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Vasectomy reversal


Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due October 2020

A vasectomy reversal is an operation to try to reconnect the tubes that carry sperm from your testicles to your penis. This aims to get your fertility back after having a vasectomy. We have a separate topic on vasectomy.

You’ll meet the surgeon who’s going to do your procedure to discuss your care. It may be different from what we’ve described here as it will be designed to meet your individual needs.

About vasectomy reversal

You might find that after having a vasectomy, you come to regret your decision and want it reversed. This can happen for a variety of reasons as your circumstances in life change. It's possible to reconnect the tubes that carry sperm from the testicles to your penis (called the vas deferens) in most men after a vasectomy. But it’s important to know that it isn’t always a success.

It’s more likely to work if you have a reversal fairly soon after your original vasectomy procedure. The longer the gap between having a vasectomy and reversing it, the less likely you’ll be able to father a child. The chance of success may also depend on the type of vasectomy you’re having reversed.

A successful vasectomy reversal doesn't guarantee that your partner will get pregnant. You can read more about the range of things that can affect your chances of fathering a child in our separate topic: Male infertility.

If your vasectomy reversal procedure doesn’t restore your fertility, it might be possible to have a second reversal but this is a difficult procedure. It isn’t usually possible to have a vasectomy reversed on the NHS and private health insurance companies don’t usually fund it.

Preparing for a vasectomy reversal

Your surgeon will explain how to prepare for your procedure. For example, if you smoke, it’s a good idea to quit. Smoking can increase your risk of getting a chest and wound infection, which can slow your recovery.

A vasectomy reversal is usually done as a day case in hospital. You’ll usually have a general anaesthetic and be asleep during the procedure. Or you might be able to have an epidural – you can read about what this involves in our topic: Epidurals for surgery and pain relief.

It’s a good idea to take some close-fitting, supportive underwear, such as tight pants or a jock strap, with you to hospital. They’ll be ideal to wear when you go home because they’ll support your scrotum and help to ease any discomfort and swelling after your procedure.

A general anaesthetic can make you sick, so it’s important that you don’t eat or drink anything for six hours before your operation. Follow your anaesthetist’s advice and if you have any questions, just ask.

Your surgeon will have gone through everything in detail before you get to the point where you go for your vasectomy reversal. They’ll also have given you the opportunity to ask questions about the risks, benefits and alternatives to the procedure. Once you get to hospital, they’ll go over what will happen before, during and after your procedure, and any pain you might have. You should have all the information you need to give your consent for the vasectomy reversal to go ahead. You’ll be asked to sign a consent form beforehand.

What are the alternatives to vasectomy reversal?

An alternative to vasectomy reversal is to use assisted reproductive techniques, such as intra-cytoplasmic sperm injection (ICSI). In this procedure, a surgeon will remove sperm directly from your testicle or from your epididymis (where sperm are stored inside your scrotum). Your partner will also have a procedure to remove an egg, and then a single sperm is injected into this. The fertilised egg is then transferred to your partner's womb. This means you and your partner will need to have IVF (in vitro fertilisation) treatment.

You can read more about IVF in our separate topic: Treatments for infertility.

What happens during a vasectomy reversal?

Your procedure will usually take up to three hours, but this will depend on which technique your surgeon uses. A procedure called a vasovasostomy is most common. If you have a vasoepididymostomy, it will take longer (about four hours).

Your surgeon may use a microscope in either operation, this is called microsurgery. The microscope magnifies the tubes by five to 40 times their size.

Your surgeon will start by making cuts (about 2cm wide) in each side of your scrotum, usually in the same place as your vasectomy scars.

Next, your surgeon will carefully pull out the tubes that carry sperm from the testicles to your penis, which are called the vas deferens. They’ll cut these above and below where they were tied or sealed in your vasectomy. They’ll remove any scar tissue and then check if there’s any fluid in the tubes and if this has sperm in it. This is the point at which your surgeon will decide which technique to use.

Vasovasostomy

If there are sperm in the fluid, this shows that the path is clear between your testis and where the vas deferens was cut. Your surgeon can then rejoin each tube using dissolvable stitches. They’ll then put the tubes back inside your scrotum and close the cuts in your skin using dissolvable stitches.

It isn't always possible to rejoin the vas deferens tubes in both testicles, and your surgeon may only be able to rejoin one.

Vasoepididymostomy

If there aren’t any sperm in the fluid, it can mean that there’s a blockage. In a vasoepididymostomy, your surgeon will join the vas deferens directly to the epididymis above the block, bypassing it. Your epididymis is a narrow tube that lies on the back of each testicle and stores sperm.

Vasoepididymostomy is a more complex operation than a vasovasostomy but the results are almost as good. Sometimes your surgeon may do a vasovasostomy on one side, and vasoepididymostomy on the other.

