Vasectomy reversal

Vasectomy reversal

Vasectomy reversal may be performed for men who have previously had a vasectomy, but who now wish to try and father a child again. Most commonly this occurs because of a change in personal circumstances, such as a new relationship. The decision is often a difficult one to reach, and is usually made in consultation with their partner.

When a man is considering having a vas reversal, it is usually sensible for the couple to see their GP and discuss their plans. The GP can then make a referral to Cambridge Urology Partnership.

At Cambridge Urology Partnership, you will have the opportunity to meet your surgeon, Oliver Wiseman, in an out-patient clinic to discuss your individual circumstances. An examination of the testicles will be carried out, and then he will discuss with you the surgery, possible complications and post-operative recovery period, as well as give you the chance to answer any questions. It is helpful if both partners attend the consultation. You will be given an information sheet to take away with you, and if needed Mr Wiseman can ring you back at a later date to answer any further questions.

What does a vasectomy reversal procedure involve?

A full general anaesthetic (where you will be asleep throughout the procedure) will be used. The operation is performed through two incisions at the side of the scrotum and the ends of the tubes are re-joined using a microscope. The microscope allows good visualisation of the lumen of the vas, which is very small, and allows for accurate suture placement. Because of the delicate nature of the surgery, the operation usually takes three hours.

vasectomy

A picture through the microscope showing the ends of the vas tubes being sewn together.

What are the success rates of vasectomy reversals?

A number of factors affect the success of the procedure. The most important factor is the length of time since the vasectomy was performed. The results are better the more recently the vasectomy was performed, with a chance of over 90% of sperm returning to the ejaculate of the vasectomy was performed less than 3 years ago, to 70% if the vasectomy was performed over 15 years ago. These results are those from a large multi centre study (i.e. more than one surgeon) in the USA. Mr Wiseman’s success rates for the procedure are high when compared to published literature.

Other factors which can affect the chance of success of the operation or the chance of pregnancy, which the operation cannot correct for account for, include:

  • Age of female partner: The age of your partner is a key factor. A woman’s peak fertility is early in the third decade of life. As she ages beyond 35 years (and particularly after age 40 years), the likelihood of becoming pregnant is less than 10% per month. This does not mean that you should not have the operation done if your partner is nearing this age, but it is important that you realize that even if sperm return to your ejaculate, your partner may not become pregnant.
  • Female menstrual or ovulatory difficulties: if your partner has menstrual or ovulatory difficulties, it is best for her to be seen by a gynecologist prior to considering you undergoing treatment.
  • Lifestyle issues: Alcohol, obesity, smoking and recreational drugs can affect sperm function, and so should be avoided.

Who does the vasectomy reversal operation?

The procedure is performed by a recognised male fertility specialist, Oliver Wiseman, who has been trained in microsurgical vas reversal in the UK and the USA. His success rates for the procedure are high, and compare well to those published in the literature. He works together with the world famous infertility clinic, Bourn Hall Clinic, to offer patients freezing of sperm at the time of their reversal, so that if the procedure is not successful, or if it is successful but the couple do not manage to conceive naturally, then there is some stored sperm which can be used for assisted conception such as IVF and ICSI.

Where can I get more information?

More information can be obtained by contacting Cambridge Urology Partnership on 0800 756 7771, or visting our Contact page, and we can then send you an up to date information sheet and arrange an appointment if you wish.

Vasectomy

What is vasectomy?

Vasectomy is a method of permanent contraception. It is a small operation to remove of a small section of vas from both sides with interposition of tissue between the divided ends to prevent re-joining. Once the vas deferens is cut, sperm can no longer get into the semen that is ejaculated during intercourse.

How reliable is vasectomy?

Vasectomy is very reliable – but not quite 100%. About 1 in 500 operations are not successful, and semen tests show sperm still present after the operation. Even after a successful operation about 1 in 2000 men who have had a vasectomy will become fertile again at some point in the future. This is because, rarely, the two ends of the cut vas deferens join together again in time.

How is a vasectomy done?

It is usually done with a local anaesthetic (but is sometimes done under a general anaesthetic). Local anaesthetic is injected into a small area of skin on either side of the scrotum above the testes. A small cut is then made to these numbed areas of skin. The vas deferens (spermatic cord) can be found under the cut skin and is cut, and the two ends are tied. The small cuts to the skin are then stitched close with dissolvable stitches. The operation takes between 20 and 30 minutes.

There is usually some discomfort and bruising for a few days afterwards. This normally goes away quickly. The discomfort can be helped by wearing tight fitting underpants day and night for a week or so after the operation. It is also best not to do heavy work, exercise, or lifting for a week or so after the operation.

Are there any risks to the operation?

Most men have no problems after a vasectomy. Problems are uncommon but include the following.

  • A small amount of bruising and scrotal swelling is inevitable for several days
  • Seepage of a small amount of yellowish fluid from the incision several days later
  • Blood in the semen for the first few ejaculations
  • Sufficient specimens of semen must be produced after the operation until they have been shown to contain no motile sperms on two consecutive specimens in order for you to stop using alternative contraception methods
  • Chronic testicular pain (10-30%) or sperm granuloma (tender nodule at the site of surgery)

The procedure should be regarded as irreversible. Although vasectomy may be reversed, this is not always effective in restoring fertility, especially if more than 7 years have lapsed since the vasectomy

For more information please read our Vasectomy information sheet

How do I know it has been successful?

You are not sterile immediately after the operation because some sperms have already passed beyond the site where the tubes are tied off. These sperms are cleared by normal ejaculation; it takes, on average, 20-30 ejaculations before you are likely to be clear. At 16 and 20 weeks after the operation you will be asked to produce specimens of semen for examination under a microscope; please read the instructions for production and delivery of these specimens very carefully. If no sperms are present, you are sterile and we will write to tell you so. If there are still a few non-motile or dead sperms, you may be regarded as sterile but, if there are large numbers of motile sperms, further specimens will be required until you are clear. Until you get the “all clear” you must continue with your contraceptive precautions.

What are the advantages of vasectomy?

It is permanent and you don’t have to think of contraception again. It is easier to do, and more effective, than female sterilisation.

What are the disadvantages of vasectomy?

It may take a few months before the semen is free from sperm. As it is permanent, some people regret having a vasectomy, especially if their circumstances change. If you later decide that you wish to have your vasectomy reversed, the results for this operation are not guaranteed, and you would likely need to pay for this procedure yourself as it is not available on the NHS.

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