vasectomy reversal surgeryVasectomy is an effective and safe way of birth control. In the US, about 800,000 men undergo a vasectomy each year. In the UK, the NHS figures are showing a decline for many different reasons but many still have their vasectomy via private clinics and these figures are not calculated. Vasectomy is still promoted as a worthwhile method of birth control and there is even a World Vasectomy Day to promote this.

Around 16% of men in the UK have had a vasectomy and for many different reasons, many of those men eventually decide to have a vasectomy reversal surgery.

What is Vasectomy Reversal Surgery?

Vasectomy reversal surgery is the procedure of performing a microsurgical reconstruction of the male reproductive tract in order to bypass the surgically induced vas deferens obstruction of the vasectomy surgery and its subsequent effects.

The two main methods are a vasovasostomy  which connects the two parts of the vas deferens which was previously cut in the vasectomy procedure. This is the more common method. The other is a vasoepididymostomy, forming a connection between the vas deferens and the epididymis, the most difficult technically and least performed method of reversal to restore their fertility.

The reasons for needing a reversal of sterilisation come from second marriages, second relationships, having had a vasectomy too soon, the death of a child, or for postvasectomy pain treatment. 

What is the Chance of Success?

chance of successThrough the years, the success of vasectomy reversal surgery has improved from relatively low patency rates to high rates of 98% as a result of procedural and technologic innovation.

Vasoepididymostomy has significantly lower success rates than vasovasostomy.

The Vasectomy Reversal Procedure: 

Preparation

A full history is taken paying attention to:

  • The duration of time since the vasectomy
  • Any prior inguinal or scrotal surgery
  • Any post-vasectomy complications, including a re-do vasectomy.

There is no need for:

  • anti-sperm antibody tests are these are a product of having the vasectomy
  • blood tests as long as the testes have remained the same size since vasectomy
  • imaging scans

Anaesthesia

Vasectomy reversal surgery, vasovasostomy and vasoepididymostomy, are ideally performed under general anesthesia. This enables powerful analgesia to be provided and an optimum access to all the anatomy required.

The incision

The vasectomy reversal surgery is usually performed in the supine position through one scrotal incision.

Postoperatively: 

  • Patients are discharged home within hours of the surgery.
  • They are advised to wear tight fitting underpants for support.
  • Postoperative pain can be controlled with oral analgesics.
  • Return to light work duties can occur after 7 day whereas heavy work duties after two weeks.
  • Patients should refrain from substantial physical exertion and sexual activity for at least 2 weeks in order to minimize the risks of the surgery coming apart.
  • Semen analysis is typically performed at 12 weeks post operatively.

Complications:

Postoperative scrotal swelling can occur but usually resolves by itself over a period of days.

Postoperative infection is around 5%.

Postoperative haematoma is also rare.

Operation failure: It is suspected if there is absence of sperm on semen analysis after 12 months.

Secondary azoospermia/oligospermia:  Sperm count motility decreases postoperatively with time. It occurs to 12% of patients. It is caused by scarring at the point of the rejoin. Cryopreservation of sperm is recommended in case azoospermia occurs and if azoospermia does occur, a “redo” vasectomy reversal can be performed. 

Method of Reversal Surgery

There are a few different ways to perform vasectomy reversal surgery: single layer, modified single layer and multi-layer. Evidence exists that the single layer method results in quicker surgery, lower surgical costs and similar outcomes to other methods.

Alternatives to Vasectomy Reversal Surgery

IVF/ ICSI (intracytoplasmic sperm injection) is the alternative to having a vasectomy reversed. This is a more expensive option and the chance of pregnancy is reduced the the cycle of fertility treatment undertaken. During the fertility treatment, the sperm are aspirated from the testes under a general anaesthetic and then they are individually injected into the harvested eggs obtained from the female.

Success rates vary from clinic to clinic. It is more expensive than a vasectomy reversal and for that reason, many people explore having a vasectomy reversal first where there is a chance to conceive every month assuming a successful surgical outcome.

References:

  1. Namekawa T, Imamoto T, Kato M, Komiya A, Ichikawa T. Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade. Reproductive medicine and biology. 2018 Oct;17(4):343-55.
  2. Pavlovich CP, Schlegel PN. Fertility options after vasectomy: a cost-effectiveness analysis. Fertility and sterility. 1997 Jan 1;67(1):133-41.
  3. Jee SH, Hong YK. One-layer vasovasostomy: microsurgical versus loupe-assisted. Fertility and sterility. 2010 Nov 1;94(6):2308-11.
  4. Chan PT, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU international. 2005 Sep;96(4):598-601.
  5. Patel AP, Smith RP. Vasectomy Reversal: a clinic updateAsian J Androl. 2016 May-Jun; 18(3): 365–371.
  6. Sharlip ID. Vasovasostomy: comparison of two microsurgical techniques. Urology. 1981;17:347‐352.
  7. Nyame YA, Babbar P, Almassi N, Polackwich AS, Sabanegh E. Comparative cost‐effectiveness analysis of modified 1‐layer versus formal 2‐layer vasovasostomy technique. J Urol. 2016;195:434‐438
  8. Kumar R. Mukherjee S. “4 × 4 vasovasostomy”: A simplified technique for vasectomy reversal. Indian Journal of Urology 26(3):350-2