Considering a vasectomy reversal? Here’s some information about vasectomy reversal procedures you might find useful. It comes from Professor Earl Owen, the surgeon who performed the first successful microsurgical vasectomy reversal for an Australian man in 1971.
What happened after my vasectomy?
Since your original vasectomy, years ago, millions of sperm cells have been produced by the testicles on a daily basis. Normally, these sperm cells go through the process of maturation (mainly in the epididymis, the maturation coil next to the testicle) for six or more weeks. The sperm cells then progress, as ‘spermatids’ (cells with a small body and a little tail), into the vas deferens, which are small tubes that connect the testicles with the prostate and the urethra. The vas deferens are aided by muscles that push the seminal flow about 22 centimetres to the prostate gland; this takes another few weeks. The cells arrive as mature sperm that can be ejaculated. The sperm are then 10 weeks old, can swim well and are finally ‘ready to go’.
In the original vasectomy, your system was tied off in the vas deferens. The sperm production continued, however, slowing down as the pressure increased because the immature sperm had nowhere to go once they reached the tied off vas deferens.
A vasectomy is a mechanical obstruction; sperm production still goes on, the epididymis stretches and the tubules in the testicle swell and a certain laxity in the system contains the increased pressure. Being mainly water (more than 80%) the sperm cells then disintegrate and are absorbed by the body.
Some facts about vasectomy reversal surgery
Over 22,000 Australian men have a vasectomy each year. That’s because it’s the easiest, most efficient and least troublesome form of permanent contraception and it’s done as outpatient surgery.
A vasectomy is also reversible.
The surgical management of a vasectomy reversal was pioneered in 1971, and has since been perfected and successfully performed by Professor Owen. His team, unchanged for the past 24 years, does more vasectomy reversals each year than any other unit in Australia. Men aged 22 to 70 have had a successful vasectomy reversal, from 1-3 years after their original vasectomies. Professor Owen publishes the team’s outstanding baby birth rates – not just the technical successes of each vasectomy reversal performed – and it’s the only team of surgeons to do so.
The vasectomy reversal procedure
The vasectomy reversal procedure is quite similar to the vasectomy procedure. The techniques and risks involved and the recovery time are also very similar. Vasectomy reversals need a bit more time than vasectomies because reconnecting severed tubes is a lengthier process than just cutting them.
In a vasectomy, the vas deferens that carries sperm cells are cut so there are no sperm cells in the ejaculated semen. A vasectomy reversal reconnects the ends of the vas deferens, so the sperm once again have access to becoming part of the semen. Basically it fixes the ‘plumbing’ so everything goes back to working as it should.
Most vasectomy reversals are performed in an outpatients clinic and can be performed under local or general anesthesia.
The sooner the reversal, the better the result
After a routine vasectomy, sperm production continues and sperm accumulates in the system. It is eventually reabsorbed.
The fluid left in the system inevitably thickens; therefore, the longer the interval between vasectomy and vasectomy reversal, the less likely it is to flow. Other factors that influence the success of a vasectomy reversal are microsurgical precision, the surgical microscope and equipment and, of course, the skill and experience of the doctor who performs the vasectomy reversal.
The success rates of a vasectomy reversal surgery also depends on the state of what was left of the vas deferens after the original vasectomy was performed.
How long does it take for sperm to come back after vasectomy reversal?
The vasectomy reversal operation takes up to one hour for each side and is not painful when you awaken from a light general anesthetic. You will be advised against having sexual intercourse for the first month after the vasectomy reversal, to allow for healing at the operation site. Your doctor will then recommend more sexual activity than you are used to, as that activity causes peristaltic muscle movement to help empty out the old accumulated sperm in the system.
How do we know whether it has been successful?
Ten weeks after the operation you’ll be requested to take your referral form to the nearest pathologist’s laboratory, where the first sperm count will be taken. After you provide them with a sperm sample, it is examined to check whether there are any sperm present and also to check the success of the new sperm’s return. After that is done, it’s safe to commence intercourse to get your partner pregnant.
Pregnancy rates are much higher a couple of months after the vasectomy reversal, as accumulated sperm made under pressure will have been passed. The staff at Professor Owen’s clinic check the sperm count, advise you and your partner and also keep in touch, as they like to collect baby photos!
Vasectomy reversal success rate
These are the success rates of most western clinics. As you can see, the more time since the vasectomy was performed the lower the chances of a successful vasectomy reversal.
