Is a vasectomy reversible?

Though vasectomy is considered a permanent method of contraception, in many cases it is possible to reverse the operation. It won’t be successful for everyone, and various factors affect how effective it will be, but still for many men this is an effective surgery that can allow them to conceive children once more.

An estimated three to six percent of men decide to undergo a vasectomy reversal. This can be due to multiple reasons, from couples changing their mind about expanding their family to a separation or remarriage, or even the death of a child. The reasons for having a vasectomy reversal, much like the reasons for having a vasectomy in the first place, are varied and highly personal.

Here we’re taking a look at some of the most commonly asked questions about vasectomy reversal, from how the operation works to its chances of success, to the typical recovery period.

What is a vasectomy reversal?

Your sperm is produced in your testicles. Sperms gain the ability to move or swim in your epididymis (a coiled tube that connects to your vas deferens). You have two vas deferens – one at each side of your testicle. Each vas deferens is a long muscular tube (45 cm in length) that transports your sperm from each testicle to your penis. Your sperm then exits your penis through this tube with your ejaculate (discharge of semen or fluid from your penis).

During a vasectomy these tubes are cut and tied off or sealed using heat. As a result, the passage of sperm out of your penis is interrupted, and when you ejaculate your semen will no longer contain any sperm. This lack of sperm prevents your partner’s egg from being fertilised and causing pregnancy. But if you change your mind about a vasectomy, a reversal could be possible. A vasectomy reversal is a procedure that involves reconnecting the two tubes that were cut or blocked during your vasectomy.

How can a vasectomy be reversed?

A vasectomy reversal re-establishes the transport of sperm back to your ejaculate (semen). This surgical reconnection can be accomplished in two ways:

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

Vasovasostomy

According to the Urology Care Foundation, before carrying out a vasovasostomy, your consultant will make a small incision on each side of your scrotum. The ends of your tubes (vas), which were cut and closed off during your vasectomy, are then trimmed. For each tube, your consultant will extract fluid (also known as vasal fluid) from the end that is the closest to your testicles. This fluid will be examined to check for the presence of sperm.

If sperm is present in this vasal fluid, it shows that there is a clear path between your testicles and where the incisions were made. This means the ends of your tubes (vas deferens) can be rejoined – this is known as vasovasostomy.

Vasoepididymostomy

If sperm is not present in your vasal fluid, this could be due to a rupture in your epididymal tubule which can obstruct the passage of sperm. In this case, your consultant will recommend a vasoepididymostomy. This will involve bypassing this obstruction and the upper end of your tube is joined to your epididymis.

When is a vasectomy reversible?

You might decide to have a vasectomy reversal many years after having a vasectomy. But the success of your reversal depends on the type of vasectomy that you have had and how long ago it took place. For example, the more time that has passed since your vasectomy, the more scar tissue that will have formed in your vas deferens.

What is a vasectomy reversal's success rate?

“The chances of success are primarily related to the length of time that has passed since the original operation,” explains Mr Chris Gallegos, a consultant urological surgeon. “It’s important to check your consultant’s success rates, and to remember that the presence of sperm does not necessarily mean that a man is fertile.”

The success rate of a vasectomy reversal to help you conceive also depends on your recovery and your partner’s fertility. All things considered, after a vasectomy reversal, about 50%-60% of couples have a baby within a two-year period.

If a vasovasostomy is performed on both of your tubes, there is about a 90% chance of having your sperm return to the ejaculate. But if a vasoepididymostomy is performed on both tubes, there is about a 60% chance of having sperm return to your ejaculate.

If a mixed operation is performed (vasovasostomy on one side, vasoepididymostomy on the other tube), the 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.

What is the average sperm count after a vasectomy reversal?

Although certain home-testing kits for fertility problems in men identify a low sperm count as below 20 million sperm per millilitre of semen, the NHS guidelines show anything more than 15 million sperm per millilitre of semen is normal.

A fifteen-year study published by the American Society for Reproductive Medicine (formerly known American Fertility Society) found sperm counts ranged from 29 to 43 million up to 18 months after a vasectomy reversal. The percentage of motile sperm ranged from about 20% during the first six months after a vasectomy reversal to about 28% following these six months.

What are your options if there are no sperms coming through after the operation?

Mr Gallegos says: “Repeat surgery can be performed with a 75% vasectomy reversal success rate, otherwise you may want to consider alternatives, such as IVF.”

What are you and your partner's chance of conceiving after a vasectomy reversal?

According to the NHS, your partner’s fertility and age also affect your chance of having a baby after a vasectomy reversal. For example, the likelihood of your partner becoming pregnant is lower if they are aged 40 or over. A study published by the US National Library of Medicine found the pregnancy rate for women aged 35 to 39 after a partner’s vasectomy reversal was 46%, while for women aged 40 or over it was 14%.

Sometimes, you might not be able to conceive even after your vasectomy reversal as your sperm could be less mobile. If this is the case, you could receive fertility treatment such as surgical sperm retrieval, where your sperm is removed, stored and later used as part of in vitro fertilisation (IVF) treatment. IVF is a fertility treatment that involves removing an egg from your partner’s ovary and fertilising it with your preserved sperm in a laboratory. This fertilised egg is then placed into your partner’s womb to develop into a baby.

Are there any complications that can occur after a vasectomy reversal?

Vasectomy reversal is comparable in safety to vasectomy. The likelihood of complications is very low. The main risk is that pregnancy may not occur.

Sometimes the cause of this infertility can be identified, but not always.

What should you expect after a vasectomy reversal procedure?

Usually, recovery from a vasectomy reversal will include three weeks of active rest, a phased return to work, and not having sexual intercourse until after three weeks is recommended. “You should avoid ejaculating for at least two weeks to three weeks after the operation. After that you can resume normal activity when you are comfortable,” says Mr Gallegos.

During the first two to three days after a vasectomy reversal, you could experience mild to moderate soreness and swelling. But this can often be managed with oral pain killers.

A scrotal supporter is recommended for about 10 days following your vasectomy reversal. This is used to support the surgical site and provide additional comfort to patients. You can have a shower around 48 hours post-surgery. However, baths should be avoided for at least two weeks. All the sutures (stitches) are dissolvable on their own after a few weeks and do not need to be removed.

Having a vasectomy reversal with Circle Health Group

If you would like to speak to a specialist about having your vasectomy reversed, please contact a member of our team by calling us directly or booking an appointment online.