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Vasectomy reversal

Published by Bupa's health information team, March 2010.

This factsheet is for men who are having a vasectomy reversal operation, or who would like information about it.

A vasectomy reversal is an operation to reconnect the tubes (called the vas deferens) that carry sperm from the testicles to the penis. Vasectomy reversal aims to restore fertility after a vasectomy.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About vasectomy reversal
What are the alternatives?
Preparing for a vasectomy reversal
What happens during a vasectomy reversal
Animation - How a vasectomy reversal is carried out
What to expect afterwards
Recovering from a vasectomy reversal
What are the risks?
Questions and answers
Related topics
Further information
Sources

About vasectomy reversal

A vasectomy is an operation to cut and seal the tubes (called the vas deferens) that carry sperm from your testicles to your penis. Vasectomy is a permanent form of contraception and means that having children is no longer possible.

Some men come to regret their decision to have a vasectomy and want it reversed.

Illustration showing the position of the vas deferens and surrounding structures
The position of the vas deferens and surrounding structures

It's possible to reverse a vasectomy in most men who have the operation, although it's not always successful. Vasectomy reversal is an operation to reconnect the vas deferens, so that they can carry the sperm from your testicles to your penis. This can mean that you become fertile again and can make your partner pregnant.

Vasectomy reversal is more successful if it's done fairly soon after the original vasectomy. The longer the time between your vasectomy and a reversal operation, the less likely you will be able to father a child. The success rate falls as time goes on.

It's important to understand that success is not guaranteed. Sperm become present in semen for around eight out of ten men who have a vasectomy reversal. However, only about half of men will make their partner pregnant in the two years following the operation. The presence of sperm in your semen doesn't guarantee that your partner will get pregnant. The factors that can affect your chances of a successful reversal include:

the time since your vasectomy
the type of vasectomy being reversed
the type of technique used to do the reversal
any problems with other parts of your reproductive system
the presence of sperm antibodies
your partner's age and her fertility

It may be possible to have a second reversal operation if the first has not restored your fertility, but the chances of success may be lower.

What are the alternatives?

An alternative to vasectomy reversal is intra-cytoplasmic sperm injection (ICSI). Sperm is removed directly from your testicle or from your epididymis (a narrow tube inside your scrotum, where sperm are stored and matured). A single sperm is injected into your partner's egg. The fertilised egg is transferred to your partner's womb.

ICSI means that your partner will need to have IVF (in vitro fertilisation) treatment. ICSI isn't as successful as a vasectomy reversal.

Preparing for a vasectomy reversal

Your surgeon will explain how to prepare for your operation. For example, if you smoke you may be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

A vasectomy reversal is usually done as a day case. Most vasectomy reversal operations are done under general anaesthesia. This means you will be asleep during the procedure.

You can also have a vasectomy reversal done under local anaesthesia. This completely blocks pain from the groin area and you will stay awake during the operation. You may be given a sedative with a local anaesthetic. This relieves anxiety and helps you to relax.

Your surgeon will discuss which type of anaesthesia may be most suitable for you.

If you're having a general anaesthetic you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may do some tests, such as checking your heart rate and blood pressure, and testing your urine. You will be asked to change into a hospital gown and you may be asked to shave your scrotum.

Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure, and have given your permission for it to go ahead.

What happens during a vasectomy reversal?

A vasectomy reversal can take up to three hours. The operation can be done in two ways.

Standard vasectomy reversal

The technique most commonly used is called vasovasostomy.

Cuts are made into each side of your scrotum, usually in the same position as your vasectomy scars. Sometimes, only one cut is needed in the centre of the scrotum.

Scar tissue is removed from the vas deferens and the tubes are carefully pulled through the cuts. Your surgeon will check to see whether there is any fluid in the tube and may look for signs of any sperm in the fluid. If there is no fluid or sperm this may mean that there is a blockage. If this is the case the operation may be more complicated and your surgeon may decide to do a Vasoepididymostomy instead.

If there are signs of fluid and sperm your surgeon will rejoin each tube using dissolvable stitches. The tubes are placed back inside your scrotum and the skin cuts are closed using dissolvable stitches or surgical clips.

Sometimes it isn't possible to rejoin the vas deferens tubes in both testicles and only one is rejoined.

How a vasectomy reversal is carried out

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Vasoepididymostomy

Vasoepididymostomy is a more complicated procedure that involves joining the vas deferens directly to the epididymis (this is where the sperm are stored in each testicle). This can bypass any blockages in the vas deferens that may have developed after a previous vasectomy or reversal operation.

What to expect afterwards

You will need to rest until the effects of the general anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will wear supportive underwear to help relieve any discomfort.

Occasionally, fine plastic tubes are left in the scrotum for up to 24 hours. These allow blood and fluid to drain into a bag. If this is the case you will need to stay in hospital overnight. If tubes aren't used you will be able to go home when you are fully awake and after you have passed urine.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you advice about caring for the healing wound, hygiene and bathing before you go home.

The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. They usually disappear in around two to three weeks, but it can sometimes take longer. Surgical clips are removed after two weeks.

Recovering from a vasectomy reversal

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Continue to wear close-fitting underwear day and night for a few weeks. This will help ease any discomfort and swelling.

You can shower two days after your operation, but don't have a bath or soak your wounds for two weeks after your operation. You can do gentle exercise after the first week but don't do any heavy lifting or vigorous exercise for the first three weeks after your operation.

You shouldn't have sex until four weeks after your operation. You won't know if you are producing sperm when you ejaculate until your doctor has checked a sample of semen. This is usually done three months after vasectomy reversal. If you have had a vasoepididymostomy it can take longer for sperm to appear in your semen, so you may need to have your semen tested every three months until sperm are seen.

What are the risks?

Vasectomy reversal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects you may get after having the procedure. Your scrotum will feel sore, and you will have some bruising and swelling for a few days.

Complications

Complications are when problems occur during or after the operation. Most men aren't affected.

The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding, or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Specific complications of vasectomy reversal are uncommon, but can include:

infection - this can be treated with antibiotics
bleeding inside your scrotum (haematoma) - this may need surgery to stop the bleeding and drain the area
fluid building up in your scrotum (hydrocele) - this may need treatment to drain the area
damage to blood vessels - this can cause permanent damage to one or both testicles (testicular atrophy)
long-term testicular pain - this is caused by pinched nerves or scarring and may need surgery

It's possible that vasectomy reversal may not restore your fertility and you may need further fertility treatments to have a baby. Scar tissue may develop following the operation and this may lead to blocking of the vas deferens. Sometimes the quality of sperm can also be poor after a vasectomy reversal.

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.