by Dr. Herb Singh
Vasectomies can be reversed, meaning healthy sperm can be restored to the ejaculate. Vasectomy reversals are performed when the personal circumstances of a couple have changed: remarriage, the loss of a child, or the desire for more children. Any man who has had a vasectomy and is interested in having more children is a candidate for a vasectomy reversal. Vasectomy reversals are highly successful in returning sperm to ejaculate, with rates exceeding 95% in the first five years following vasectomy. With increasing time between the vasectomy and the vasectomy reversal, the success rate slightly declines but continues to remain high. In certain rare instances, the the vasectomy reversal is not successful. The options in these circumstances are either to perform a redo vasectomy reversal, undergo in vitro fertilization with sperm harvested using a procedure such as microscopic epididymal sperm aspiration (MESA), or to use donor sperm.
Ultimately, the success endpoint of a vasectomy reversal is, of course, having a health baby, not just have healthy, numerous sperm in the ejaculate. To that end, the female partner’s fertility is also critical. In certain instances, couples are best served by directly proceeding with in vitro fertilization in combination with a sperm harvesting procedure such as microscopic epididymal sperm aspiration (MESA), rather than a vasectomy reversal. Decisions about the best choice are made on a case by case basis for couples.
Some couples are curious about the quality of sperm following a vasectomy reversal. The quality and quantity of sperm generally return to the baseline characteristics which were present before the vasectomy. Furthermore, there is no evidence that children conceived following a vasectomy reversal have any issue with birth defects or developmental abnormalities, nor is there any evidence that there is an increased risk of miscarriages.
Couples who are interested in a vasectomy reversal should visit a urologist with experience as a microsurgeon. Generally speaking, you want to visit with a urologist who has performed more than 100 vasectomy reversals. The urologist should be comfortable performing a direct sperm duct to sperm duct connection using a microscope (called a microscopic vasovasostomy) and a connection between the sperm duct and epididymus using the microscope (called a microscopic epididymovasostomy). In certain patients, a epididymovasostomy is the preferred method of a vasectomy reversal and the surgeon should be comfortable performing it. That decision is made intraoperatively based on the findings at the time of surgery.
The step-by-step process of proceeding with a vasectomy reversal is to meet with a urologist who has expertise in vasectomy reversals. The urologist will review your history, perform a physical exam, and assess for the distance between the two ends of the sperm duct on both sides. The examine of the male partner is also to make sure there are no abnormalities that could complicate a successful vasectomy reversal. The vasectomy reversal surgery is outpatient. Patients are typically asked to abstain from sexual activity for one month following the vasectomy reversal. Light activity is acceptable following the procedure, but the patient should abstain from vigorous activity following the procedure for one month. Overall, the vasectomy reversal is a safe and effective method to restore healthy sperm to the ejaculate.