What is a Vasectomy?
A Vasectomy is a safe, simple, quick and effective method of contraception. Vasectomy is a surgical procedure that disrupts the flow of sperm through the vas deferens. A cut is made through the Vas Deferens and a clip or suture is placed around the cut ends.
A Vasectomy Reversal is a surgical procedure that restores the flow of sperm through the vas deferens. It is usually performed by an experienced Microsurgeon using an operating Microscope. There are two types of Vasectomy Reversal – Vasovasotomy and Vasoepididymostomy:
A Vasovasotomy is the operation most frequently performed for Vasectomy Reversal. It involves stitching the cut ends of the vas deferens together. This is the surgery of choice for vasectomy reversal, however if excessive inflammation or scarring has occurred in the epididymus, sperm may be blocked from getting to the vas deferens. If a blockage has occurred in the epididymus, merely connecting the two cuts ends of the vas deferens will not solve the problem. To bypass the blockage in the epididymus, a Vasoepididymostomy must be performed.
With the implementation of Microsurgery into Vasectomy Reversal, success rates following microsurgical Vasovasotomy and Vasoepididymostomy have risen.
Recent studies indicate that following Vasovasotomy, sperm appears in the semen in approximately 85 – 97% of men and approximately 50% of couples subsequently achieve a pregnancy.
Following Vasoepididymostomy, sperm appears in the semen of approximately 65% of men and approximately 20% of couples subsequently achieve a pregnancy.
The length of time from Vasectomy to Reversal Surgery correlates with success, however no interval is considered too long to perform reversal surgery.
No special preoperative tests are needed before a Vasectomy Reversal – other than the standard lab tests required by some hospitals.
The surgery can be performed as Day Surgery, however a General Anaesthetic will be required and you will not be discharged from Hospital until the Surgeon and staff are satisfied with your recovery from the anaesthetic.
Vasovasotomy takes about two to three hours, however Vasoepididymostomy may take as long as five or six hours. The length of surgery depends on individual circumstances, some of which are not evident until the time of surgery.
Incisions are usually in the front of each side of the scrotum. The incision is vertical so that it can be extended in length if there is difficulty in locating the site of the vasectomy.
Microscopic technique is used to rejoin the ends of the vas deferens in a Vasovasotomy and to create a bypass is Vasoepididymostomy. Microscopic dissolving sutures are used.
You will be required to see your Surgeon for follow-up in the immediate post-operative period. The first semen analysis is usually undertaken at about eight weeks after surgery and then again at two to three month intervals.
Discomfort following Vasectomy Reversal varies from patient to patient. In general, pain may be similar to that experienced with Vasectomy. You will be given medication for pain from your Surgeon prior to discharge from the Hospital. Swelling and bruising is usually evident in the immediate post-operative period and can be reduced by cool compresses applied to the area. You may be asked to wear a scrotal support for four weeks following surgery. Excessive standing or walking should be avoided in the immediate post-operative phase, as this will create additional dependent swelling and bruising.
Normal strenuous exercise can be resumed four weeks after surgery, provided there are no complications present. Gentle walking is permitted commencing in the day or so following your surgery.
It is generally best to wait three weeks after surgery before resuming any type of sexual activity.
Three months after a Vasovasotomy, the semen analysis often reveals a good sperm count with poor motility. After six months, the count is usually stable or slightly improved and the motility is also improved.
After Vasoepididymostomy, sperm usually takes longer to appear in the ejaculate, and in most cases, it takes at least four to six months to appear.
Studies have shown that following initially successful reversal surgery, where good sperm counts and motility has been obtained, a significant number of men subsequently experience significant deterioration in sperm counts. This may be caused by the formation of scar tissue, which can occur from sperm leakage at the reversal site or from a disruption of the blood supply at the site of surgery.
In the light of the 10 to 20 percent of patients who deteriorate after successful surgery, sperm banking should be a consideration, particularly after a Vasoepididymostomy.
The average time from reversal surgery to conception is 12 months.
Options for Unsuccessful Vasectomy Reversal:
If surgery is unsuccessful, then you can consider re-operation or assisted reproductive techniques such as IVF or ICSI. For a man who has no sperm in the ejaculate after reversal, sperm for IVF and similar can be obtained through a minor surgical procedure which extracts sperm directly from the testicles and/or epididymus in some cases.
Normal signs and symptoms after surgery include slight swelling, bruising or discolouration of the scrotal area.
A sore throat, headache, nausea, constipation and general body ache due to the anaesthesia may also be present. These symptoms usually resolve in a few days.
Additional complications include:
• Scrotal haematoma – which may require drainage and further hospitalisation
• Wound infection – requiring antibiotic treatment and which may require further hospitalisation.
• Unsuccessful reversal
Vasectomy Reversal is the procedure performed to reverse the effect of Vasectomy and has varying degrees of success, enhanced over the last years with improved microscopic technology and technique. Discussions on the procedure, risks and outcomes will be further undertaken with your Plastic Surgeon. It is sometimes helpful if you make a list of questions to take to your consultation with you, so that you may cover all areas of concern at that time.