectomy reversal surgery is. We are happy to note that vasectomy reversal surgery is successful for many patients, allowing them to have children again. That said, the success of the procedure is often dependent on when the initial vasectomy was performed. The sooner the reversal procedure is performed, the more likely the reversal procedure will be successful.
During your consultation process, we will be more than happy to go over all of the pros and cons of vasectomy reversal surgery, helping you make the most well-informed decisions about the treatment process.
Alternatives
Alternatives to Vasectomy Reversal include
Assisted reproductive technique (ART)
- intracytoplasmic sperm injection (ICSI).
- in vitro fertilization (IVF)
AND
Sperm retrieval technique
- microscopic epididymal sperm aspiration (MESA)
- testicular sperm extraction (TESE).
Following a vasectomy, despite the most careful planning and decision making, almost 10% of men will change their minds and decide to have additional children. A vasectomy reversal enables men to once more have children of their own. A successful microscopic vasectomy reversal will allow patients to establish a pregnancy without requiring highly technical or expensive assisted reproductive techniques (ART) such as IVF and intracytoplasmic sperm injection (ICSI).
What are the success rates of a vasectomy reversal?
Success rates with vasectomy reversal can be as high as ~95% sperm return to the ejaculate and pregnancy rates with vasectomy reversal can be as high as 75%. Vasectomy reversal should also be strongly considered in couples wishing to have more than one child.
Some couples, however, for various reasons may decide to have sperm “retrieved” and proceed to IVF-ICSI. The most frequent forms of sperm retrieval, a necessity if sperm are to be available for IVF, include microscopic epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE).
Microscopic epididymal sperm aspiration (MESA) is a technique for the procurement of sperm from the epididymis of men in whom transport of sperm from the testicle to the ejaculate is not possible because the drainage (ductal) system is absent or is not subject to reconstruction. This problem most commonly occurs in men with vasal agenesis, a condition in which the vas deferens or drainage system of the testicle fails to develop prior to birth. The obstructive problem, however, also may be acquired, such as following a vasectomy or with vaso-epididymal obstruction from inflammation and/or infection. Epididymal and vasal obstruction may be amenable to reconstructive surgery (vasovasostomy or epididymovasostomy).
When reconstruction is not possible or not desired by the couple, MESA is carried out. During MESA, sperm are directly aspirated from an isolated epididymal tubule until 10-20 million are obtained. The entire procedure is performed through an operating microscope. The recovery period is approximately 24 hours. Sperm, which have been aspirated, are specially processed and prepared for ICSI insemination with the wife’s eggs. The procedure is routinely performed in advance of IVF with (intracytoplasmic sperm injection) so that the couple can be assured adequate sperm are extracted and available on the day of oocyte retrieval. Recent data indicate that there are no differences between fertilization and pregnancy rates when frozen rather than fresh sperm are utilized.
While the husband is being evaluated prior to the actual aspiration of sperm, the female partner is usually prepared for IVF and ICSI. The success of pregnancy from this procedure is reported to be 45%-50% in selected IVF centers. It is a complex process, requiring significant manipulation of the human gametes (eggs and sperm), but one which offers a previously sterile couple the chance of establishing a pregnancy using their own genetic material.
Men whose semen has been shown to contain no sperm cells (azoospermia) are eligible for testicular sperm extraction (TESE).
Azoospermia can be the result of an obstruction or a blockage in the sperm ducts: for example, as a result of vasectomy or the congenital absence of the vas deferens. Azoospermia can also result from spermatogenic failure.
Patients who require TESE can be divided into three categories:
(1) Men with obstructive azoospermia. These men typically have a congenital or acquired obstruction of the male ductal system, such as following a vasectomy. In patients with obstructive azoospermia, TESE is close to 100% successful at retrieving sperm especially if diagnostic biopsies have previously demonstrated sperm in the testis.
(2) Patients with spermatogenic failure. Until recently, these men were felt to be untreatable; however, these patients can now often be treated effectively with TESE and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) if areas of normal sperm production can be demonstrated in a testicular biopsy.
(3) Sperm cryopreservation in patients diagnosed with cancer will allow for future use in assisted reproduction. However, when a patient is azoospermic at the time that cancer is diagnosed, testicular sperm extraction and cryopreservation of testicular tissue may be offered.
During a testicular biopsy, a small incision is made in the testicle and small pieces of testicular tissue are removed. The testicular tissue is examined for sperm cells by the embryologist in the fertility laboratory. If sperm cells are found, the tissue is frozen for potential future use in fertility treatment. Because of the relatively few sperm obtained with TESE, these sperm need to be combined with the wife’s eggs using intracytoplasmic sperm injection (ICSI).
In patients with nonobstructive azoospermia (spermatogenic failure), several biopsy specimens may need to be obtained from each testis in order to find areas of active spermatogenesis. This can usually be performed through one small incision on each side of the scrotum. This testicular tissue is then sent to the IVF laboratory, where it is microdissected and processed in order to obtain sperm. In the nonobstructed testicle, recent studies have shown that 50% of patients will have some sperm obtained by microscopic TESE. Pregnancy rates ranging between 30% and 50% per cycle of ICSI have been reported recently for patients with nonobstructive azoospermia.
Couples can also use donor sperm from a sperm bank. These sperm samples are safe, as the donors have been screened for blood borne pathogens and other communicable diseases such as hepatitis and HIV. In addition, use of a sperm donor is usually less expensive than most other forms of surgically assisted procedures, as the female partner may only need an office procedure termed intrauterine insemination (IUI) to conceive.
Finally, adoption is another way to build a family. Adoption can be as expensive as IVF-ICSI with sperm retrieval although adoption can be complicated by administrative hurdles, these can be successfully addressed. Adoption is an important alternative for some couples to achieve their reproductive and family-building goals.