Why is this done?
This procedure is performed to restore fertility in a man who has had a vasectomy previously.
What does the procedure involve?
Microsurgery is used to rejoin the previously separated tubes (vasa) with fine sutures.
What are the alternatives to this procedure?
Alternatives to this procedure include other forms of assisted conception and sperm aspiration. If your vasectomy was performed 20 or more years ago, assisted conception with sperm aspiration may be a better option for you but this may involve your partner in some manipulation as well, to retrieve eggs. The complications of sperm aspiration include bleeding into the scrotum (less than 5%), infection (1%) and shrinkage of the testicle (less than 5%). There is a 5 to 30% risk of multiple pregnancies following assisted conception. Overall, the pregnancy rate is approximately 25 - 30% but this may require several cycles of treatment. Assisted conception is normally performed by an IVF clinic.
What should I expect before the procedure?
Please note that it may be necessary to establish that your partner is ovulating before vasectomy reversal is undertaken depending on the age of your partner. You will usually be admitted to hospital on the same day as your surgery. You may receive an appointment for a “pre-assessment” to assess your general fitness.
You will be asked not to eat and drink for six hours before surgery.
Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
- Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you are unable to feel anything from the waist down) will be used. All methods reduce the level of pain afterwards. Your anaesthetist will explain the pros and cons of each type of anaesthetic to you. The surgeon usually makes a small incision in the front of the scrotum. The ends of the tubes are found and rejoined with fine stitches using microsurgical techniques (pictured). If the surgeon is not able to do this, it may be possible to join the upper ends to the sperm-carrying mechanism (epididymis). Unfortunately, the results of this are not as good as those from re-joining the vasa.
What happens immediately after the procedure?
You may experience discomfort for a few days after the procedure but we will give you painkillers to take home. Absorbable stitches are normally used and do not require removal.
The average hospital stay is less than one day.
Are there any side-effects?
Most procedures have possible side-effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.
Common (greater than 1 in 10)
- A small amount of scrotal bruising.
- No guarantee that sperm will return to the semen (more likely with increasing age).
- Pregnancy is not always achieved, even though sperms are present.
- Miscarriage rate of 15 to 20%; this is no greater than the risk in the normal population.
- Blood in the semen for the first few ejaculations.
Occasional (between 1 in 10 and 1 in 50)
- Bleeding needing further surgery.
- Chronic testicular pain (5%) or sperm granuloma (painful nodule at the operation site).
- 5% of reversals (1 in 20) stricture off each year after the procedure, resulting in no sperms being ejaculated.
Rare (less than 1 in 50)
- Rarely, inflammation or infection of the testes or epididymis requiring antibiotics.
- Inability to perform the procedure on one or both sides.
What should I expect when I get home?
Over the first few days, your scrotum and groins will become a little uncomfortable and bruised. It is not unusual for the wound to appear swollen and weepy in the early days; if you are at all worried about this, you should contact Dr Nathan’s rooms or your GP. Your skin sutures do not need to be removed and will usually drop out after a couple of weeks. Occasionally, they may take slightly longer to disappear.
You are advised to take 10 to 14 days off work after the operation and not to have sex until you feel completely comfortable – usually 4 weeks.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your surgeon or your GP.
Are there any other important points?
You will be asked to produce a sperm counts 6 and 12 weeks after the operation. On average, sperms take two to six months to appear in the semen, although this sometimes takes as long as a year. If you have no sperms in the first two samples, they are not likely to appear at a later date. The average time between surgery and conception is 12 months. Even if sperms are produced in the semen, you may still not be able to produce a pregnancy. This is because your sperms may be poor quality or because you have formed antibodies to your own sperms. In some men who get positive sperm counts, the tubes may block off at a later stage although it may be possible to repeat the operation if this happens.
Vasectomy reversal is not usually available through the public hospital system and usually needs to be performed privately. The total cost for the procedure can be obtained from your urologist.
The chances of success are related to the time that has passed since the original vasectomy; they are shown in the table below:
|Interval Since Vasectomy (years)||Patency rate (live sperm in ejaculate)||Pregnancy rate|
|Less than 3||97%||75%|
|3 to 8||88%||50%|
|9 to 14||79%||40%|
|15 to 19||70%||30%|
|More than 19||40%||Less than 10%|
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.