Clinical Specialties : Male Urologic Health

Vasectomy Reversal

There are many reasons to reverse a vasectomy like remarriage following a divorce, having a change of heart, or starting a family over after the loss of a wife or child. Regardless of your reason, there are now advanced methods to restore your fertility. A vasectomy is a minor surgical procedure in which the sperm duct, or vas deferens, is cut in order to achieve sterility. Vasectomy reversal restores fertility by reconnecting the ends of the previously severed vas deferens. This procedure is performed using microsurgery and ultimately restores the tubal passage for sperm to be ejaculated.

Vasectomy reversals are generally performed in an outpatient area of a hospital or in an ambulatory surgery center. The operation is usually performed with general anesthesia. Once the patient is anesthetized, the urologist will make a small cut on each side of the scrotum and first remove the scarred ends of the vas deferens at the point of blockage created by the previous vasectomy. The urologist will then extract a fluid sample from the end closest to the testicle to see if the fluid contains sperm.

The presence of sperm in the fluid is an indication that there is no obstruction between the testicle and the location in the vas from which the fluid was obtained. When sperm are present in the fluid, the ends of the vas can be connected to reestablish the passageway for sperm. The medical term for reconnecting the ends of the vas is vasovasostomy.

The microsurgical approach is recommended and uses a high-powered microscope to magnify structures. Use of an operating microscope provides better results, as it allows the urologist to manipulate stitches smaller in diameter than an eyelash to join the ends of the vas deferens. When microsurgery is used, vasovasostomy results in return of sperm to the semen in 70-95 percent of patients and resulting pregnancy in 30-75 percent of female partners. These numbers however depend upon the length of time from the vasectomy until the reversal but more importantly the microscopic finding of sperm during the operation under a microscope. Dr. Ramasamy has published on the factors that influence success after vasectomy reversal and determined that intraoperative microscopy is the most important factor. If the urologist does not find sperm in the fluid sample, it may be because the original vasectomy resulted in back pressure causing a break in the epididymal tubule. Because any break in this single, continuous tube can result in a blockage, the urologist will have to employ a more complicated reversal technique called an epididymovasostomy or vasoepididymostomy. In this procedure, the urologist must bypass the blockage in the epididymis by connecting the “upper” end of the vas deferens to the epididymis above the point of the blockage. While vasoepididymostomy is a more complex procedure than vasovasostomy due to the very small size of the tube inside the epididymis, recent advances in the surgical technique have made outcomes nearly as successful as vasovasostomy. You may need a combination of the two techniques, with a vasovasostomy done on one side and a vasoepididymostomy on the other side. Vasoepididymostomy usually requires a longer incision into the scrotum.

Dr. Ramasamy is an expert in vasectomy reversal in Miami, Florida and has published several studies on vasectomy reversal.

1. Bernie AM, Osterberg EC, Stahl PJ, Ramasamy R, Goldstein M. Vasectomy reversal in humans. Spermatogenesis. 201; 1;2(4):273-278

2. Ramasamy R, Schlegel PN Vasectomy and Vasectomy Reversal: An Update. Indian J Urol. 2011; 27:92-7

He recently demonstrated that success following vasectomy reversal depends on microscopic examination of vasal fluid during vasectomy reversal

1. Ramasamy R, Mata DM, Jain L, Perkins A, Marks SF, Lipshultz LI: Microscopic visualization of intravasal sperm is positively associated with patency after bilateral microsurgical vasovasostomy. Andrology 2015

2. Scovell J, Mata D, Ramasamy R, Herrell L, Hisao W, Lipshultz LI: Association between the presence of sperm in the vasal fluid during vasectomy reversal and postoperative patency: a systematic review and meta-analysis. Urology 2015 85(4): 809-13.

What can be expected after a vasectomy reversal?

Recovery from a vasectomy reversal should be relatively swift and fairly comfortable. Any pain that might be experienced after surgery can be controlled with oral medications. About 50 percent of men experience discomfort that is similar to the level they had after the original vasectomy. Another quarter report less pain than accompanied the vasectomy. The final 25 percent say the pain is somewhat greater than after the vasectomy. The reassuring news is that any pain severe enough to require medication rarely lasts longer than a few days to a week.

Most patients are back to normal routine and light work within a week. Urologists usually want their patients to refrain from heavy physical activity for two to three weeks. If your job requires strenuous work, you should discuss with your surgeon the earliest time you can return to work. You will be advised to wear a jockstrap for support for several weeks. You will likely be restricted from having sex for approximately two to three weeks.

It takes on average one year to achieve a pregnancy after a vasectomy reversal. Some pregnancies occur in the first few months after the reversal procedure, while others do not occur until several years later.The urologist will request a semen analysis every two to three months after surgery until your sperm count either stabilizes or pregnancy occurs. Unless a pregnancy occurs, a sperm count is the only way to determine surgical success. While sperm generally appear in the semen within a few months after a vasovasostomy, it may take from three to fifteen months to appear after a vasoepididymostomy.

In either case, if the reversal works, the patient should remain fertile for many years. The possibility of subsequent pregnancies is an important advantage of this procedure over sperm retrieval techniques for in vitro fertilization. Only approximately 5 percent of patients who have sperm appear in the semen after a vasectomy reversal later develop scarring in the reconnected area, which could block the passage of sperm again.

Make an appointment

Ranjith Ramasamy, MD
Director of Male Reproductive Medicine and Surgery
Call: (305) 243-6090
e-mail or make an online appointment.