Vasectomy is intended to be a permanent method of birth control.
It is an office based or sometimes an outpatient minor surgical procedure. It generally only requires fifteen to thirty minutes to accomplished and is most commonly performed on men who have decided that they no longer desire to have additional children with their partner.
But can a man change his mind about that last part? The answer is “yes”.
Vasectomy reversal surgery exists and often can offer a high chance of restoring a man’s fertility potential. It is performed as an outpatient surgical procedure with the goal of restoring flow of sperm into the ejaculate.
How is it performed?
To understand that, first you must understand what is accomplished in a vasectomy. A vasectomy is a procedure that disrupts flow of sperm through the vasa (men generally have one vas on each side), into the ejaculate. Typically a small piece of the vas is removed and the ends are sealed and cauterized.
A vasectomy reversal typically involves removing the sealed ends and joining the pieces of vas back together.
This is a bit more complicated that it sounds. The vas is a thick muscular tube as it has to be, in order to propel the sperm into the ejaculate. The lumen or hollow central portion of the vas is very small in relation to that muscular wall and also very small in general. In fact, it is often smaller than a millimeter, unless dilated or stretched open. So, in order to perform a vasovasostomy , the procedure to put the tubes back together, microsurgical techniques are required in order to get the best result. This requires a higher level of surgical skill on the part of the surgeon, as well as more time, often taking a few hours.
There are also additional considerations.
If it has been a long time since vasectomy, there may be additional blockage at the level of the “epididymis”, the tubules that receive the sperm from the testes before they pass into the vas. In this case of a secondary blockage beyond the vasectomy, connecting one end of the vas to the other end will not accomplish much and instead a vas to epididymis connection would be required. This is called an epididymovasostomy and requires even more microsurgical skill and time.
If vasovasostomy is accomplished the success rate of returning sperm to the ejaculate is very good, generally above ninety percent.
If epididymovasostomy is required, success rates are somewhat lower, occurring about two thirds of the time. If the surgery is not successful at restoring sperm into the ejaculate, there still remains another option which is surgical sperm retrieval combined with in vitro fertilization. In fact, I sometimes perform this procedure for my patients at the same time as vasectomy reversal so that a back up plan is available without requiring an additional procedure.