Vasectomy: An Irreversible Decision?En Español (Spanish Version)
Yes, it is true. There really is a procedure that can reverse a
(called a vasovasostomy). And every year, many men, for a variety of reasons, make the decision to undergo this procedure. But, before we get into the details of a vasectomy reversal, let’s talk about what a vasectomy entails.
As you probably know, the testicles (housed in the scrotum) are sperm factories. The sperm is stored in the epididymis, a tiny structure that lies on top of each testicle. During ejaculation, the sperm leaves the epididymis via a tube called the vas deferens, travels to the prostate (where other fluids and substances are added to the semen), and then exits via the urethra through the tip of the penis.
A vasectomy is a form of permanent sterilization for men. It involves clamping off, cutting, burning, and/or sewing closed the tubes (vas deferens) that carry sperm between the epididymis and the prostate. Sperm is still manufactured in the testicles and stored in the epididymis, but it ultimately just dies off. The semen that a man ejaculates after a vasectomy should not contain any sperm.
Men may choose to undergo vasectomy for lots of reasons. Maybe they have completed their ideal family; maybe they have never wished to have children; maybe their family has a known genetic problem that they want to avoid passing on to offspring.
A man may want to reverse a vasectomy for different reasons as well. Some reasons may be a new relationship (particularly after divorce or the death of a partner), the death of a child, or a change in a family’s financial situation that makes it possible to afford another child.
Very rarely, a man who has undergone a vasectomy experiences chronic pain in his testicles. Although this is a very uncommon complication of vasectomy, some of these men have experienced pain relief after a vasectomy reversal.
A vasectomy reversal is major surgery, requiring either
or sedation and local anesthesia.
The surgical technique used for a vasectomy reversal may require opening the scrotum to visualize the internal structures, or operating through tiny keyhole-like openings. Very high-powered operating microscopes magnify the tiny structures.
Basically, a vasectomy reversal attempts to reattach the severed ends of the vas deferens. This is very tricky microscopic surgery as the opening of the vas deferens is approximately the size of a pinhead. Furthermore, once the vas deferens has been cut, burnt, or clipped, it may develop scar tissue, which could block the sperm from moving through it. So even if the ends of the vas deferens are reattached, sperm may still be prevented from exiting the epididymis due to scar tissue. In this case, the urologist may need to perform a more complicated procedure, called a vasoepididymostomy, in which the upper end of the vas deferens is attached to the epididymis itself, in an attempt to bypass the area of obstruction within the vas deferens.
In most cases, it takes about 1 year for partners of men who had vasectomy reversals to get pregnant. The sooner you undergo reversal after your original vasectomy, the greater you and your partner’s chances are of conceiving.
As mentioned above, scar tissue in the vas deferens might account for some of the
of men who have undergone a vasectomy reversal. Even after the ends of the vas deferens are rejoined, scar tissue within the vas deferens may obstruct the free flow of sperm.
The other reason is a bit more complicated. After a vasectomy, the testicles continue to make sperm, even though they cannot travel to the outside world. These sperm may be mistaken by the man’s immune system as foreign invaders, and the immune system produces antibodies against them in the same way that the immune system makes antibodies to destroy other foreign invaders, such as viruses or bacteria. This can mean that, even after a vasectomy reversal, the man’s immune system continues to destroy his sperm.
Researchers are also looking at how vasectomy may affect other microscopic, chemical fertility factors in men that may not be restored with vasectomy reversal.
If you are concerned that your vasectomy reversal will not work, your doctor may try harvesting sperm from the epididymis either during or after the reversal procedure. This sperm can be stored for future use. Sperm harvested this way are not strong swimmers, so they are not useful for artificial insemination (in which sperm is placed into a woman’s vagina near the cervix).
Instead, these sperm are used for a much more complicated (and expensive) procedure called intracytoplasmic sperm injection. In this case, the woman must take strong hormonal medications to induce the release of multiple eggs; the eggs are removed from her ovaries, and the man’s sperm is injected into the eggs. The injected eggs are then watched in the lab through several cell divisions, and the resultant cells are put back into the woman’s uterus, with the hopes that one (or more) embryo will implant and develop as a pregnancy.
Men do not have the same age limitations on reproduction that women have. Men continue to produce sperm throughout their lifetimes, although the risk for certain genetic diseases increases with a father’s age. However, because women’s fertility decreases with age, your partner may want to talk to her doctor.
American College of Surgeons
Sexuality and U—The Society of Obstetricians and Gynaecologists of Canada
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Last Reviewed December 2014