Vasectomy Reversal

Although many choose to undergo a vasectomy, there are plenty of reasons to want to reverse the procedure once it’s been completed (divorce, loss of a child, change of heart). Nowadays there are advanced methods to do so effectively and restore your fertility. Because a vasectomy is a minor surgical procedure, undoing it simply involves reattaching the previously severed vas deferens. Vasectomy reversal reconnects the pathway for the sperm to get into the semen.

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The Procedure

Performed using microsurgery (special microscopes), vasectomy reversals are generally done in an outpatient area of a hospital or in an ambulatory surgery center with general anesthesia. This procedure is called a vasovasostomy. Once the patient is sedated, Dr. Hsieh will make a small cut on each side of the scrotum to remove the scarred ends of the vas deferens at the point of blockage. He will then extract a fluid sample from the end closest to the testicle to see if the fluid contains sperm. If sperm are present in the fluid, it indicates that there is no obstruction between the testicle and the location in the vas from which the fluid was obtained. When sperm are present in the fluid, the ends of the vas can be connected to reestablish their passageway.


Microsurgery

Microsurgery uses a high-powered microscope to magnify structures, providing better results. This method allows the urologist to manipulate stitches smaller (in diameter) than an eyelash to join the ends of the vas deferens. When microsurgery is used, vasovasostomy results in return of sperm to the semen in 90 to 95 percent of patients. These numbers, however, depend upon the length of time from the vasectomy until the reversal as well as the microscopic finding of sperm during the operation under a microscope.

Dr. Hsieh has published on the aspects that influence success after a vasectomy reversal and has determined that intraoperative microscopy is the most important factor. If there are no sperm in the fluid sample, it may be because the original vasectomy resulted in back pressure causing a break in the epidydimal tubule. Since any break in this single, continuous tube can result in a blockage, a more complicated reversal technique called an epididymovasostomy or vasoepididymostomy will need to be performed.

For this method, the urologist must bypass the blockage in the epididymis by connecting the upper end of the vas deferens to the epididymis above the point of the blockage. Because a vasoepididymostomy uses a very small size of the tube inside the epididymis, it is a more complex procedure than a vasovasostomy. However, recent advances in the surgical technique have made outcomes nearly as successful as a vasovasostomy. Sometimes patients may need a combination of the techniques, with a vasovasostomy done on one side and a vasoepididymostomy on the other side with a longer incision into the scrotum.