Vasectomy Reversal Q&A

Ask the Consultant

A leading urology consultant answers common questions on vasectomy reversal including effective treatments.

  • Mr Krishnan Ananthakrishnan

    Mr Krishnan Ananthakrishnan

    Consultant Urologist

Mr Krishnan Ananthakrishnan
Sperm are produced in the testicles. Sperm mature and gain the ability to move or swim in the epididymis. The epididymis is a highly coiled tube that connects to the vas deferens. The vas deferens (or vas) is a muscular tube through which sperm must travel in order to come out of the penis with the ejaculate. During a vasectomy, the vas is occluded (divided, clipped, tied off, and/or ends cauterized), therefore interrupting the passage of sperm. 

A vasectomy reversal is a surgical procedure that re-establishes the transport of sperm back to the ejaculate. The surgical reconnection can be accomplished in 2 ways:

• a direct vas to vas reconnection (vasovasostomy) or
• a vas to epididymis connection (vasoepididymostomy)

Mr Krishnan Ananthakrishnan
It could be a number of years, after vasectomy, that one could undergo vasectomy reversal; Whether or not a vasectomy reversal is successful depends on the type of vasectomy one has had and how long ago it took place. For example, the more time that has passed since the vasectomy, the more scar tissue will have developed in the tubes that carry sperm to your penis. The surgeon, takes these into consideration and addresses it appropriately with due counselling, so as to improve the tube joining, maximise sperm passage and also different techniques.

Pregnancy rates also depend on the fertility of the female partner and are lower if she is 40 or older. In some cases, pregnancy still may not happen after a vasectomy reversal, even when there is sperm in your semen. This is because your sperm may be less mobile after the procedure than they were before. However, we have methods and ways of dealing with these, and I always request my patient couples, not to despair.

Mr Krishnan Ananthakrishnan
Both male and female factors contribute including timing of coitus influence, patient dynamics, surgical/technical features, healing aspects, and female partner factors. All things considered, after a vasectomy reversal, about 50%-60% of couples have a baby within a 2-year period. 

If a vasovasostomy is performed on both sides, there is about a 90% chance of having sperm return to the ejaculate. If a vasoepididymostomy is performed on both sides, there is about a 60% chance of having sperm return to the ejaculate. If a mixed operation is performed (vasovasostomy on one side, vasoepididymostomy on the other), sperm returns to the ejaculate in about 75% of cases. It depends on various factors, predominantly with time between the vasectomy and the reversal attempt as well as the age of the female partner. 

The general rule of the thumb for vasectomy reversals is as follows:
  • Up to three years, it is said to be 100% successful
  • Between 3 and 10 years, the success rate drops to 83%
  • After 10-20 years of vasectomy, the quoted success rates are 60 to 70% 
  • Patients who have had the operation done 30 years ago have a success rate of only 50%

Mr Krishnan Ananthakrishnan
Current estimates are that about one percent of men who have undergone a vasectomy will eventually want reversal surgery and there are 65,000 men who undergo this procedure each year in UK; While the number of men requesting vasectomy has remained approximately the same, the number of men requesting vasectomy reversal has increased.

Mr Krishnan Ananthakrishnan
Vasectomy reversal is comparable in safety to vasectomy. The main risk is that pregnancy may not occur. Many men will have a vasectomy before having any children or a small number of children. Some may have had unrecognized male infertility or sub-optimal fertility before their vasectomy. Vasectomy induced epididymal dysfunction, formation of anti-sperm antibodies, and female infertility are recognised associations. Equally possible is the vasectomy reversal may be 100% successful but the female partner may be the source of infertility.

Some couples will have everything working perfectly (normal sperm count, regular ovation, and normal fallopian tubes) and not be able to conceive because of unexplained infertility.

Mr Krishnan Ananthakrishnan
Normally, I recommend 3 weeks of active rest, a phased return to work and restart the sex life after 3 weeks, if the postoperative is uneventful. During the first 2-3 days after the operation, there can be a mild to moderate amount of soreness and swelling which is usually managed well with oral pain killers. A scrotal supporter is recommended for about 10 days following the surgery to support the surgical site and to provide additional patient comfort. I recommend a shower after 48 hours and baths should be avoided for at least 2 weeks.

All the sutures are dissolvable on their own after a few weeks and do not need to be removed. My private secretaries are always there to help individual situations and tailor the treatment to achieve the maximum success and satisfaction.

You can expect full support, excellent communication and holistic clarifications regarding your surgery. A mobile number contact is provided for contacting the surgeon, if need be.

Mr Krishnan Ananthakrishnan
I have never regretted going into medicine. I'd do it again tomorrow, and I will be a Doctor, if I am reborn as a human being; One could count in one hand, how many vocation demands respect and public faith; I chose medicine–surgery–because it combined a pursuit for knowledge with a way to serve, to save lives, and to alleviate suffering and to improve quality of people’s lives. 

The use of clinical knowledge and technical skills combined with the experience of dealing with a diversity of people on a daily basis, make surgery a field that is not only challenging and satisfying, but rewarding as well, both monetarily and to my emotional intelligence as well; Assisting people who are ill/injured or those in need has been and continues to be a rewarding dimension of the surgical profession for me. 

I would certainly pursue a career as a surgeon again without a second thought. And I would highly recommend the surgical profession to my children or any young person who is interested in a career that requires a lot of you and gives you even more in return.

Mr Krishnan Ananthakrishnan
My career highlights threads around my ability to succeed in various setups; For example, I completed my Masters in General Surgery in India, followed by basic science research on kidney stones in South Manchester; This lab based model, which we developed fetched us a huge grant of funds (£ 93,993) from The National Kidney Research Fund for the project entitled ‘Identification of factors important in urolithiasis using an in vitro model of kidney stone formation’; During my Mersey region training, I obtained European Urological Scholarship Programme [EUSP] and Royal College of Physicians and Surgeons – College Travelling Fellowship, to visit Prof Struder, Berne, then Mansoura, Egypt, to learn reconstructive urology techniques; I also visited Montreal and Dallas, Texas to sharpen my female urology skills; Following the consultant appointment, I developed a new prostate biopsy clinic to detect prostate cancers in Newark, reconfigured the paediatric Urology Service, initiated the new sling procedure TVT[O] for female urinary incontinence, started a New ‘Breaking Bad News’ Biopsy diagnosis multi-professional clinic and introduced local anaesthetic Botox Injections to bladder for overactive bladder problems.

 

You can find out more about our vasectomy reversal procedure or you can make an enquiry online.

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