Vasectomy Reversal

Definition

Vasectomy reversal is a surgery to undo a vasectomy. After successful vasectomy reversal, sperm are present in your semen again and you may be able to get your partner pregnant. A more complicated surgery than vasectomy, vasectomy reversal re-connects the tubes that carry sperm from the testicles into the semen. Vasectomy reversal can be attempted even if a long time has passed since you had your vasectomy. However, only about half of vasectomy reversals are successful.

Why it's done

Men decide to have the surgery to restore fertility for a number of reasons, including loss of a child, remarriage or improved finances making it feasible to raise a child. A small number of men have a vasectomy reversal to treat testicular pain.

Risks

Major complications following vasectomy reversal are rare. Risks of vasectomy reversal include:

  • Bleeding within the scrotum. This may lead to a collection of blood (hematoma) that causes painful swelling. You can reduce this risk by avoiding aspirin before and after surgery and following your doctor's instructions to rest after surgery.
  • Infection at the surgery site. This isn't common, but is a risk with any surgery.
  • Inflammation. Sperm leakage into the scrotum can prompt your immune system to form an inflammatory mass called a sperm granuloma. Granulomas usually occur sometime after surgery and can be a sign that a vasectomy reversal wasn't successful.
  • Damage to nerves and blood vessels. In some cases, this reduces fertility after a vasectomy reversal.

Call your doctor if you develop any of these signs and symptoms after your vasectomy reversal:

  • Fever
  • Swelling that worsens or won't go down
  • Difficult urination
  • A marble-sized lump in your scrotum
  • Bleeding from an incision that continues after you've pinched the site between two gauze pads for 10 minutes

How you prepare

Before having vasectomy reversal surgery to restore fertility, your doctor will want to make sure you can produce healthy sperm. For most men, having gotten a woman pregnant before is proof enough.

  • If your doctor is unsure whether you are producing enough healthy sperm, you may need a testicular biopsy. In this test, a needle is used to remove fluid from your testicles to check for sperm.
  • Your female partner also needs to be tested to make sure she doesn't have fertility problems. It's a good sign if your partner has been pregnant in the past. Her doctor will want to know if she has regular menstrual cycles, and will do a pelvic exam. The doctor may recommend other tests to make sure your partner's fallopian tubes aren't blocked and that she's producing eggs (ovulating).

Doctors usually perform vasectomy reversals at a surgery center or at a hospital. It's a delicate procedure that can be done using a few different surgical techniques.

  • Before you choose a doctor, ask how many vasectomy reversals he or she has performed, and how many men have successfully fathered children after the reversal surgery.
  • After choosing a doctor, meet with him or her to discuss the procedure, risks and potential complications. Include your partner in this initial consultation, if appropriate.
  • Two weeks before and after your vasectomy, don't take aspirin, ibuprofen (Advil, Motrin, others) because they can increase your risk of bleeding. Instead, use acetaminophen (Tylenol, others) to relieve pain.
  • The surgery usually takes two to four hours. You'll also need time to recover from anesthesia. Arrange for someone to drive you home after surgery.

What you can expect

Vasectomy reversal is a technically challenging operation that requires specialized skills and expertise. The surgery is more difficult than is the original vasectomy. The tube that carries sperm from each testicle to your semen (vas deferens) must be sewn back together or attached to the epididymis. The epididymis is the coiled tube on the back of each testicle where sperm matures. The surgery usually is done on an outpatient basis — without an overnight stay at the surgery center or hospital.

During the procedure

You may receive general anesthetics to make you unconscious during the surgery. Or, your surgeon may use an epidural, spinal or local anesthetic. In any case, your anesthesia will need to keep you completely still because the surgery is so delicate. It's done using a microscope that magnifies the surgery area.

The surgeon will make a cut on the underside of your scrotum, expose the testicle and release it from surrounding tissues. Next, he or she will cut open the vas deferens and examine the fluid inside.

After surgery

Immediately after surgery, your doctor may cover the incisions with bandages. You'll put on your jockstrap to hold any bandages in place and apply pressure to reduce swelling and movement. You'll need to rest with an ice pack placed on your scrotum to reduce swelling. As the anesthetic wears off, you may have some pain and cramping that can be relieved with a painkiller, such as acetaminophen. For most men, the pain isn't severe and gets better after a few days to a week.
After you return home, take it easy. You may be sore for several days, which you can treat with acetaminophen or, if your doctor prescribes it, acetaminophen plus codeine. You may also have bruising, but the discoloration should lighten and disappear after about two weeks. Any stitches should dissolve in seven to 10 days.

  • For the first two days after surgery, avoid bathing and swimming.
  • Refrain from sports and heavy lifting for at least three weeks.
  • If you have a desk job, you'll probably be able to return to work three days after surgery. If you perform physical labor or have a job that requires much walking or driving, talk to your doctor about when it's appropriate to resume working.
    You shouldn't have sexual intercourse or ejaculate for about four weeks. At that point, you may resume sexual activity.
  • You'll need to wear a jockstrap for several weeks at all times, except when showering. After several weeks, you'll need to continue to wear a jockstrap during exercise.

Results

You can resume sexual intercourse once the incisions are healed — usually a few weeks after surgery. If a vasectomy reversal is successful, sperm usually appear in the semen after a few months, but can take as long as 15 months with some procedures. Vasectomy reversal leads to pregnancy in about half of couples within two years.

Sometimes problems with conception are due to female infertility. When the female partner doesn't have fertility problems, couples are more likely to conceive a child after a vasectomy reversal.

Your surgeon will want to examine your semen after surgery to see if the operation was successful. Unless you achieve pregnancy, a sperm count is the only way to tell if your vasectomy reversal was a success. Your doctor will likely want to do a semen analysis every two to three months.

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