Considering Vasectomy Reversal? MUSC Urologist Explains the Procedure

Over 500,000 vasectomies are performed every year in the United States, and about 6 percent of men will undergo a procedure to have their vasectomy reversed. We talked with Dr. Solomon Hayon, a fellowship-trained reproductive urologist and director of Men's Health and Male Infertility at MUSC Health, to find out the success rate for a reversal, reasons for reversal, and the microscopic surgical technique that he uses to perform the surgery.

What is a vasectomy?

A vasectomy is a form of male birth control. The procedure is typically done in a physician's office and involves separating and sealing the vas deferens (the tubes that carry sperm from the testicles), so there is no longer sperm in the ejaculate.

What is a vasectomy reversal?

A vasectomy reversal is a procedure that re-establishes the flow of sperm from the testicles to the ejaculate. It is a microsurgical procedure traditionally performed under general anesthesia. Although it is an outpatient procedure, it is much more in-depth than a vasectomy. It takes longer to complete and longer to recover from. The procedure is performed using a high-powered microscope (30 times more powerful than the human eye) and very thin sutures (smaller than human hair) to reconnect the vas deferens.

How is the vas deferens reconnected?

The reconnection is performed in one of two ways: a vasovasostomy (VV) or a vasoepididymostomy (VE). Both techniques require specialized equipment and advanced training in microsurgery.

• Vasovasostomy: A VV is a direct connection of the cut ends of the vas deferens and is performed most of the time. This connection is performed in two layers to achieve a watertight closure, which helps prevent scarring and improves surgical outcomes. A VV is a highly successful procedure, with over a 90 percent chance of returning sperm to the ejaculate and a roughly 50 percent chance of pregnancy in the first year, depending on the partner's age.
• Vasoepididymostomy: A VE is essentially a bypass procedure where the vas deferens is connected directly to the epididymis, which sits on top of the testicle. A VE is a more complex procedure and is only performed if there is a blockage farther "upstream" from the vasectomy site. If a VE is performed on both sides, the chance of sperm returning to the ejaculate is roughly 60 percent, and the chance of pregnancy drops to about 30 percent, again, depending on the partner's age. A VE is a delicate procedure, and not all surgeons who perform vasectomy reversals offer this type of reconnection.

How do you determine if a VV or a VE should be performed?

Our guiding principle is to make sure we do the right operation depending on what the body tells us is going on. During the operation we examine the fluid from the testicle. If the fluid is clear and contains sperm or sperm parts, then we can perform a direct vas to vas connection (VV).

Conversely, if the fluid coming from the testicle is thick and contains no sperm, this indicates a blockage upstream. In this scenario, a VE is more likely to be successful than a VV.

Why do men come to you seeking a reversal?

The primary reason for reversal is to achieve a pregnancy. In rare cases, we consider a reversal for men with persistent pain after a vasectomy. This type of pain happens in less than 1 percent of men who undergo vasectomy and is thought to be caused by the blockage of sperm or an irritation of the nerves at the vasectomy site.

Does age affect the results of a vasectomy reversal?

There is no age limit for vasectomy reversal, and men continuously produce new sperm after a vasectomy. However, some research has shown that men over age 40 have declining semen parameters and produce sperm with more DNA damage. Female partner age also plays into success rates, with declining pregnancy rates seen after about age 35.

What is the process for a man seeking a vasectomy reversal?

Prior to a reversal, I meet with the patient and his partner to discuss options for pregnancy after a vasectomy. If the couple decides on a reversal, we start by looking for indicators of healthy testicular function. This includes a physical exam and hormone testing. Depending on the age of the female partner, we may also suggest she be evaluated by a female reproductive specialist to ensure there is no female factor infertility that would require assisted reproduction (such as IVF).

What do you tell your patients about timing for reversal?

The timing of vasectomy reversal is a personal decision. From a technical standpoint, the shorter the time from vasectomy to vasectomy reversal, the higher the rates of VV and potentially procedure success. Research on this topic is varied, but generally, the rate of VE is higher if the vasectomy reversal is performed greater than 10 years after the vasectomy.

With that said, I typically advise patients to wait until they're ready to achieve a pregnancy before having a reversal. The best time to get pregnant is in the first year after vasectomy reversal, as that is when the tubes are most likely to be open. Over time the new vas deferens connection can develop scar tissue that blocks sperm, a phenomenon we call re-stenosis. Occasionally a repeat vasectomy reversal is needed in these circumstances.

What alternatives does a couple have to vasectomy reversal?

Prior to undergoing a vasectomy reversal, I talk with my patients about all the possible options and help couples decide on the best treatment for them. A vasectomy reversal is a great option if the chances of natural pregnancy are high. Other options include a surgical sperm extraction, in which sperm is removed directly from the testicle or epididymis and used during in-vitro fertilization (IVF). Sometimes during a vasectomy reversal, we will perform a sperm extraction at the same time as the reversal. This sperm can then be frozen as a backup for use with later IVF if needed. There is an extra cost to freezing the sperm, but sperm extraction only adds about 20 minutes to the procedure and does not alter the recovery process for the patient.

Once the reversal is performed, how soon before you can try to get pregnant?

We typically get a semen analysis six weeks after the procedure to check for sperm. Everyone is different, however, and it can take over six months to get sperm back, especially for patients who undergo VE. Again, the success rate for sperm returning to the ejaculate for a VV is over 90 percent.

How long is the recovery?

Patients will be sore for three to five days but will be up and walking on the day of surgery. Pain typically starts to resolve around day seven, and men can slowly resume activities two weeks after surgery.

Why should someone come to MUSC Health for a vasectomy reversal?

When it comes to vasectomy reversal success, surgical technique certainly plays a role. At MUSC, we use a high-powered surgical microscope to optimize our results, and I have gone through specialized microsurgical training to perform high-quality vasectomy reversals. We have an outstanding microsurgery team at MUSC and have worked to make vasectomy reversal financially accessible to patients, as the procedure is not typically covered by insurance.

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Dr. Solomon Hayon specializes in male infertility, vasectomy, vasectomy reversal, microsurgical sperm extraction, varicocele repair, as well as erectile dysfunction, hypogonadism, and Peyronie's disease. He sees patients at East Cooper Medical Pavilion in Mount Pleasant and MUSC Health North Area Medical Pavilion in North Charleston. To make an appointment at one of these locations, call 843-792-7888. Learn more about MUSC Health Urology services.