Vasectomy reversal

Vasectomy is intended to be permanent. Nevertheless, approximately 5% of men who undergo vasectomy will regret having the procedure, in particular men who had vasectomy at a young age and those who have no children of their own (Jamieson et al, 2002 Obstet Gynecol). Reasons for requesting reversal include: death of a child, a partner without children, and remarriage.

What are the available options for men who have had a vasectomy in order to father a pregnancy?

Several options are available for men who have already had a vasectomy:

• Vasectomy reversal (discussed below)
• Surgical sperm aspiration, IVF and ICSI
• Donor insemination

What is vasectomy reversal?

The tube, which carries the sperm from testicles to the penis, is called the vas deferens - this is cut and the ends are tied when vasectomy is performed. Vasectomy reversal is a microsurgical procedure (using an operating microscope) aiming to restore the flow of sperm through the vas deferens. The procedure is usually performed under a general or spinal anaesthetic. It is performed by a urologist and takes about 2 hours. A small cut is made in the scrotum; the two ends of the vas deferens are trimmed to remove scar tissue. The surgeon will then examine the fluid that comes out under the microscope to check for the presence of sperm. If sperm are found to be present, the surgeon will connect the two ends of the vas together using fine sutures (vaso-vasostomy). On the other hand, if no sperm are found (possibly due to scar tissue blocking the flow of sperm) the surgeon will connect the vas directly into the epididymis (vaso-epididymostomy). The scrotal incision will then be closed and a jockstrap is applied to hold dressing in place. If the surgeon finds sperm during the surgery, it is a good practice to freeze the sperm just in case the vasectomy reversal does not work. The main complications include: bleeding inside the scrotum (this makes it painful and swollen), infection, damage to nerves and blood vessels, and rarely testicular pain

How much does vasectomy reversal cost?

The cost of vasectomy reversal varies between different centers from $10,000-15,000 in the USA and in the UK between £2,500-3,500. Vasectomy reversal is not usually available on the NHS (in the United Kingdom) and health insurance does not usually cover it.

How successful is vasectomy reversal?

Between 80-90% of men who undergo vasectomy reversal will have sperm in the ejaculate after a few months (up to 18 months). However, the pregnancy rates are about 50% (if vasectomy reversal is within 10 years) and 25% (if vasectomy reversal after 10 years) due to poor motility of sperm after vasectomy and possibly antisperm antibodies. While pregnancy may occur within a few months, most pregnancies occur a year after the procedure.

If vasectomy reversal is not successful, the couple will be faced with surgical sperm retrieval, IVF and ICSI; or donor insemination. If vasectomy reversal is successful future birth control will need to be considered.

What are the factors may affect the success rate of pregnancy after reversal of vasectomy?

• Age of female partner - the older the female partner the less chance of conception (if 40 years or older the best option is surgical sperm retrieval,  IVF and ICSI)
• Time interval since vasectomy - vasectomy reversal is more successful if the period since vasectomy is less than 10 years (Fuchs 2002 Fertility & Sterility)
• Does the female have fertility problem? If her tubes are blocked then surgical sperm retrieval and IVF is the best option
• Type of vasectomy reversal: vaso-vasostomy or vasoepididymostomy performed. The former is more successful than the latter.
• The presence of sperm antibodies. The antibodies can inhibit the function and movement of the sperm.
• Surgeons skill

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