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Dear Dr. Joe: Can You Reverse a Vasectomy?

Wed, Nov 17, 2010

Advice, What's Up Doc?

photo by galateadia

Once a month, Dr. Joe DeOrio, a urologist in Chicago, answers your questions on male sexual health. To ask him your own question, click here.

Dear Dr. Joe,

I’ve heard that a vasectomy can be reversed. Is this true? And if so, what’s the success rate?

– Snipped

Dear Snipped,

In a nutshell, yes. But while that answer is simple, the real answer is a bit more complex. A vasectomy is a procedure for male sterilization, which involves cutting the vas deferens, the tubes that carry the sperm from the testicles to the penis during ejaculation. This procedure is a fairly straightforward, office-based endeavor taking 15-45 minutes. A vasectomy reversal, in contrast, is a technically challenging process, often taking several hours and requiring a general anesthetic.

During a vasectomy, a doctor locates the vas deferens within the scrotal sac (one on each side), dissects it free of any connective tissue, then divides the tube and removes a small intervening segment. After, he or she closes off the free ends, sometimes cauterizing them in the process. As you can guess, the procedure is very effective at preventing pregnancy, with success rates around 99.6%.

A vasectomy reversal, as its name implies, involves reversing this process. The severed ends of the vas deferens need to be sewn back together, reestablishing the connection. Considering that the inner diameter of the vas is about half a millimeter and that most surgeons performing the operation use at least 10 individual stitches, you can begin to imagine the technical complexity. In addition, after vasectomy, it is not uncommon for the vas deferens to scar in more than one location. When this occurs, the surgeon needs to perform a more complex operation, involving reattaching the severed vas deferens to the epididymis, a structure adjacent to the testicle.

How successful is it? Overall, the pregnancy rates after a vasectomy reversal are about 43%. This is, clearly, an oversimplification. In truth, success ultimately depends on several factors. The most important of these are the number of years since initial vasectomy and the experience of the operating surgeon. Other significant predictors include the technique utilized to reconnect the tubes and, of course, the fertility potential of the female partner. Successful couples will often conceive a child within the first year after reversal, but for some it can take up to two years.

Success rates are reported as both patency rates (successful return of sperm to the ejaculate fluid) and pregnancy rates (pretty self-explanatory). If less than three years have passed since vasectomy, patency is achieved in 97% of patients, with 76% eventually conceiving a child. From 3-8 years, those rates are 88% and 53%. Nine to 14 years? Seventy-nine and 44%. And if more than 15 years have passed, the patency rate falls to 71% with a pregnancy rate of 30%. If the surgeon needed to attach the vas deferens to the epididymis, all of these percentages are lower. To complicate matters, 10-12% of men with a successful reversal will re-occlude the tubes within a year or two after the procedure secondary to scarring. So a successful reversal may not remain that way.

If you are considering a vasectomy reversal, do your homework. Look for a surgeon who is trained to perform the operation and who does it fairly regularly. Also, ensure that he or she uses an operative microscope, as this improves visualization and therefore success rates. Before the procedure, ask your surgeon to harvest some sperm for cryopreservation during the reversal. If your procedure is unsuccessful, you can later use these sperm for in vitro fertilization. Finally, if your procedure is successful, consider sperm banking. If you are one of the unfortunate few whose tubes later scar closed, you will have sperm readily available for future use.

In conclusion, vasectomy reversal offers a viable method of conception, but remember that if your reversal surgery is not a success, hope is not lost. Alternative modalities — e.g. IVF — still offer a very good chance for a successful pregnancy. Good luck!

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.

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2 Responses to “Dear Dr. Joe: Can You Reverse a Vasectomy?”

  1. galateadia Says:

    Ok, I’m terribly amused that you’ve used my picture of me throwing scissors as a metaphor for “snipping” a guy. *lol*

  2. figleaf Says:

    My urologist specialized in vasectomy reversals. He said age is the biggest hidden factor. My reversal happened when I was 42 and my partner 36 — according to him that’s on the early side.

    I’d had my vasectomy at 21, and during our first consultation he hemmed and hawed a bit about the likely outcome. When he mentioned that he’d want to speak to my partner to make sure she was ok with my reversal I said sure, she’s out in the waiting room. When she walked in he brightened up, saying “oh, you’re young!” He then said he couldn’t promise it would be a slam dunk but he was pretty sure it would work out fine.

    The trick, he said, is that the scenario he sees most often for reversals (they’re not cheap and insurance pretty much never pays) is for second marriages. The men will often be in their late 40s, which generally means their partners are in their early to mid 40s, and at those ages neither men nor women are particularly at their reproductive peaks. So even if sperm starts showing up in the semen as advertised, ordinary fertility problems drag the “success” rates way down.

    I’m obviously so not a urologist, and don’t even play on on the internet, but anecdotally speaking anyway, that’s how it worked for my partner and I. After six hours of reversal surgery… and the birth of two healthy children in two and a half years… I cheerily undid all my urologist’s hard work with another 15-minute vasectomy.

    Your mileage really will vary. But I’m pretty sure it’ll also vary even more with age.

    figleaf


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