Vasectomy

Vasectomy reversal

500,000 men annually have vasectomies performed in the United States. This surgical procedure assures that a man is infertile. However, at some point of a man’s life he might wish to restore his fertility for various reasons. Vasectomy reversal makes this possible. 1% of those who had undergone vasectomy want to restore their fertility with the help of a surgeon.

What is vasectomy reversal?

Vasectomy reversal is, a surgical procedure performed in order to return the flow of sperm into a vas deferens. The surgery is usually performed by a specialized microsurgeon, who uses certain surgical instruments and a microscope.

There are two different types of surgical techniques in reversal procedures. A so-called vasovasostomy is a technique used to restore fertility sewing the cut-ends of the vase deferens together. Another technique used is vasoepididymostomy that is usually performed when there is a blockage of sperm in the epididymis (a small gland near testicles) due to former inflammations. The vas deferens is then directly connected to the epididymis to restore the flow of sperm into the vas deferens.

Success rate of vasectomy reversal

Only seldom procedures restoring fertility were successful earlier. Nowadays, with the help of new microsurgical instruments and effective techniques vasectomy reversal is a successful procedure. Data shows that sperm is present in the semen in 85-97% of men who have undergone vasovasostomy. And half of the couples are successful in achieving a pregnancy after surgery. Sperm appears in 65% of men after vasoepididymostomy. And 20% of couples achieve a pregnancy.

Price of the procedure

Check with your insurance company policies to find out whether insurance covers costs of vasectomy reversal or not. Total price includes the surgeon’s fee, the hospital fee for the use of the operating room and ambulatory care facility, and the fee for anesthesia. The price is between $5,000 and $15,000.

Reasons for vasectomy reversal

Men, who want to have vasectomy reversal performed, usually make this decision for the following reasons:

remarriage after divorce or death of a wife;
death of a child;
scrotal pain related to vasectomy;
religious beliefs.

No matter what reason is, new developed surgical equipment makes almost all vasectomies possible to be reversed.

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Vasectomy is a surgical technique used to cut off and close the tubes, also called vasa deferentia, which connect the testicles and penis and carry the sperm, mainly produced by the testicles. The procedure is a permanent male contraceptive method , although vasectomy reversal is possible. However, some sources report that 60% of all vasectomy reversal procedures are inefficient. Others claim that new reverse vasectomy techniques have the efficiency of 99% in regaining fertility in male individuals, who have sperm at the time of the procedure.

How it works?

It is important to understand the anatomy and functions of a male reproductive system in order to understand the main principle of vasectomy and how it works. Testicles that produce sperm and testosterone are located in the sack, called the scrotum, at the base of the penis. Testes are connected to epididymis — a small tube, where the sperm are kept for 6 weeks while they get mature. These tubes are linked to the prostate gland through vasa deferentia. The prostate produces seminal fluid. The sperm from the testicles and seminal fluid from the prostate gland are mixed during ejaculation to form semen.

During the vasectomy procedure vasa deferentia are sealed off and the sperm therefore cannot mix with the seminal fluid to form semen. A man is still able to ejaculate and reach orgasms. He also produces the same amounts of semen (fluid) when he ejaculates. The only difference is that there is no sperm present in the semen. A male body still produces the sperm after vasectomy but since they cannot mix with the seminal fluid, the sperm are basically reabsorbed by the body. Note that the procedure does not affect a man’s sex drive and libido, as it also does not interfere with the ability to perform and enjoy sex.

The Surgical Procedure

Vasectomy is usually performed in an out-patient department, therefore, no overnight stay in the hospital is needed. It usually takes about half an hour for the surgery to be over under local anesthesia.

A patient is asked to take a shower and wash the scrotum properly on the day of the surgical procedure. He is also asked to bring tight underpants that will be worn after surgery to support the testicles and reduce swelling. Your scrotum will be shaved prior to surgery so that no hair would get into the wound. Some male individuals prefer to do it themselves at home and may do so on the day of the surgery.

Before the procedure local anesthetics are injected in several places of the scrotum, which then numbs for the time of the surgery. The surgeon then finds the vas deferens under the skin and makes a small incision of about 1 cm on the scrotum. The tubes are then revealed and pulled out and cut in two places. The doctor takes a small segment of the vas deferens and then the ends of it are sealed off. The tubes can then be replaced back to the scrotum and the incision is sutured. The procedure is then carried out on the other side of the scrotum.

As an alternative to that is a so called no-scalpel procedure, during which a puncture incision is made instead of a cut. The surgeon uses special forceps to take the tube out, cut and cauterize.

Another alternative is placing a so called vasclip around the tube without any cut and suture.

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Advantages and side-effects of vasectomy

Vasectomy is a permanent birth control method , unless a reversal is performed. Once the semen is clear of sperm you will not have to care about other methods of contraception but will still be able to enjoy sex as earlier.
Vasectomy is a minor surgical procedure, much less complicated than tubal ligation in women.

Advantages

You might say that it is a rather expensive procedure, overall you will spend less since you won’t have to pay for other methods of birth control .

It is the most effective method of birth control, the efficiency of which is 99.9-100% once your semen is clear of sperm. However, remember that during 7-10 sexual intercourses you should use additional methods of contraception since your semen does not become sterile (clear of sperm) immediately after surgery. For this reason two tests to check for sperm in semen are performed after surgery. The first sample for the test of the semen should be taken 8-12 weeks after vasectomy, the second one should be taken 2 weeks after the first one. When both of these samples are negative for sperm a man is considered to be sterile and does not have to use alternative methods of birth control.

Side-effects and Complications

Although 500,000 of vasectomies are performed in the United States annually, most of them successfully, as with any surgery there are certain side-effects and possible complications you should be aware off.

Side-effects are very mild including a short numbness of the scrotum until a local anesthetic wears off. Some patients may experience bruising and soreness of the scrotum.

Complications are very rare but still possible. About 10% of patients suffer from bleeding, feel more pain and inflammation than others. In very rare cases the sperm may still be present in the semen within a year after the surgery. The reason for that may be a slower clearing of the sperm from the ducts, or it may be due to recanalization of the ducts resulting in a repeat vasectomy . In addition the sperm that leaks out of the cut ends may accumulate in the surrounding tissues resulting in very painful numbs, called sperm granulomas, which need operative care. Very rarely but inflammation of the sealed off ends of ductus deferens may occur requiring additional medical treatment.