Can a Vasectomy Be Reversed?

So you had yourself sterilized a few years back by a top urologist in Karachi and have now decided to have kids or add more to the family, or perhaps the pain of a recent vasectomy is too great to bear. Whatever the case, quite a few men often end up getting their vasectomies reversed. However, along with being more complicated than vasectomies, a vasectomy reversal doesn’t always guarantee the return of sperm and fertility. In fact, a reversal’s success often depends upon:

• The type of vasectomy
• Time between vasectomy and reversal
• Development of sperm antibodies
• Any tissue or tube damage during original surgery
• The female partner’s age

Success By Numbers:

Fertility and eventual pregnancy depend greatly upon the number of years that have passed since a vasectomy. If performed within 3 years, the success rate of a reversal is 75%, which drops significantly to 55 and 25-30% after 10 and 19 years following a vasectomy.

Types:

A vasectomy reversal can traditionally be performed in 2 ways, although the decision is often made after analyzing the semen (sperm fluid) and presence of sperm during surgery:

• Vasovasostomy involves sewing the severed ends of the vasa deferentia (sperm-carrying tubes) back together from the testes to the penis.
• Vasoepididymostomy involves attaching the severed ends of the vasa deferentia to the small, sperm-holding organ (epididymis) behind each testicle. Due to its high complexity level, a vasoepididymostomy is performed only when a vasovasostomy fails or isn’t possible.
• Combination Surgery may be required in some cases, during which a vasovasostomy and vasoepididymostomy are performed on either side of the genitals.

How It Happens:

Like a vasectomy, vasectomy reversals are outpatient procedures. However, they may take up to 2-4 hours as opposed to the 20-30 required for a vasectomy. After injecting local anesthesia via a fine-tipped needle or air pump into the scrotum by a top urologist in Lahore,  the vasa deferentia are cut open and examined for semen and sperm. If sperm is present, the vasa deferentia are reconnected.

In some cases, the sperm flow is obstructed by scar tissue formation, resulting in thick and pasty semen; which is then corrected by a vasoepididymostomy. After connection, the incisions are sewn together with stitches that usually dissolve in 10 days.

Post-Surgery Precautions:

Recovery from a reversal usually takes 2 weeks, during which doctors often recommend:

• Regularly wearing athletic, supportive underwear, later required only during exercise.
• Avoiding bathing and swimming for 2 days post-surgery.
• Limiting activities like jogging, biking and heavy lifting for 2-4 weeks after surgery to avoid pulling on the testicles and scrotum.
• Taking time off if your job involves hard labour and regular driving or walking.
• Refraining from sexual intercourse for 2-3 weeks post-surgery.
• Taking NSAIDs for any scrotal pain.

How To Tell If It Works:

Semen samples are collected and examined 6-8 weeks after surgery and then periodically for up to 4-6 months detect the presence of sperm. Once the sperm returns, the pregnancy rates increase exponentially. However, reversal through vasovasostomy generally requires 6-12 months for a sperm reappearance, while the wait is more prolonged in case of a vasoepididymostomy.

Risks:

• Bleeding within the scrotum can cause blood to collect and form a painful swelling.
• Although uncommon, the surgery site may become infected and inflamed and require antibiotic treatment.
• Some patients may experience chronic scrotal pain.

In-Vitro Fertilization (IVF):

Some individuals may choose to have some of their sperm extracted and frozen in a sperm bank (cryopreservation) at the beginning of a vasectomy reversal in case they fail to induce pregnancy through intercourse. In such situations, the frozen sperm is then injected the female partner’s uterus for fertilization. Alternatively, the sperm may also be retrieved directly from the testicles or epididymis during or after the surgery.

IVF is generally recommended instead of a reversal if the female partner is over 40, has never been pregnant, or has had a tubal ligation (female sterilization).  However, IVF is highly expensive and does not guarantee a pregnancy.

The success of a vasectomy reversal is highly subjective. So, remember to discuss in detail the implications of your decision with your doctor and partner if you are contemplating a vasectomy. You can also book an appointment with a top Urologist in Lahore, Karachi and Islamabad through oladoc or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your testicular concerns.