As the name implies, vasectomy reversal is a surgery that cancels the vasectomy. This medical intervention seeks to reconnect the previously cut vas deferens, which means that the semen will once again contain sperm and that the possibility of pregnancy will be reestablished. However, like vasectomy, the success rates of the medical procedure vary from person to person and will depend on a number of factors such as the time that has passed since the vasectomy, the age of the partner, the experience and training of the surgeons, and whether there is a history of fertility problems preceding the vasectomy.

More common than you might think

Any man can decide to have a vasectomy reversal and for different reasons, whether it’s a change of heart, starting a family project with a new partner, the loss of a child, etc.  Now, it is true that there are also men who perform the procedure to relieve an eventual testicular pain that in very few cases remain after the vasectomy, but it is a very small percentage.

Some associated risks

Like any medical procedure, vasectomy reversal is not free from some risks and does not guarantee success when trying to conceive a child. Besides, there will always be a greater chance of success when a shorter timeframe has passed since the date of the original procedure.

There can even be serious complications sometimes, such as:

• • Accumulation of blood within the scrotum: a hematoma, or in other words, an accumulation of blood, can occur, resulting in painful swelling. You can usually avoid this by following your doctor’s instructions regarding resting, using scrotal support, and applying ice after the surgery. Ask your doctor whether the use of anticoagulants is possible in your specific case.

• • Infections: They may not be very frequent, but they are possible. However, this complication not only concerns vasectomy reversal, but every surgery and can usually be treated with antibiotics. 

• • Chronic pain: A persistent pain after leaving surgery, also rare, but you have to be aware that it is a possibility.

Other factors worth considering

There are other aspects beyond the medical procedure itself that are worth considering when performing a vasectomy reversal:

• It can be expensive and not covered by insurance. Find out in advance and discuss costs with your health care provider.
• The procedure has a higher success rate when the surgeon is trained to perform microsurgical techniques, which of course includes the use of an operating microscope.
• The surgeon’s experience is a factor that can completely change your chances of success. A surgeon who does this type of procedure on a regular basis is preferable.
• In certain cases, a more complex operation known as a vasoepididymostomy may be required. This consists of directly joining one of the ends of the vas deferens to the epididymis. However, this is a complex operation that can take more than 5 hours. Check with your surgeon to see if he or she is able to perform the procedure if necessary.

These are just some of the more general points to consider, for more precise information, you are advised to make an appointment with your doctor. Be sure to ask him about the risks and possible complications, as well as his experience with this type of surgery in particular, and also if he has any data on the rate of reversals that have resulted in pregnancy among his patients. 

Other precautions

Keep yourself informed about the steps you need to take before surgery. Your doctor may ask you to stop taking certain medications that can increase the risk of bleeding, such as blood thinners and some pain relievers like aspirin or ibuprofen.

On the day of the surgery, show up with tight-fitting underwear, a sports jockstrap may also be a good idea. The important thing is that they serve as support for the scrotum and help to keep the bandages in place.

This is a delicate procedure that requires rest, therefore you should arrange for someone else to drive you home after surgery. The surgery usually takes between two and four hours, although it can be extended. Keep in mind that you will need a little more time to recover if the procedure involves general anesthesia.

Phases of the procedure

Before the surgery:

Your doctor will most likely want to check a number of things before surgery, such as:

• • Check your medical history and perform a physical exam. This is to ensure that there are no pre-existing factors or health problems that may cause complications during surgery.
  • Check the spermatozoa. If you never had a problem having children in the past, maybe everything is still in order. However, when the doctor has reason to doubt the ability of your testicles to produce healthy sperm, additional tests may be performed.
  • Confirm that your partner is able to have a child. It is only consequent that, if fertility is tested on one person, it is tested on the couple. The doctor will want to make sure there are no fertility problems, especially if your partner is over 40 or has never had a child.

Vasectomy reversal is an outpatient procedure that is usually performed in a hospital or surgery center since the material to perform the vasepididymostomy will be available if needed. It should be noted that the reversal is a much more complex procedure than the vasectomy itself. This usually requires microsurgery. To give you an idea, this requires an operating microscope so powerful that it magnifies the vas up to 40 times. Now you see why it is much better to do it with a specialized and experienced doctor.

The surgery may be done under general anesthesia so that you are unconscious throughout the procedure. Your surgeon may also provide you with an anesthetic that prevents you from feeling pain, but will not put you to sleep, as is the case with epidural, intradural, or local anesthesia.

 As far as the techniques used are concerned, doctors usually join the ducts that carry the sperm using the following two methods:

• • Vasovasostomy: A procedure in which the surgeon reattaches the severed ends of each vas deferens with stitches.
  • Vasoepididymostomy: During this procedure, the vas deferens are connected directly to the epididymis, which is a small organ behind each testicle that contains the sperm. This operation is usually more complex and is only chosen when vasovasostomy is not possible or when it is not likely to be successful.

The decision to perform one or the other depends entirely on the physician, who will likely make the decision during the operation when he or she confirms the presence or absence of sperm in the vas deferens fluid. Sometimes it can be a combination of both techniques, one for each testicle. In any case, it is important for you to know that the more time that has passed since your vasectomy, the more likely you are to require a vasepidymostomy.

During the surgery:

Roughly speaking, the doctor will make a small incision in the scrotum, exposing the vas deferens and freeing it from the surrounding tissues. The doctor must then make a cut to open the duct and examine the fluid in it. If the liquid contains sperm, the ends of the duct may be connected to allow the sperm to pass through again. If, on the other hand, there is none, it is possible that there is scar tissue blocking the flow. In this case, the second option will be chosen, which involves the epididymis.

After the surgery:

The incisions will be covered with bandages and you will be required to wear tight-fitting underwear in conjunction with the application of ice over the area to reduce swelling. Generally, the stitches should be absorbed within 7 to 10 days. You will also most likely be sore for several days, so rest is strongly recommended. Avoid any physical activity that may cause the testicles to move too much. This includes sexual intercourse, which you must avoid for two or three weeks.

If you have an office job, you may be able to return to work a few days after surgery. As long as it is not physical work or involves heavy lifting, riding a bike, walking or driving, everything should be fine. 

You will then be able to see the results together with your doctor, who will examine your semen under the microscope to determine whether the operation was successful. Your doctor may also decide to periodically check the progression of your semen. If the intervention was successful, the appearance of the sperm can take from a few weeks to a year or longer, so if your partner doesn’t get pregnant directly, don’t worry, give your body more time to heal.

If the vasectomy reversal fails, you can consult your doctor about a second procedure or even consider other alternatives such as in vitro fertilization. Don’t be stressed, know that today there are plenty of alternatives to allow you to become a parent.