Introduction
Of the approximately 600,000 men who choose to have a vasectomy in the
United States each year, up to 5% choose to reverse the vasectomy later.
The reasons for vasectomy reversals include:
- a joint
decision by the couple to have another child
- death
of a child
- remarriage
Background
The technical
name for a vasectomy reversal is a "Vasovasostomy." This is
surgically performed by reconnecting the previously cut ends of the
vas deferens to rebuild an open vas channel (GRAPHIC # 1).
Occasionally,
the original vasectomy has caused an increase in pressure of the epididymis,
a tube upstream from the blocked end of the vas deferens, resulting
in a blowout. In this case, a standard vasectomy reversal cannot be
performed. Instead, the surgeon must connect the vas end to the epididymis
even further upstream from the blowout (GRAPHIC # 2). This more complicated
procedure is called an "Epididymovasostomy".
The
Vasectomy Reversal procedure
The detailed
work of a "Vasovasostomy" or "Epididymovasostomy"
is usually performed using magnification to adequately visualize and
suture the vas and even smaller epididymis. The microsurgical technique
of reconnecting the tubes is frequently performed with multiple layers
of fine suture that are smaller than human hairs. A general or spinal
anesthetic is usually used. The procedure can be performed on an out-patient
basis with the patient returning home the same day as the procedure.
Success
Rate
The success
rate of a vasectomy reversal depends on the
- microsurgical
skill and experience of the surgeon
- condition
of the patient's tissues after the vasectomy.
Assuming
an experienced surgeon, there are clues before and during surgery to
help predict the condition of the tissues and thereby the chances for
success.
During
Surgery
An important
predictor of success is the quality of the fluid coming from
the vas end at the vasectomy site.
If the
surgeon finds fluid with sperm cells coming from
the vas, he or she can generally build an open channel by reconnecting
the vas ends in greater than 90% of patients. The actual pregnancy rate,
though, is less because the actual sperm may no longer be able to complete
the process of fertilization. Nevertheless, pregnancies can result in
greater than 60% of such patients.
If only
fluid without sperm can be seen coming from
the vas end, the surgeon can build an open channel through the vasectomy
site in somewhat greater than 50% of patients. The actual pregnancy
rate is frequently closer to 40%.
If the
fluid is poor or absent, the vas can be directly connected
to the epididymis ("epididymovasostomy") and there is a further
reduction in the success rate.
Before
Surgery
We can
look at the time between the original vasectomy and the time of the
vasectomy reversal to predict the success of the vasectomy reversal.
In general, men who are less than 10 years out from their vasectomy
have a better chance of success.
A study
of over 1000 patients by multiple vasectomy reversal surgeons - the
Vasectomy Reversal Study Group* - reported the following
results:
|
Years
since the Vasectomy
|
Chance
of rebuilding an open vas channel
|
Chance
of pregnancy
|
| Less
than 3 years |
97%
|
76%
|
| 3
to 8 years |
88%
|
53%
|
| 9
to 14 years |
79%
|
44%
|
| Greater
than 15 years |
71%
|
30%
|
* Belker
AM, et al. Results of 1,469 microsurgical vasectomy reversals by the
Vasovasostomy Study Group. Journal of Urology 1991; 145(3):505-11.
