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Vasectomy: An Irreversible Decision?
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Vasectomy: An Irreversible Decision?

vasectomy reversal

Yes, it’s true. There is a procedure that can reverse a vasectomy, called a vasovasotomy. And every year, many men, for a variety of reasons, make the decision to undergo this procedure. But, before we get into the details of a vasectomy reversal, let’s talk about what a vasectomy entails.

Vasectomies

As you probably know, the testicles (housed in the scrotum) are sperm factories. The sperm is stored in the epididymis, a tiny structure that lies on top of each testicle. Upon ejaculation, the sperm leaves the epididymis via a tube called the vas deferens, travels to the prostate where other fluids and substances are added to the semen, and then exits through the penis.

A vasectomy is a form of permanent sterilization for men usually performed by a urologist. It involves clamping off, cutting, burning, and/or sewing closed the tubes (vas deferens) that carry sperm between the epididymis and the prostate. Sperm is still manufactured in the testicles and stored in the epididymis, but it ultimately just dies off. The semen that a man ejaculates after a vasectomy should not contain any sperm.

Why Would a Man Want a Vasectomy Reversed?

Men may choose to undergo vasectomy for lots of reasons. Maybe they’ve completed their ideal family; maybe they’ve never wished to have children; maybe their family has a known genetic problem that they want to avoid passing on to offspring.

According to researchers, the main reasons a man may want to reverse a vasectomy include a new relationship (particularly after divorce or the death of a partner), the death of a child, or a change in a family’s financial situation that makes it impossible to afford another child.

Very rarely, a man who has undergone a vasectomy experiences chronic pain in his testicles. Although this is a very uncommon complication of vasectomy, some of these men have experienced pain relief after a vasectomy reversal.

How Is a Vasectomy Reversal Performed?

A vasectomy reversal is major surgery, requiring either general anesthesia or sedation and local anesthesia (such as an epidural or saddle block that prevents feeling below the waist or in the entire pelvic area).

The surgical technique used for a vasectomy reversal may require opening the testicles to visualize the internal structures, or operating through tiny “keyhole” openings. Very high-powered operating microscopes magnify the tiny structures. Conventional surgical techniques are usually used, although some studies are looking at the utility of using a laser to accomplish vasectomy reversal.

Basically, a vasectomy reversal attempts to reattach the severed ends of the vas deferens. This is very tricky microscopic surgery as the opening of the vas deferens is approximately the size of a pinhead. Furthermore, once the vas deferens has been cut, burnt, or clipped, it may develop scar tissue, which could block the sperm from moving through it. So even if the ends of the vas deferens are reattached, sperm may still be prevented from exiting the epididymis due to scar tissue. In this case, the urologist may need to perform a more complicated procedure, called a vasoepididymostomy, in which the upper end of the vas deferens is attached to the epididymis itself, in an attempt to bypass the area of obstruction within the vas deferens.

Can I Get My Partner Pregnant After a Vasectomy Reversal?

Overall, you and your partner have a 50-50 chance of being able to conceive after a vasectomy reversal. The sooner you undergo reversal after your original vasectomy, the greater your partner’s chances are of conceiving. Some studies have shown that the partners of men who undergo reversal surgery within three years of their vasectomy have a 75% chance of conceiving a pregnancy, while the partners of men who have reversal surgery over 15 years after a vasectomy have only a 30% chance of conceiving a pregnancy.

Why Wouldn’t a Vasectomy Reversal Work?

As mentioned above, scar tissue in the vas deferens might account for some of the fertility problems of men who have undergone a vasectomy reversal. Even after the ends of the vas deferens are rejoined, scar tissue within the vas deferens may obstruct the free flow of sperm.

The other reason is a bit more complicated. After a vasectomy, the testicles continue to manufacture sperm, even though they can’t make it to the outside world. These sperm may be mistaken by the man’s immune system as foreign invaders, and the immune system produces antibodies against them in the same way that the immune system makes antibodies to destroy other foreign invaders, such as viruses or bacteria. This can mean that, even after a vasectomy reversal, the man’s immune system continues to destroy his sperm.

Researchers are also looking at how vasectomy may affect other microscopic, chemical fertility factors in men that may not be restored with vasectomy reversal.

What Can I Do if My Vasectomy Reversal Doesn’t Work?

If you are concerned that your vasectomy reversal won’t work, your doctor may try harvesting sperm from the epididymis either during or after the reversal procedure. This sperm can be stored for future use. Sperm harvested this way aren’t strong swimmers, so they aren’t useful for artificial insemination (in which sperm is placed in a women’s vagina near the opening to the uterus). Instead, these sperm are used for a much more complicated (and expensive) procedure called intracytoplasmic sperm injection. In this case, the woman must take strong hormonal medications to induce the release of multiple eggs; the eggs are removed from her ovaries, and the man’s sperm is injected into the eggs. The injected eggs are then watched in the laboratory through several cell divisions, and the resultant cells are put back into the woman’s uterus, with the hopes that one (or more) conceptus will implant and develop as a pregnancy.

How Old Is Too Old to Undergo Vasectomy Reversal?

Men don’t have the same age limitations on reproduction that women have. Men continue to produce sperm throughout their lifetimes, although the risk for certain genetic diseases increases with a father’s age. However, because women’s fertility decreases with age, you may wish to have your female partner consult her physician to ascertain that she is still fertile and capable of conceiving a pregnancy.

RESOURCES:

American Urological Association
http://www.auanet.org/index.cfm

Urology Health
http://www.urologyhealth.org/

References:

Barone, MA, Nazerali, H, Cortes, M, et al. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision. J Urol. 2003;170:892.

Dassow P, Bennett JM. Vasectomy: an update [review]. Am Fam Physician. 2006;74:2069-2074.

Hollingsworth MR, Sandlow JI, Schrepferman CG, Brannigan RE, Kolettis PN. Repeat vasectomy reversal yields high success rates. Fertil Steril. 2007;88:217-219. Epub 2007 Mar 6.

Kolettis, Peter N. et al. Pregnancy outcomes after vasectomy reversal for female partners 35 years old or older. The Journal of Urology. 2003;169:2250-2252.

The patient’s guide to vasectomy reversal. Columbia University Health Systems website. Available at: http://cpmcnet.columbia.edu/dept/urology/infertility/vasectomy/vasr0000.html. Accessed June 30, 2003.

Vasectomy Reversal. American Urological Association website. Available at: http://www.urologyhealth.org. Accessed June 30, 2003.

Walsh PC, ed. Vasovasotomy. Campbell’s Urology. Philadelphia, PA: Elsevier. 2002:1541-1547.



Last reviewed July 2007 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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