What to expect afterwards

You’ll need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You’ll usually be able to go home when you feel ready. It’s a good idea to have someone take you home. And ask them to stay with you for a day or so while the anaesthetic wears off. Your nurse will give you some advice about caring for the wounds in your scrotum before you leave. They might also give you a date for a follow-up appointment.

How long it takes for your dissolvable stitches to disappear will depend on what type you have but they’ll usually disappear in about two to three weeks.

Recovering from a vasectomy reversal

It usually takes a few days to a week to recover from a vasectomy reversal and go back to work. But this can vary, so follow your surgeon's advice.

If you need something to help with the pain, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Having a general anaesthetic can really take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.

It’s best to wear close-fitting, supportive underwear, such as tight pants or a jock strap, day and night, for the first 24 hours after your procedure. And you might find it more comfortable to wear them for a few weeks afterwards during the day. They’ll support your scrotum and help to ease any discomfort and swelling.

While you can do some gentle exercise a week after your procedure, don't lift anything heavy or do any strenuous exercise for the first few weeks.

It’s best to wait a couple of days until you have a shower, and a couple of weeks before having a bath. Dry your genital area gently and thoroughly afterwards.

Sex and your fertility

It’s best to wait about a month before you have sex again. There’s a risk you could harm the healing (and the success of the reversal) if you have sex before this time.

You won't know if you’re producing sperm when you ejaculate until your doctor checks a sample of your semen. They’ll usually do this three months after your vasectomy reversal.

If you’ve had a vasoepididymostomy, it can take longer for sperm to appear in your semen. Your doctor might need to test your semen every three months for a year until they find sperm.

Side-effects of vasectomy reversal

As with every procedure, there are some risks associated with a vasectomy reversal. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Your scrotum will feel sore, and you’ll have some bruising and swelling for a few days. You might see some blood in your semen the first few times you ejaculate.

Complications of vasectomy reversal

Complications are when problems occur during or after the operation. Possible complications of a vasectomy reversal include:

  • bleeding inside your scrotum – this is called a haematoma
  • an infection
  • hard lumps in your testicles, called sperm granulomas
  • damage to blood vessels, which can cause your testicles to shrink (testicular atrophy)
  • long-term pain in your testicles
  • scar tissue forming in the join, which re-blocks the tubes (vas deferens) that carry sperm from the testicles to your penis

It's possible that a vasectomy reversal won’t restore your fertility and you may need further fertility treatments to have a baby.

Frequently asked questions

  • Vasectomy reversal won't affect your ability to have an erection, or affect your sex drive.

    Most men have occasional problems getting or keeping an erection, but for some men the problem can be more serious. Often, erection problems are caused by physical and emotional issues. For example, feeling anxious about your fertility or the emotional pressure of trying for a baby. If you think this might be happening to you, talk to your GP. They may be able to help you or recommend or refer you to a counsellor.

  • It can take several months for sperm to re-appear in your semen, particularly if you’ve had a vasoepididymostomy. So if a test shows no sperm at three months, your surgeon will suggest a repeat test every few months until they find some.

    If sperm haven't reappeared a year and a half after your vasectomy reversal, it's unlikely that your procedure has worked. Your surgeon will then talk to you about your options. They may suggest you have another vasectomy reversal operation. Or assisted reproductive techniques, such as in vitro fertilisation (IVF) treatment may be an option for you.

  • The quality of sperm doesn't just depend on the count, but also on how healthy they are and how fast they can move. Men who smoke have a lower sperm count and more damaged sperm. Drinking too much alcohol also affects the quality of your sperm. So you might want to quit for a while, or cut down. Some medicines, such as those used to treat high blood pressure, as well as some antidepressants, can also damage sperm. Ask your doctor if there are any alternatives you could take instead.

    If you lead a healthy lifestyle, eat a healthy balanced diet and keep active, it will improve your health and fertility. Sperm develop best at a lower temperature than the rest of your body, which is why the testes are outside of the body. Although there’s no proof it will work, it might help to wear loose underwear, such as boxer shorts, or loose-fitting trousers.


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Related information

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    • Vasovasostomy and vasoepididymostomy. Medscape. emedicine.medscape.com, updated 21 December 2016
    • Personal communication, Professor Raj Persad, Consultant Urological Surgeon, Spire Bristol Hospital, 3 October 2017
    • Reversal of vasectomy. British Association of Urological Surgeons. www.baus.org.uk, published June 2017
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    • Testes and epididymis anatomy. Medscape. emedicine.medscape.com, updated 30 June 2016
    • What can I expect after a vasectomy reversal? American Urological Association. www.urologyhealth.org, accessed 8 September 2017
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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, October 2017
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due October 2020



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