Vasectomy Reversal Surgery
The Birmingham Prostate Clinic provides specialist expertise in vasectomy reversal surgery. A vasectomy is an operation to cut and seal off the tubes (each called the vas deferens) that carry sperm from the testicles to your penis.
It is an effective method of long-term contraception, and over 15 per cent of men in the UK choose to have a vasectomy when they feel that they do not want to have any more children. Unfortunately, despite having no intention of having children again when they have the vasectomy performed, some men then change their minds.
Is it common to want a vasectomy reversal?
Yes. About one per cent of all men who have a vasectomy will want it reversed; the figure may be higher than this. The usual reason is that the man’s social circumstances have changed some time after the vasectomy operation and he wants to start a new family with another partner. However some couples in a stable relationship simply change their minds about the size of their family and want more children. In these couples, where there is a ‘proven fertility record’, the chance of success is very high.
Can my vasectomy be reversed?
Yes, almost certainly. Reversal can be attempted in almost all men who have had a vasectomy. Very occasionally, at the time of operation, we find that so much vas (tube) has been removed by the surgeon who performed the original operation that the vas ends cannot be joined up. However this has to happen on both sides for the reversal operation to be abandoned, and this is extremely rare.
What are the chances of success?
There are two things to consider. Firstly, the sperm production rate after the reversal, which is the proportion of men who produce sperm after the operation has been performed. The sperm production rate is sometimes called the patency rate because it depends on the join between the tubes being patent (open) after the reversal. It also depends on the testicles still producing sperm. Sometimes, especially if a long time has passed between the vasectomy and the reversal, sperm production stops. If the reversal is performed within about ten years of the vasectomy, the sperm production rate should be in the order of 85 per cent. If the reversal is after 10 years, the sperm production rate may be lower.
Sperm production is not the only factor in a couple’s fertility, so the second thing to consider is the pregnancy rate. The most important factor here is the age of the female partner. The age of the male partner isn’t so important, but the pregnancy rate is also affected by the length of time between the vasectomy and the reversal. The chances of pregnancy for every couple is different, but for those where the woman is under 35 and the vasectomy was performed less than 10 years before the reversal the pregnancy rate is roughly 50 per cent, decreasing to less than 20 per cent if the woman is in her 40s and the vasectomy was performed more than 10 years previously.
If you are comparing results from different clinics and surgeons, make sure you compare the same thing. The sperm production rate is always much higher than the pregnancy rate. Also, some clinics only quote their results after leaving certain groups of people out of their calculations – for example men whose partners are over 35.
Why might I produce sperm but not be able to get my partner pregnant?
Just like every couple trying for a baby, there are male and female factors which might make things difficult. If both male and female factors are present they may compound each other and make things even harder – this is often the case.
Male factors are usually sperm numbers and sperm quality. After a vasectomy no sperm are produced, after the reversal sperm production needs to get going again. Sometimes it does, but not very well, so the sperm count is low and the quality of the sperm (in particular their ability to swim well) is decreased. Some men make antibodies to their own sperm which can damage them.
Female factors are usually related to age, but obviously there are reasons for infertility in all women. Common problems include irregular or absent ovulation or blocked fallopian tubes. A previous pregnancy means these problems are less likely but doesn’t rule them out. Some women like to discuss these issues with their GP or a gynaecologist before their partner has a reversal.
What does the operation involve?
The operation is performed under general anaesthetic (asleep), usually as a day case. A cut is made in the middle of the scrotal sac and the cut ends of the vas (the tubes) are identified and joined together with stitches. It takes about an hour. Most men are on their feet a couple of hours later and able to return home.
Are there complications?
Complications may occur after any surgery. The commonest is swelling and bruising. Most men get some swelling, usually it is minor and lasts a few days, but occasionally it can be more severe and persist for a week or even longer. Developing swelling or bruising does not affect the results of the operation. Less commonly the wound may bleed or get infected. Pain is not usually a major problem, and simple “over the counter” painkillers are usually all that is needed.
How long will I be out of action for?
After the operation it is important to take it very easy for a week, to prevent any risk of disruption to the very delicate join which has been made between the tubes. Ideally you should spend as much time as possible simply resting at home. After a week, most men can return to normal activity (including work), but if you have a particularly strenuous job which involves heavy lifting, stretching or significant exercise you should take another week off. You should avoid sporting activity for a total of two weeks and contact sports for a total of four weeks. You can start to have sexual intercourse one week after the operation, as long as you are careful.
When can I hope my partner will become pregnant?
It takes several weeks for the sperm count to build up after a reversal. We suggest you do a sperm count test after 12 weeks to check that sperm are present, and if there are no sperm present it unfortunately means the operation has not been successful. Obviously if sperm are present, it doesn’t mean pregnancy is guaranteed. Just like every other couple trying for a baby, it may take several months to achieve a pregnancy. If there is no pregnancy after a year, success isn’t out of the question, but it is unlikely.
Occasionally women become pregnant very quickly after their partners have had a reversal. If a pregnancy is undesirable at that time you should consider using contraception.
The operation failed – what now?
It may be possible to have another reversal procedure – your surgeon should be able to advise you if it is technically possible. However the success rates are not as good second time around. Assisted conception (see below) may be a better option for you.
I don’t fancy a vasectomy reversal – are there any other options?
If you’ve had a vasectomy, the only way you and your partner can have a baby which is biologically yours is either to have a reversal or to undergo assisted conception. This is also known as IVF (in-vitro fertilization). The technique used is known as ICSI – intra-cytoplasmic sperm injection. This is much more intensive and obviously less natural than a reversal and therefore most couples would prefer to have their child by vasectomy reversal if possible. There is a lot of information about ICSI on the internet – for example at infertility.co.uk
This information was written by Mr Mike Foster, a Birmingham Prostate Clinic consultant urologist specialising in vasectomy reversal surgery.
“About one per cent of all men who have a vasectomy will want it reversed: despite having no intention of having children again when they have the vasectomy performed, some men then change their minds.”