+ How is vasectomy reversal performed?

While vasectomy itself is commonly done in the office with only local anesthesia, a reversal of vasectomy is much more complicated. In order to achieve the best outcome and chances of success, microsurgical vasovasostomy is performed by a urologist with advanced training in microsurgery. This requires use of general anesthesia and micro-suturing techniques for the delicate reconstruction of the vas deferens on both sides. Surgery time may take 3 to 4 hours. Dr. Carrasquillo specializes in microsurgical vasectomy reversal.

Occasionally, a more complicated reconstruction is needed due to the accumulation of scarring after the vasectomy that prevents sperm from leaving the epididymis and entering the channel of the vas deferens. This is called epididymovasostomy. To bypass this scarring and blockage, the vas is connected directly to the epididymis, again using microsurgical technique.

+ What are the success rates?

Success depends on several factors, including the length of time from vasectomy and maternal age. While a reversal may be successful in restoring sperm in the semen, a woman’s fertility decreases significantly with each passing year beginning around age 37. If your partner is of this age, surgical sperm aspiration and IVF may be discussed to ensure your best chances of pregnancy.

Overall, direct vasectomy reversal (vasovasostomy) carries a 95% patency rate (sperm in the semen) at 6 weeks after surgery, and 60% pregnancy rate within 1 year of surgery.

Epididymovasostomy carries a roughly 60% patency rate at 12 weeks and 30% pregnancy rate within 1 year of surgery. Due to the lower chance of success, it is recommended to consider freezing and banking of sperm at the time of surgery if epididymovasostomy is required. This sperm can later be used in IVF if a natural pregnancy cannot be achieved.

+ Can a repeat vasectomy be performed?

Vasectomy can be performed again following successful reversal of an initial vasectomy. Vasectomy should not, however, be considered as a means of temporary male birth control.

+ What is recovery after vasectomy reversal?

• Return home from surgery on the same day.
• Remain on bedrest at home for 2 days. Use ice packs, close-fitting briefs or jockstrap to minimize swelling and pain.
• 1 week: If your work involves heavy lifting, you may be asked to remain on light duty. Follow up with Dr. Carrasquillo after surgery to ensure proper healing.
• 2 weeks: Resume sexual activity, bath/pool, weight lifting and exercise.
• 6 to 8 weeks: Dr. Carrasquillo will obtain a semen analysis to confirm the presence of sperm in the semen.

+ What is sperm cryopreservation and is that an option?

Cryopreservation, or the freezing and banking of healthy sperm, can be offered to any man undergoing vasectomy reversal. Sperm are collected at the time of the surgery or from an ejaculated semen sample following surgery. This is meant to serve as a backup in the event that sperm counts after surgery are insufficient for successful natural pregnancy. Cryopreserved sperm can be used for IVF.

+ Are there alternatives to vasectomy reversal?

An alternative to vasectomy reversal is microsurgical epididymal sperm aspiration (MESA). While still involving a microsurgical dissection to harvest sperm from the blocked testis, no reconstruction is required and surgical time is approximately 60 minutes. MESA allows you to harvest viable sperm to use in IVF. MESA is a good option for men when their female partner has fertility issues requiring IVF, their female partner is older and chances of successful natural pregnancy are decreased, or for men who simply do not wish to have reconstructive vasectomy reversal due to preference.