Can You Get a Vasectomy Reversed?

A vasectomy is a surgical, out-patient procedure where a urologist disconnects the vas deferens (the sperm duct) from the rest of the male reproductive system. This stops sperm from entering semen, making ejaculate sterile. 

It is one of the safest and most effective forms of birth control–it’s over 99% effective at preventing pregnancy. It is done in an office setting, it’s usually covered by insurance and it’s over in about 20 minutes. More than 500,000 men elect to have vasectomies every year in the United States. But what happens if you change your mind, or your circumstances change? Good news: A vasectomy can be reversed. 

If your goal is to reverse your infertility, and conceive a biological child, there are multiple procedures to choose from depending on your specific case. 

Why Would You Want a Vasectomy Reversal?

The most common reason someone might want to reverse a vasectomy is a change in desire to have children. “In developed countries, like the United States, the most common reason is divorce,” Neel Parekh, MD, Clinical Assistant Professor of Urology at the Cleveland Clinic, told Health. “In underdeveloped countries, the reason is death of a child.”

Some doctors see couples where an individual previously thought they had met their paternity goals, and believed they were done having children, but remarried and wanted a biological child with their new partner. “Most people come in as a new partnership looking to have a baby,” Sriram Eleswarapu, MD, PhD is an Assistant Professor of Urology at UCLA, and clinical urologist at The Men’s Clinic at UCLA, told Health

There is also a small number of people who look to reverse their vasectomy after the original procedure caused them physical pain and discomfort, but it is unclear if reversal will relieve those symptoms. 

Health Photo Composite - Vasectomy

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How Are Vasectomies Reversed?

There’s a few different ways to reverse a vasectomy. Here are some of the most popular ways.

Sperm Extraction

A urologist takes sperm directly from the testicle or the epididymis–a small, coiled tube sitting at the back of the testicles, where sperm is created. This option is sort of like the male reproductive version of egg retrieval.

Unfortunately, sperm found here don’t have the qualities, quantity or motility for direct intrauterine insemination, but it is enough for in vitro fertilization (IVF), said Dr. Eleswarapu. So, it can be a good option for families that are already planning IVF. 

Since IVF rounds are both expensive and physically hard on the partner going through IVF, some families prefer to fully reverse the vasectomy so they can try to conceive naturally. In that case, they will need a reversal surgery.

Reversal Surgery

Vasectomy reversal is a much more challenging microsurgery than a vasectomy (the stitches used in this procedure are thinner than a strand of hair), so you want to make sure you have a qualified and experienced doctor. “This is not the same as getting a vasectomy in the office,” said Dr. Parekh. “It’s a bit more involved.” 

During a vasectomy reversal surgery, a urologist uses a microscope to reattach the vas deferens, reconnecting the full reproductive system and bringing sperm back into the ejaculate.

There are two places they can make this reattachment:

  1. Vasovasostomy (VV): The surgeon reattaches the vas deferens to itself, tube to tube.
  2. Vasoepididymostomy (VE): The surgeon attaches the vas deferens directly to the epididymis. This surgery is a bit more complicated, takes additional time and has slightly lower success rates. VE is most commonly used for patients that are 10 years or more out from their original vasectomy. 

A VV takes about two hours, while a VE takes around three hours. Since there are two tubes, and two testicles, patients might have a VV on one side and VE on the other. Doctors don’t know which one they are doing until they have started the surgery because they have to assess fluid in real time. “Make sure your doctor is comfortable and capable of doing both types of reversal surgery,” said Parekh.

Unlike the vasectomy surgery, during reversal surgery patients are more commonly under general anesthesia. However, the decision is up to the patient and surgeon. Doctors go into the previous incision site on the scrotum, pull up the vas deferens, cut out the dead segment and assess the fluid there. This is when your doctor confirms if you need a VV or a VE. 

“We are looking for clear fluid and sperm parts,” said Dr. Parekh. If the fluid is clear they can directly reconnect the tubes. If the fluid is thick and white, like toothpaste, and there’s no evidence of sperm, they will connect directly to the epididymis. 

