Vasectomy reversal

Vasectomy reversal is the procedure to reopen the path of sperm that was closed in a vasectomy (male sterilisation surgery) procedure. This allows the sperms to reach the urethra and the ejaculate again and restores male fertility.

The sperms produced in the testis pass through tubes called efferent ducts into a 15-18 feet long tightly coiled tube called the epididymis. The epididymis is responsible for the storage and maturation of sperms. It leads the matured sperms to another tube called the vas deferens, which in turn propels the sperm into the urethra (the tube within the penis). From the urethra, the sperm are then ejaculated during an orgasm. In the vasectomy surgery, male sterilisation is achieved by cutting the vas deferens, thus preventing the passing of sperms from the epididymis to the urethra. This ensures that the sperm do not reach the ejaculated fluid and thus does not allow a man to make a woman pregnant.

Vasovasostomy and vasoepididymostomy are surgical procedures that reverse a vasectomy.

In a vasovasostomy, the surgeon reconnects both the vas deferens that had been cut during the vasectomy, allowing the sperm to return into a man’s semen (the fluid released through the penis during orgasm) making him fertile again. During the surgery, a high-power surgical operating microscope, which magnifies the organs thirty to forty times, is used. Stitches that are too tiny to be seen by the naked eye are placed to connect the vas deferens.

In some cases, the sperms may not enter the vas deferens even after a vasovasostomy due to obstruction or blockage in the epididymis. In such cases, a vasoepididymostomy is performed, which bypasses the blockage in the epididymis by directly joining the segment of the epididymis before the blockage to the vas deferens. You will require this surgery if you have had vasectomy more than 9 years ago, or if the vasectomy was performed at close proximity to the testicles. This surgery may be performed as an individual procedure or during the same surgical setting of vasovasostomy. A vasoepididymostomy is considered to be a challenging procedure for the treatment of male fertility since the epididymis is very thin, with a diameter just two times that of a hair follicle.

The successful reversal of vasectomy depends on the duration between the two surgeries, the vasectomy and its reversal. The reason for this is that after the vasectomy, your body may develop additional blockages in the tubes carrying the sperm or develop special cells (antibodies) that kill your own sperm cells.

Doctors recommend a vasovasostomy in men for:

• The reversal of vasectomy.
• The development of any complication (epididymal or testicular pain) due to the vasectomy.
• Obstruction in the vas deferens leading to the absence of sperms in the semen.

A vasoepididymostomy is performed when a vasovasostomy cannot be done due to the obstruction being in the epididymis. In such cases, the vas deferens is connected to the unblocked section of the epididymis.

The contraindications for a vasectomy reversal include:

• Severe health problems
• Bleeding disorder
• Scrotal skin infection
• Urinary tract infection 
• Bilateral testicular atrophy (shrinking of testicles) due to testicular disease

You will need the following preparations before the surgery:

• The doctor will ask you about your fertility before vasectomy.
• Tests will be performed to look for sperm antibodies in the semen before and after the procedure. You may not be able to make your partner pregnant in the presence of these antibodies after surgery. Read more: Antisperm antibody test 
• The doctor should be informed about all the medicines you take, including non-prescription medications.
• You may have to stop any blood-thinning medicines like aspirin and warfarin for a few days before the surgery. 
• Inform your doctor if you have any health conditions or allergies.
• You should discontinue smoking before the surgery.
• Do not soak in a bath or hot tub before the surgery as this may affect your sperm production.
• Do not eat or drink anything from the night before the surgery.
• You will need to shave the hair on the scrotum region a day before the surgery.
• A consent form will be given to you to sign before the surgery.
• On the day of the surgery, you will be advised to carry an athletic supporter or cotton briefs.

You may be given regional, local or general anaesthesia (a sleep-inducing medicine) as needed. The steps of vasovasostomy are as follows:

• The surgeon will make an incision of about three to five centimetres in your scrotum (the testes and epididymis are present in this area).
• He/she will identify your vas deferens and free it from the surrounding tissue.
• Next, the surgeon will identify the region where the vas deferens is blocked due to vasectomy and will make a cut below and above the blockage. 
• He/she will remove some fluid flowing from your testicle end of the vas deferens to check under the microscope for the presence of sperm. The occurrence of sperms shows that there is no blockage between the testes and the section where the vas deferens will be reconnected.
• The surgeon will then rejoin the tube using six to 10 very fine sutures.

If the microscopic examination does not show the presence of sperms in the fluid from the vas deferens, the surgeon will perform a vasoepididymostomy. Here is the procedure for a vasoepididymostomy:

• The surgeon will create an incision in your epididymis on the testicular end of the suspected epididymal obstruction.
• He/she will check the fluid from that portion is checked for the presence of sperms.
• If the sperm is not present in that fluid, an incision is repeated towards the testicular end of the epididymis.
• Once the fluid in the epididymis shows the presence of the sperms, the surgeon will use sutures to reconnect that part of your epididymis to the vas deferens under the operating microscope. This bypasses the obstruction.

The surgery is completed in two to four hours, and you will be discharged on the same day.

Take the following care at home after the surgery:

• Frequently use ice packs over the scrotum after the procedure and the next day. You can discontinue this from the third day.
• Keep the dressing on for about a day and a half to two days and then take it off. Keep the scrotal support on for about a week. 
• Take a shower once you remove the dressing. Bath can be taken after a week.
• Take your medicines for pain as advised.
• You can have a balanced diet once you are back home. Consume a lot of fluids to keep yourself hydrated. 
• You can perform non-vigorous physical activities after two days of surgery. However, more strenuous activities like lifting weights and jogging should be avoided for two to three weeks.
• You can resume work in two to four days.
• Avoid masturbating or having sex for three weeks. 
• Wear athletic support or well-fitted cotton briefs for support.

The primary benefit of this surgery is that it restores fertility in men. The sperms may appear in your semen after a successful vasovasostomy procedure in about a month, while in those who have undergone the vasoepididymostomy procedure, it may take about 3-15 months. However, it may take anywhere from a few months to two years for these surgeries to lead to pregnancy.

When to see the doctor?

See the doctor if you observe any of these symptoms:

• Pain
• Drainage from the incision
• Fever and chills
• A lump in the area that seems to be growing
• A large black and blue area (bruising) at the surgical site
• Excessive swelling

Some risks of a vasovasostomy are:

• Bleeding inside the scrotum
• Infection
• Failure of surgery
• After successful surgery in which sperms have returned to the semen, late azoospermia (no sperm found in the semen due to scarring of tissue).
• Injury to the blood vessels in the scrotum

Some complications after vasoepididymostomy are:

• Only non-motile (incapable of motion) sperm are seen in the semen where initially motile sperm were seen
• Late azoospermia

A follow-up visit is usually scheduled about two to three weeks after the surgery, and you will need a semen analysis six to eight weeks after the surgery to check how the surgery has worked.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.