If you have had a vasectomy but are considering having another child in the future, you may wish to investigate the world of vasectomy reversals. Advances in this surgery have made vasectomy reversals highly successful and they now offer a real possibility for extending your family.
What is a Vasectomy?
About 500 000 men in the United States undergo a vasectomy every year. One of the few methods of birth control offered to men, a vasectomy is a permanent way to guard against pregnancy. Men choose to have a vasectomy when they have decided they do not want to father any children or do not plan on having any additions to their families. Men may also undergo the procedure in order to remove the burden of birth control from their wives or partners.
The vasectomy procedure is a fairly non-invasive surgery that prevents your sperm from mixing with your semen. This way, when you ejaculate, there is no sperm present in your semen to fertilize an egg. Sperm is created in your testes and then must travel through two tubes, called the vas deferens, in order to mix with your sperm. During a vasectomy, your doctor cuts and blocks each of the vas deferens, preventing any sperm from getting mixed in with your semen.
What is a Vasectomy Reversal?
Sometimes, men who have undergone a vasectomy wish to reverse the procedure so that they can father another child. Men may desire a reversal vasectomy for any number of reasons, but often they are desired after remarriage, the death of a child, or improved financial circumstances. Thanks to new microsurgical procedures, which enable a surgeon to use a microscope to reconnect the vas deferens, vasectomy reversal surgery is becoming much more successful. Usually, 50% of men who undergo these reversals are able to produce a pregnancy after vasectomy.
Types of Vasectomy Reversal
The vasectomy reversal procedure works by allowing sperm to once again mix with a man's semen. There are two general methods used to restore a man's fertility. Depending upon your health, how your vasectomy was performed, and the length of time since your vasectomy, you will receive one of these two procedures:
Vasovasostomy: The vasovasostomy is performed in two-thirds of all vasectomy reversals. In this procedure, the surgeon uses a microscope to locate the cut vas deferens and then reattaches the ends using sutures. This should allow sperm to pass through the vas deferens and once again mix with your semen. Vasovasostomies take about two hours to complete. Vasovasostomies are usually performed in uncomplicated cases and are generally the most effective procedure. If you have little scarring on your vas deferens and if semen is present in them, you will be offered this procedure.
Epididymostomy: The epididymostomy accounts for about one-third of all vasectomy reversals. This procedure is only done if a vasovasostomy cannot be completed for some reason. If your vas deferens has no sperm present in it at the time of the reversal, this could indicate a blockage. In this case, the ends of the vas deferens cannot be reconnected, and, instead, one end of the vas deferens is connected directly to the epididymis in order to restore sperm flow. This procedure is generally less successful than the vasovasostomy and is also more complex, taking up to five hours.
How the Procedure is Performed
A microsurgical vasectomy reversal is usually performed in the hospital, but most patients don't need to stay overnight. Some private clinics also perform the procedure and this option may be more comfortable for some patients.
Vasectomy reversals are surgical procedures and are more complicated than your previous vasectomy. Most patients choose to be given general anesthetic though sometimes local anesthetic is an option. Once you have been anesthetized, your surgeon will make a vertical incision on both sides of your scrotum. This will allow the surgeon to access both of your vas deferens. Your surgeon will examine the vas deferens for signs of scarring or blockage with a special microscope. Any liquid in the vas deferens will also be expelled and analyzed for the presence of semen. If semen is present in your vas deferens, your surgeon will go ahead with a vasovasostomy. If semen cannot be found, than you will receive an epididymostomy. Semen can also be retrieved for use in in-vitro fertilization.
Vasectomy reversal recovery will be quite similar to that of your vasectomy procedure. After the surgery, you will stay in the hospital for a few hours until your anesthetic has worn off. You will also be fitted with a snug athletic support in order to help you heal. You must wear this support for six weeks.
Bed rest is recommended for the first 48 hours after the procedure. You can return to deskwork after a few days, but you should hold off from any strenuous physical activity for three weeks. You should not have sexual intercourse or ejaculate for four weeks, in order to prevent any damage to the vas deferens or incision site.
As with any surgery, there are possible side effects and complications, but if you take proper care of yourself after the procedure, most of these can be avoided. Side effects associated with reversal are similar to vasectomy complications. For the first few days after surgery you will probably experience some pain and swelling around the incision site. Your doctor can prescribe you Tylenol or codeine for the pain. You may also experience nausea, constipation, headaches, and muscle aches as a result of the surgery. These are all normal side effects and to be expected.
Infection is a more serious complication associated with the procedure. If you notice heat, pain, or redness around your incision, get checked out by your doctor. Antibiotics should clear this infection up within a few days. Sometimes blood will collect inside the scrotum after the procedure. This is called a hematoma and often causes throbbing pain. Your physician will drain the area but sometimes hematomas can be ongoing problems. 10% of men who undergo vasectomy reversals will actually experience a decline in their sperm count, making conception difficult. This occurs most often in vasectomy reversals done two or more years after the initial vasectomy.
Vasectomy reversal success rates can vary greatly and depend upon the type of procedure you receive and the skill and experience of your surgeon. Pregnancy rates following vasectomy reversal generally do not take in to account women with infertility problems. You should consult a vasectomy reversal specialist to determine your chances of producing a child.
99% of those who receive a vasovasostomy will be able to pass sperm through their vas deferens. 64% will have a baby after vasectomy reversal. About 65% of men who undergo an epididymostomy will have sperm travel through their vas deferens. This procedure is associated with a 41% pregnancy rate.
It takes time for vasectomy reversals to begin to work. You semen may not contain sperm for a few months after the procedure, so you will receive sperm testing to measure the quantity, quality, and motility of your sperm. Within six months of a vasosostomy, and 18 months of an epididymostomy, your semen should contain sperm. If it does not, it is likely your vasectomy reversal has failed. At this point you do have the option of having a repeat reversal.
The Cost of Vasectomy Reversals
Because vasectomy reversals are complicated surgical procedures, they are also very expensive. However, vasectomy reversal costs can rang depending on where you get your surgery.
In the United States, most vasectomy reversals will cost around $10 000 and are not covered by medical insurance. Low cost vasectomy reversal is available in Canada, costing around CAN$5 000, but, again, they are not covered by most insurance plans. It is important to weigh your decision to have a reversal carefully.
Not all men should pursue the procedure, especially if they are being pressured into a decision or are unprepared for the emotional and physical effects of surgery. However, for those men prepared for the surgery, a vasectomy reversal can be a rewarding and life changing event.