Understanding the Process of Reversing a Vasectomy Reversal

Can a vasectomy reversal be reversed? Yes; however, the decision to have a vasectomy should be carefully considered. A reversal procedure can be performed, but it does not guarantee a restored fertility. For patients interested in learning more about reversing a vasectomy reversal, Dr. Larry Lipshultz can discuss this at his Houston practice with you to help you make an informed decision about your health. 

Vasectomy reversal is an operation that re-establishes a connection between the two ends of the vas deferens that were separated at the time of a prior vasectomy.  Vasectomies can be reversed even after very long periods of time, sometimes after more than 25 years.  Vasectomy reversal restores sperm to the ejaculate in approximately 90% of men.  On average, about 50% of couples achieve a pregnancy within 1 - 2 years after vasectomy reversal surgery.  Microsurgical techniques appear to help produce higher quality grade of sperm and better pregnancy rates than macro-surgical techniques.  Sperm are constantly being produced in men and even after long periods of time, there should be active sperm. However, the success of the reversal, in terms of achieving a pregnancy, is dependent upon the experience of the surgeon, the age and fertility status of the female partner, and the length of time since the vasectomy.

There are two types of vasectomy reversal surgical procedures. A vasovasostomy, where the severed ends of the vas deferens are sewn back together. The other procedure is a vasoepididymostomy, during which the vas deferens are surgically reattached directly to the epididymis the gland transporting sperm from the testis to the vas. This procedure is more difficult to perform and is used when vasovasostomy cannot be performed or does not work. These procedures help restore sperm flow so that sperm can be ejaculated out of the urethra. Both types of procedures are performed on an outpatient basis, and the patient can return home the same day. It is not possible to know in advance which procedure will be performed. The surgeon will make the decision whether to use vasovasostomy or vasoepididymostomy based on a fluid sample taken at the start of the operation. The fluid is removed from the vas end closest to the testicle and examined for its appearance and the presence of sperm. If sperm are present or the fluid is clear, it indicates that there is no blockage in the epididymis, and a vasovasostomy can be performed during surgery. No sperm, or a creamy, thick appearance of fluid, is a sign of blockage, and the vasoepididymostomy surgical approach to bypass the blockage should be used. Other factors may also determine the surgeon's choice of reversal surgical procedure. In some cases, a combination of the two surgeries may be used, with vasovasostomy performed on one side and vasoepididymostomy on the other side.

After vasectomy reversal, men can under go a repeat vasectomy and it will not have any adverse effects on a man’s sex life. The purpose of a vasectomy is to prevent sperm from entering the seminal fluid so that the female egg cannot be fertilized subsequent to intercourse. After vasectomy, sperm cells are still produced by the testicle, but they will disintegrate and be reabsorbed. Additionally, after vasectomy a man’s hormones remain normal, and there is no noticeable difference in the ejaculate since the sperm constitute a small part of the overall semen volume.