What to know about a vasectomy reversal

A vasectomy is a contraceptive surgical procedure specific to the male anatomy. Sometimes, patients of vasectomy change their minds and may wish to regain their reproductive abilities, which is possible with a vasectomy reversal procedure, as described in this article by consultant urologist Mr Rowland Rees.

A vasectomy is one of the main options that men have as a long-term contraceptive. The procedure involves the cutting and blockage of the vas deferens, the two tubes through which sperm travels from the testicles to the penis. Once the vas deferens are cut, the ejaculatory ability is unaffected, but the semen no longer is comprised of sperm and just consists of the seminal fluid

Patients may opt to undergo a vasectomy if they do not want to have children or if they do not want any more children.

What does a vasectomy reversal involve?

Unlike most other contraceptive surgeries, a vasectomy is reversible, even if conducted several decades after the initial surgery – however, success isn’t always guaranteed and the longer the time since the initial surgery, the higher the chances of failure become. A vasectomy reversal involves the reconnection of the vas deferens and undoing the blockage so that the sperm can combine with the seminal fluid and travel to the penis.

What happens during a vasectomy reversal?

Before a vasectomy reversal, surgeons will open up the vas deferens just before the original cut to assess the current condition. This helps to determine the type of vasectomy reversal the patient needs:

• A vasovasostomy, where the ends of the vas deferens were cut are joined together using dissolvable sutures. This is performed if there are still sperm in the vas deferens.
• A vasoepididymostomy, where the vas deferens are then connected to a structure within the testicle called the epididymis, which is where sperm finish maturing. This is performed if the vas deferens, upon being opened, were dry, which indicates blockage elsewhere. This technique is more complex, but may be necessary if it has been more than 10 years since the vasectomy.

Regardless of technique, vasectomy reversals take around four hours to perform but are typically an outpatient procedure under a general anaesthetic. The incision to access the vas deferens is placed in the scrotum, and it is small, only around 2cm long. Because of this, the surgeon may employ a technique called microsurgery, where a microscope is utilised to amplify the surgeon’s viewpoint.

What happens after a vasectomy reversal?

After a vasectomy reversal, patients can go home once the anaesthetic has worn off. They may experience a bit of pain and discomfort, for which they can be prescribed painkillers.

Recovery time can take up to a month. In the first weeks, patients are advised to avoid strenuous activities, and wear form-fitting or compressive underwear/trousers for support and to help against swelling. After a month, it should be healed enough for the patient to engage in sexual activities, however, that does not mean that their fertility will be restored at this time.

For around six months, patients will have to return to their clinic to have their semen tested to see if the procedure worked. It can take up to a year for the sperm to return to the semen after a vasovasostomy, and up to a year and a half after a vasoepididymostomy.