Sperm extraction can also be done during this surgery. If you have the budget and are planning to do IVF, have the surgeon extract sperm at the same time as your reversal.

How Successful Are Vasectomy Reversals?

The likelihood of having sperm return to someone’s ejaculate is 80% to 90%. However, the chance of pregnancy following a vasectomy reversal is anywhere from 22%-68%. The range is wide because sometimes there are other obstacles, such as one partner not producing viable eggs, sperm quality isn’t high enough, or maybe there are other unexplained fertility issues.

Favorable outcomes of vasectomy reversals appear to drop the longer it’s been since the original vasectomy procedure. According to data from the American Society for Reproductive Medicine (ASRM) reversing the vasectomy within three years has a 97% chance for sperm return and 76% pregnancy rate. However, those numbers decline to 71% and 30% respectively if it’s been over 15 years since the original vasectomy.

For anyone more than six years out, ask your healthcare provider about getting blood tests before the procedure to confirm that your hormones are in the right place to facilitate conception. This helps rule out potential hormonal issues that would prevent the body from creating sperm even after a successful reversal surgery. 

The success rates of a vasectomy reversal also depends on your healthcare provider. The gold standard for this procedure is microscopic reversals, so be sure to ask your doctor for their stats with the microscope technique. Shop around, find the big players in your geographic area and make sure you find someone doing microscopic reversals. “Look for someone that does this procedure multiple times a month” said Dr. Eleswarapu.

Recovering from a Vasectomy Reversal

Expect a similar recovery to the original vasectomy procedure as far as pain, swelling, discomfort goes, but be prepared for more aftercare. “[I tell my patients] no heavy lifting or strenuous activity for three weeks, absolutely no ejaculation for three weeks, and to wear compression shorts or a jock strap for three weeks,” said Dr. Parekh. 

You’ll probably deliver your first semen analysis at about six weeks after the reversal and your healthcare provider will track sperm improvement, working with you to predict best chances for pregnancy. It can take months for your body to start up natural sperm production again, but your urologist will track the sperm throughout that process by reviewing sperm count and sperm motility improvements. Expect it to take four months to over a year before your sperm is ready to impregnate someone.

Risks from this procedure are pretty rare, and typically are common to any surgical risk: anesthetic reaction, infection or swelling. “Like any surgeries there can be discomfort, scar tissue, rare episodes of infection, but they are exceedingly rare,” said Dr. Eleswarapu. There’s a small chance for bleeding or hematomas, and in extremely rare cases, there’s a chance for chronic pain caused by disrupting blood supply to the testicle.

What Does Vasectomy Reversal Cost?

Insurance does not typically cover the reversal (although many do cover the initial vasectomy). Costs will vary depending on where you live, with more populated areas charging higher rates.  Expect to pay between $5,000-$15,000 for vasectomy reversal surgery. If you find someone offering the procedure for less than that, be careful and do your research. They might not be using the microscopic technique. 

What if Vasectomy Reversal Doesn't Work?

Vasectomy reversals have very high success rates, returning sperm flow in the large majority of cases. If you had an unsuccessful vasectomy reversal but think it could've been doctor error (maybe they didn’t use a microscope) or you had an injury to the area during the recovery period, you could attempt another vasectomy reversal. If done by a skilled surgeon a repeat reversal can have the same success rates as a first time vasectomy reversal. 

A Quick Review

If you had a vasectomy within the last 10 years, it is possible to get sperm flowing in your body again.

There are very effective options to bring sperm back to your semen, but keep in mind that they aren't fast solutions. It’s important for people to understand their timeline, budget and the potential struggles with conceiving after a vasectomy.  It’s likely going to be months, or potentially years, before the reproductive system is producing sperm healthy enough to cause natural conception, so factors like the age of your partner come into play. 

If you are hoping to conceive a biological child and have the money and time for reproductive procedures like IVF, vasectomy reversal could be a good option for you.

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