From the time of vasectomy:
- First 5 years – 95%
- Years 6-10 – 90%
- Years 11-15 – 80%
- Years 16-20 – 57%
- Years 21-35 – 45%
Once the ends of the vas deferens have been reconnected, if there are any male infertility problems, they can be addressed, as sperm retrieval is now possible.
Whether the infertility’s origin is in the male or female partner, there are other fertility techniques that can be used, such as in vitro fertilization, intracytoplasmic sperm injection or intrauterine insemination. Sperm banking is another possibility if the semen analysis shows that the sperm are viable.
Talk to your health care provider if you’re having difficulty conceiving after your vasectomy reversal.
Vasectomy reversal cost
There is a wide range of prices for a vasectomy reversal. Even in the same country, vasectomy reversal prices can vary greatly from one fertility center to another. Make sure you do thorough research into the options available near you, taking into account not only the cost but the presence of an experienced surgeon and the success rates of the surgery center.
Can a reversal be impossible in some cases?
The age of the man and the length of time since the original vasectomy are important factors for a successful vasectomy reversal. There are also other significant pointers to success: the consistency of the flow; and the point at which the vasectomy was done – e.g. it might have tied off the epididymis low down in the scrotum.
If it is in the vas deferens itself and there is reasonable flow, then the results are likely to be good; if not, the chance of success is lower. Until they operate, the doctors can’t know what they will find inside the tiny tubes. This will be explained to you before the operation; patients are usually asked whether they want the surgeons to continue if they find things in a too damaged state. If they do not want to continue, the surgeon will close up the small incisions and, in some cases, refund most of the fees.
Make sure you discuss this with the staff at the clinic where you intend to have your reversal operation.
Recovery from vasectomy reversal
The most frequently question Professor Owen’s team is asked is, ‘If the operation is painless and you feel okay afterwards, why do you have to stay for hours in hospital?’
Professor Owen says:
‘The answer concerns how we humans heal. In the first 40 hours, you will get almost perfect healing if you allow the tiny blood capillaries to join up across the surgical join. It takes that amount of time in a wound with freshened ends brought together ‘just right’: not too tight, and not too loose, in a technique allowing the exact juxtaposition of the two shaped ends – and not too many stitches either. I won’t bore you with surgical details but we pride ourselves as not only being the world’s first ever clinical microsurgeons in Sydney, but also keeping the highest standards of patient care possible, while enjoying our procedures, which we developed and perfected’.
Scrotal support has been proved to help patients post-surgery. Not only does it protect the surgical site but it supports the testicles and prevents them from moving. This helps if there is any painful swelling or persistent pain. Investing time in your recovery helps to reduce the number of cases of post vasectomy pain syndrome or chronic testicular pain.
Getting the best results
There is a big difference between the results achieved by different surgeons, using different methods.
Many urology healthcare providers publish their pregnancy rates or their results related to the return of sperm to the ejaculate. These remain the ‘gold standard’; however, when looking for the right provider, it’s important that you also look for their ‘birth rate’.
This is a very important parameter to take into account. The birth of a live healthy baby is the ultimate reason why a couple would go through the process of a vasectomy reversal.
Imagine going through the operation to end up not getting your partner pregnant or the sperm becoming of such low quality that, once pregnancy is achieved, your partner miscarries the baby.
Another factor to take into account is whether or not the clinic you are enquiring about operates after surgeons have already failed to achieve a positive result.
The choice of anesthetic is also a key factor, especially if you are planning to take the general anesthetic option.
The equipment and technique are also important. Bear in mind that this is highly concentrated and meticulous microsurgery on the vas deferens, which have an internal bore (similar to the internal diameter) approximately the width of two hairs (0.2 mms) and an outside diameter of less than 1 mm. It has an internal pressure of 100 to 200 mm mercury (which can be higher than blood pressure) when the muscle is pushing the sperms along by peristaltic contractions as soon as the anesthetic wears off. Unless the joins are made with an overlapping three layer technique, your tiny (one micron sized) sperm could be squeezed out straight away, rather like water out of a watering can and, as leaking sperms are toxic to your own tissues, they form dense scar tissue and block the vas deferens again as it heals.
Research shows that vasectomy reversal is safe and the success rate keeps increasing.
However, make sure you take all these factors into account when deciding where to get your vasectomy reversal. Thorough research into the best possible options near you can make a significant difference in your parental journey.