Dr. Gholami California Urologist




Vasectomy Reversal

Technique

When the vas deferens is divided at the time of vasectomy, sperm continue to be produced in the testicles on each side. Most of this sperm is either reabsorbed by the body or accumulates in the epididymis, the small gland located behind each testicle where sperm normally mature and gain the ability to swim. The epididymis is a very fine, single tube that is prone to blockage when a long time interval has occurred between vasectomy and vasectomy reversal (long usually means greater than 10 - 15 years).

 

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There are two possible operations that should be offered to complete a successful vasectomy reversal. Both of these are performed through a small incision in the scrotal area. At the time of surgery your physician will examine the fluid present at the testicular side of the vasectomy site in the vas tube. If there are sperm present at this site, a two-layered, microsurgical connection of the two ends of the vas will be performed (vasovasostomy). If sperm are NOT present, this signifies that an obstruction to sperm flow has occurred in the epididymis, as mentioned above. In this instance, a standard vasovasostomy will NEVER be successful and the second type of surgery will be performed. This consists of connecting the vas tube (the side leading to the abdomen) to the epididymal tube in a location close to the testicle, thereby "bypassing" the blocked site in the epididymal tube (epididymovasostomy). Vasovasostomy is ALWAYS the preferred operation because it is technically much easier to perform and allows for a precise anatomic connection between two tubes that are the same size (see success rates listed below).

The decision to perform vasovasostomy versus epididymovasostomy is one that can only be definitively made at the time of surgery. There are, however, some factors that can help predict preoperatively which surgery will be necessary. The following factors would favor the ability to perform a vasovasostomy:

  • Time from vasectomy < 10 years
  • Vasectomy performed higher in the scrotum away from the epididymis
  • The presence of a small, "pea-sized" lump at the vasectomy area. This is called a sperm granuloma and consists of a microscopic leakage of sperm from the vasectomy site into a walled-off area. This is not dangerous and the sperm are rapidly resorbed by the body. It does, however, act as a "pop-off" valve to prevent build-up of pressure in the epididymis which contributes to epididymal obstruction.

It should be noted that the findings at the time of surgery may not be the same on each side. Thus, it is possible that a vasovasostomy could be performed on one side while an epididymovasostomy could be performed on the other.


Success Rates

Using the operating microscope, your physician performs a two-layered anastamosis (connection) on all patients using microsurgical suture. Success rates of vasectomy reversal are listed below:

 

Years between vasectomy & reversal

Sperm Return

Pregnancy Rate

<3
97%
76%
3-8
88%
53%
9-14
79%
44%
>15
71%
30%

Sperm Aspiration

Sperm cryopreservation (banking) can be done at the time of vasectomy reversal in many men. This adds about 30 minutes to the surgery time but does not affect incision size or recovery time. If this is chosen, sperm are be collected from the vas, epididymis or even the testicle during surgery and sent to a sperm bank for freezing. It is important to understand that achieving pregnancy with this sperm requires in vitro fertilization. Nonetheless, many patients choose this option as an "insurance" policy to the reversal itself not being successful. Some patients also choose to bank sperm at their initial semen analysis following surgery (6 weeks) from an ejaculated specimen. If there are sperm present in the ejaculate, these sperm can usually be frozen in higher numbers than sperm obtained during the time of surgery.