Vasovasostomy

The sterility from a vasectomy should be thought of as permanent. However, vasovasostomy is a reversal procedure that may restore fertility in some men. It can also relieve chronic pain from vasectomies. This pain occurs very rarely. The procedure may offer some chance for pregnancy even in women over 35.

PROCEDURE

  • The procedure involves sewing together the two tiny ends of two tubes. Each tube has a pinhead-sized opening. This would be the same as you splicing your garden hose, but a very small one.

  • It can usually be done on an outpatient basis. Patients can usually return to work within one to two weeks. It is more difficult and expensive than a vasectomy. It is even costlier if it involves connecting the vas to the epididymis (another one of the tubes which carries the sperm). This procedure usually takes about three hours.

  • Reversal surgery is usually not covered by health insurance.

  • The results may not be known for some time.

The surgeon may view the surgical site using magnification instruments. This is called microscopic vasovasostomy. Microscopic techniques may improve the chance of a reversal's success. Macroscopic vasovasostomy has a slightly lower success rate. However pregnancy rates can still be over 50% with a macroscopic procedure. A macroscopic procedure:

  • Is less expensive.

  • Has a shorter operating time.

The microscopic approach is preferable for repeat surgery when an initial procedure failed.

SUCCESS IS MORE LIKELY WHEN:

  • The section removed during vasectomy was not long.

  • The original procedure was performed on straight sections of the vas deferens.

  • The pieces being joined together are of equal size.

  • The vasectomy was recent.

  • The male partner does not change female partners after the procedure.

CAUSES OF FAILURE

  • Various factors play a role in the failure of reversal surgery.

  • If the sperm count does not recover, it is often due to blockage from scarring in the epididymis. This may be corrected with a second procedure.

  • The body develops immune system responses that kill its own sperm after a vasectomy. This cannot be reversed.

  • Immune system responses may injure sperm DNA, contributing to infertility.

  • Inadequate technology available or specialty care not available.

  • Remarriage seems to make the procedure less likely to be successful.

FREEZING SPERM PRIOR TO VASECTOMY

Freezing sperm prior to vasectomy or during vasovasostomy may help if the reversal process fails. This sperm can be used later with artificial methods. Men should discuss these options with their doctor.

REVERSAL SURGERY VERSUS ASSISTED REPRODUCTION

Vasovasostomy is still a better choice than assisted reproductive technologies (ART). Success rates with reversal surgeries are improving. The costs are lower than with ART. In addition, the reversal process does not pose a risk for multiple births. Even for men who have failed reversal procedure, a repeat procedure appears to be less expensive than starting fertility treatments.

ART may be a better approach than reversal for men whose immune system attacks sperm due to vasectomy.