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BCM - Baylor College of Medicine

Giving life to possible

Urology

Vasectomy Reversal

A vasectomy reversal is an operation that reestablishes a connection between the two ends of the vas deferens that were separated at the time of a prior vasectomy. Sometimes the vas deferens is reconnected to the epididymis (epididymovasostomy) because of a secondary obstruction in the epididymis.

Increasing numbers of men are coming to the urologist for vasectomy reversals, most commonly because of remarriage and the desire to initiate a pregnancy. Vasectomy reversals are also requested by couples who have merely "changed their minds," as well as by couples who have lost a child and are attempting to initiate another pregnancy. Fortunately, microsurgical advances are now resulting in significant pregnancy rates.

The success of a vasectomy reversal depends on:

  • The skill of the surgeon
  • The findings at the time of surgery

Intraoperative Results

A surgeon who frequently performs this procedure will usually have a higher success rate than surgeons who do not have a corresponding level of experience. Over 150 vasectomy reversals are performed at the Scott Department of Urology each year with the following success rates:

Sperm Present: Yes
Procedure: Vasovasostomy
Patency Rate: 95%
Pregnancy Rate: 75%

Sperm Present: No
Procedure: Vasovasostomy
Patency Rate: 60%
Pregnancy Rate: 50%

Sperm Present: No
Procedure: Epididymovasostomy
Patency Rate: 50%
Pregnancy Rate: 45%

Approximately three procedures are performed weekly on an outpatient basis. This arrangement allows you to return home or to a nearby hotel without actually being admitted directly to the hospital, thus saving considerable expense and making the overall experience much more pleasant. Surgeries are done at the day surgery unit of Baylor St. Luke's Medical Center or Houston Methodist Hospital in the Texas Medical Center. Both of these facilities feature state-of-the-art microsurgical equipment and a hospital staff well trained to assist in these procedures.

Operating time for a vasovasostomy or epididymovasostomy is approximately three hours. A general anesthetic usually is used, but a regional anesthetic (spinal or epidural) can also be selected. Out-of-town patients are requested to stay in Houston for at least one day after surgery.

Postoperative follow-up includes an evaluation of wound healing at 10 days to 2 weeks and a semen analysis at 6-8 weeks. Monthly semen analyses are then obtained for approximately four-six months, or until the semen analysis stabilizes. If semen quality is less than expected, anti-inflammatory medication is often introduced to decrease scarring.

Medical Details of Vasectomy Reversal Surgery

Sperm production takes place in the testis. After passage through the efferent ducts, sperm are stored and undergo maturation within the epididymis. Those sperm that have not passed through the epididymis are generally not able to fertilize eggs under normal conditions. The epididymis is a continuous, tightly coiled tube approximately 15-18 feet in length, which leads into the vas deferens. The vas deferens is responsible for directing and propelling the sperm into the urethra.

When the vas is opened, fluid will flow from the testicular side of the vasectomy site. If sperm are present, then we expect 90 percent or more of patients to demonstrate a return of sperm with an associated 60 to 70 percent pregnancy rate.

If no sperm are present, yet the vasectomy fluid looks abundant and appropriate for ultimate sperm production (e.g., clear, watery), then a direct vasovasostomy is performed with a successful outcome of approximately 50 percent. If poor-quality fluid is present (e.g., thick, pasty) and sperm are absent, or no fluid at all is found, then an epididymovasostomy (connection of the vas to the epididymis) is performed with a successful outcome of approximately 40 to 50 percent.

We use a two-layer anastomosis utilizing microscopic sutures and the latest microsurgical equipment.

Cryopreservation of sperm (sperm banking) is routinely performed at the time of vasectomy reversal if whole, motile sperm are present. Cryopreservation is performed as a safety "backup" in case inadequate sperm counts are present after surgery. Because vasectomy reversals may infrequently scar, despite good initial results, cryopreservation may also be performed on ejaculated specimens early in the course of recovery when semen quality is exceptionally good. Sperm are stored at the Scott Department of Urology's Sperm Bank.