When plans change: Understanding vasectomy reversal

Each year, about half a million American men undergo a vasectomy. But what happens when there’s a change of plans?

Anand Shridharani, M.D., a fellowship trained microsurgeon and male infertility expert with Erlanger Health System and assistant professor of urology at University of Tennessee Medical School, offers some perspective.

Q: What options are available when a couple decides to expand their family after a vasectomy?

A: There are really four different options. But vasectomy reversal is the only way that allows a couple to conceive naturally. Vasectomy reversal is also performed for men who experience post-vasectomy pain syndrome, which occurs in a small percentage of cases.

The other options for those looking to have children following a vasectomy include in vitro fertilization (IVF) using the man’s sperm, intrauterine insemination using donor sperm, and adoption.

Q: What exactly does vasectomy reversal involve?

A: Well, first let’s consider what vasectomy does. A vasectomy procedure involves blocking the sperm from reaching the semen that’s ejaculated during sexual activity. Semen is still produced, but it has no sperm in it.

A man’s testes still produces sperm following a vasectomy, but it’s absorbed by the body. So, during a vasectomy reversal, a surgeon removes scar tissue to reopen the pathways for sperm to travel outside the body.

One of the most important steps of a vasectomy reversal is testing the testicular fluid. If the fluid looks good and has sperm in it, then you make the connection where the vas deferens was cut during the vasectomy.

When you’re able to make that vas to vas connection on both sides, there’s usually a procedure success rate in the 95 percent range.

If there’s no sperm there or it’s degenerated sperm, that usually signifies that there’s a blockage in the tube closer to the testicle called the epididymis. This requires a more complicated complication between the vas tubes and the epididymis.

This type of procedure requires a great deal of expertise, and needs to be performed using an operating microscope.  When you have to do the vas to epididymis connection on both sides, the average success rate is around 75 percent.

It is important to understand that the success of this procedure requires extensive microsurgical training usually done as a fellowship after urology residency.  This training also allows you to get the best counseling regarding having a child after vasectomy as well. Unfortunately, some vasectomy reversal practices neither tailor their counseling to the couple nor can they perform complex surgical reconstruction sometimes necessary for a successful outcome.

Q: Is vasectomy reversal painful?

A: Actually, recovery in general is pretty easy — almost like undergoing a vasectomy. There’s a little swelling and discomfort, but patients are generally back to relatively normal activity within a week. There are no stitches to remove; they just dissolve.

Men are asked to refrain from sex for at least three weeks to allow for healing. A semen analysis is performed six weeks after surgery to see if the connection was successful.

Q: How successful is vasectomy reversal?

A: A surgical success occurs when sperm is identified in the semen, and the success rate is high especially if done within several years of the vasectomy. The longer the interval between the vasectomy and the reversal the success rate decreases.

Also, keep in mind that success rates are averaged over the course of a year, so it’s not necessarily an immediate effect. Many people who get there semen checked right after the procedure may not have sperm in it; but, nevertheless, get pregnant over time.

Most couples are more interested in the pregnancy rate, after all that is the main reason a reversal is pursued. Pregnancy rates are dependent on a successful connection as well as on the fertility status of the man’s partner. Her fertility status may depend on her age and the status of her cycles.

Q: Is vasectomy reversal available at Erlanger?

A: Yes, and our services go beyond that. At Erlanger, we have a men’s health clinic for people wanting to restore their fertility, and also help with other male issues to improve their quality of life overall.

If men are considering vasectomy reversal, we have navigators who can assist them through the entire process. Insurance doesn’t typically cover this procedure, so we provide counseling to determine whether it’s the best option for a couple, along with guidance related to financing.

Interested in learning more about vasectomy reversal and whether it’s an option for you? Contact the Men’s Urology Clinic at (423) 778-4MEN or book an appointment online. Comprehensive pricing packages are available.