Vasectomy & Vasectomy Reversal

Vasectomy

Vasectomy is a form of permanent sterilization that is appropriate when a male no longer desires the ability to father children. Vasectomy is comparable to tubal ligation in the female but is more effective and less invasive. Tubal ligations fail in 1 per 2,000 procedures whereas vasectomy fails in only 1 per 4,000 procedures. Although vasectomies can be reversed with the use of microscopic surgical repair, vasectomy should not be performed as a means of temporary birth control.

Vasectomy is generally performed in the office using local anesthesia and mild sedation. The procedure is completed in about 20 minutes and has few complications. Following the procedure, the patient maintains compression using an athletic supporter for several days and may resume regular activity (athletics, sexual intercourse) in one week. Sterility must be confirmed by performing a semen analysis to assure absence of sperm prior to resuming unprotected intercourse. This is usually done 7 weeks after the vasectomy by which time the sperm beyond the vasectomy site have been cleared. Until the absence of sperm in the ejaculate is confirmed, other methods of birth control should be continued to prevent unwanted pregnancy.

Each year in the United States, 500,000 vasectomies and 5,000 vasectomy reversals are performed- on average, 1% of vasectomies are reversed. Most common indications for vasectomy reversal include new marriage, death of a child, and medical indications.

Vasectomy reversal

Vasectomy reversal is most often performed using microscopic surgical techniques that reconnect the two ends of the vas with two layers of suture- an inner layer to align the mucosa (lining of the tube system) of the tubes and an outer layer connecting the muscularis (muscle layer that is responsible for propelling sperm along the vas from testicle to ejaculatory ducts). Generally, the fluid expressed from the vas on the testicular side of an obstruction is examined at the time of surgery to determine fluid quality- if sperm are present or if the fluid is thin and clear, we proceed with connecting the two ends of the vas; if the fluid is cloudy and thick, this predicts that a secondary obstruction has occurred due to epididymal “blow-out” or rupture of the epididymal tubule which is up-stream from the vasal obstruction or vasectomy site. In that situation, reconnecting the vas will fail and a more complicated procedure is indicated: vasoepididymostomy. While non-microscopic techniques have been performed for both vasovasostomy and vasoepididymostomy, success rates are significantly lower compared to microsurgical reconstruction.

“Success” in vasectomy reversal is judged by two criteria: 1) patency (the channel remains open and sperm are present in the ejaculate) and 2) pregnancy. In general, patency success exceeds pregnancy success by 20%.

Vasectomy reversal success is correlated with time since vasectomy and the use of microscopic surgical techniques. The longer time elapsed between vasectomy and attempt to reverse vasectomy, the lower success rate expected for both return of sperm in the ejaculate and successful impregnation and pregnancy. Longer time lapse between vasectomy and reversal is also correlated with increased incidence of epididymal “blow-out” and the need to perform the more complicated and more delicate vasoepididymostomy.

The vasectomy reversal is usually performed as an outpatient procedure with anticipated time to resume activities of daily living of one week. Return to physical exertion and sexual activity is delayed one month.

Alternative to Vasectomy Reversal

Alternative reproductive strategies would include sperm collection from the male partner (microscopic epididymal sperm aspiration/ MESA or testicular sperm extraction/ TESE) which is then used in in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). Studies have shown that the cost efficiency favors the microscopic vas reversal strategy to achieve pregnancy given the relatively high pregnancy success rate of vasovasostomy when compared to the relatively high expense of performing complicated procedures on both the male and female partner.

The University of Cincinnati Urology Division is one of the leading urology programs, not just in Cincinnati, but in the U.S. UC Urology provides quality health care using the most advanced technology and state-of-the-art diagnostic treatments. Many of our urologists are recognized in multiple national and local "Best Doctors" and "Top Doctors" listings. We provide minimally invasive surgical treatments which include laparoscopic, robot-assisted laparoscopic and endourologic procedures as well as comprehensive care for all urologic conditions.