Vasectomy Reversal

Men's one effective form of birth control is the Vasectomy. Normally vasectomy is considered permanent, but circumstances can change. Studies have shown that about 5% of men who've undergone a vasectomy choose to have it reversed down the road. It is possible through a vasectomy reversal to regain the ability to naturally conceive a child. A vasectomy reversal is also the most cost-effective way to have a child after a vasectomy compared to IVF and sperm retrieval.

Why get a vasectomy reversal?

Situations change over the years, but perhaps you have remarried and want to have children. As a couple, you and your spouse might have changed your mind and want more children. The common thought around vasectomy reversal is that it's an invasive procedure and potentially unsuccessful if it's been a long time since your vasectomy. That thought is incorrect, where a vasectomy reversal is quite successful and quick procedure at most intervals after the initial vasectomy.

How do you reverse a vasectomy?

The objective is to restore the flow of sperm into the ejaculate. The procedure is a relatively simple outpatient surgery that normally takes 2-4 hours. It includes finding the severed ends of the vas and putting back together under an operating microscope. This procedure is called the Vasovasostomy or Vas to Vas connection. During the surgery, the presence of sperm at the cut end of the vas deferens will be confirmed. If the fluid exiting the vas is good and contains moving sperm, a connection can be made. If no sperm is found, there might be a blockage closer to the testicles. If the Vas to Vas can't be made, the fertility doctor will choose to connect the vas deferens to the epididymis, the structure behind the testis that allows the sperm to mature. This second procedure is called the epididymal-vasectomy and is more complicated and often less successful.

Alternatives to Vasectomy Reversal

We also offer two alternatives to the vasectomy reversal procedure. The PESA (Percutaneous Epididymal Sperm Aspiration) or the TESA (Testicular Epididymal Sperm Aspiration).

Near the spot where the seminiferous tubules meet up to form the collecting system, there is a structure called the epididymis. The epididymis is a long, tightly coiled tube where sperm is stored and eventually transported to the vas deferens, which in turn, transports it to the outside world. The tightly coiled epididymis occupies much of the back of the testicle and is usually fairly easy to locate. A urologist can take a small needle and (with some anesthesia, of course) place it into the epididymis and aspirate a few droplets of fluid.

Because the blockage produced by the vasectomy takes place beyond the epididymis, sperm is still being produced in the testicle and stored in the epididymis. These few droplets of sperm will generally contain thousands (even millions) of sperm – enough for several in vitro fertilization procedures.  The procedure to obtain sperm is called a percutaneous (through the skin) epididymal sperm aspiration, or PESA for short. It generally takes about 20 minutes to perform and the patient will walk quite normally afterward, with minimal recovery required. PESA is the most commonly performed of the vasectomy reversal alternatives. Sperm can also be obtained directly from the testicle in a similar procedure called TESE, which is more painful and has a longer recovery time. 

IVF After a Vasectomy

While the sperm obtained through these techniques functions well for IVF, it generally has little motility and often lacks the ability to fertilize an egg on its own. For this reason, IVF with direct injection of sperm into the eggs is the method of choice for using sperm from PESA. Pregnancy rates with PESA-obtained sperm are not significantly different from those with normally ejaculated sperm.