A vasectomy is an operation to cut the tubes that carry sperm from the testicles to the penis creating a complete block, so sperm cannot flow out of the body. This leaves you unable to father any children. The cut ends of these tubes (the vas deferens) are sealed by clipping, stitches, or cauterisation. A vasectomy therefore does not stop the production of sperm, it merely prevents them from exiting the body. After you’ve had your vasectomy, sperm gathers at the site of the blockage unable to progress any further and is harmlessly reabsorbed.

This article is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

A vasectomy should be considered a permanent solution to birth control, however, for some men life can change dramatically either through divorce, death of their partner or child, or other unexpected changes in circumstances, and they wish to reverse the operation. A vasectomy reversal can facilitate the creation of a new family even if it’s been more than twenty years since you had the vasectomy.

What is it?

During a vasectomy reversal, the surgeon will attempt to rejoin the cut tubes of the vas deferens. If there is no excess pressure build-up at the site of the vasectomy, and you have not experienced an epididymal blowout, a straight forward vaso-vasostomy can be performed. This is where each end of the cut tubes can be re-joined, with stitches, to the other ends.

In cases where there is a blockage caused by pressure or an epididymal blowout, the southern half of the vas deferens will have to be bypassed, connecting the northern vas deferens to the epididymal tube itself. This is called an epididymal-vasostomy.

Both the above are common vasectomy reversal procedures and both are highly challenging for the surgeon. The channel inside the tube, which must be kept open for sperm to flow again, is only about 1mm across. The thread the surgeons sew with are thinner than a human hair, so they have to use special magnifiers to perform the surgery (which is called microsurgery).

What happens during the operation?

The vasectomy reversal operation is usually performed under general anaesthetic which means you will not be conscious during the procedure. It can take between one to four hours, depending on the complexity of the operation and which type of vasectomy reversal procedure is used.

An access cut is made into each side of the scrotum or sometimes just one cut in the centre. If there’s any scar tissue, debris, or sperm blocking the vas deferens this is removed, and then the cut ends of the tubes are gently pulled through the cuts for maximum visibility during the operation. The surgeon will then trim the ends to remove any damaged tissue and carefully squirt fluid into the end of the tube that leads to the penis. It’s vitally important to ensure that there are no blockages further down the tube, or the vasectomy reversal will have been in vain. He will also take a sample of any fluid found at the other end of the vas deferens (the one that lead back to the testicle) to see if there is any sperm there. No sperm may mean a blockage in this tube – also, if there are any problems with sperm production later, this sperm can be saved (frozen and stored) and used during IVF treatments in the future.

The surgeon then repairs the cuts by finely sewing the ends of the inner tubes together with one row of dissolvable stitches, before sewing the outside also with dissolvable stitches, so the tubes are completely sealed. They’re then placed back inside the scrotum and the small access cuts are joined together using either fine stitches or surgical clips.

Will my vasectomy reversal work?

The more recent your vasectomy the better your chances are of success. Studies show that if you have your vasectomy reversed within ten years, the success rate is approximately 55%. If your vasectomy was performed more than ten years ago then the success rate falls to about 25%. Generally, as time goes on, the rate of success decreases. However, there are several reasons why your vasectomy reversal may not work, aside from the length of time it’s been since the original operation:

  • Blockage forming – a blockage can form after the operation due to sluggish sperm building up in the narrow vas deferens tubes at the site of the join, or sometimes further back towards the testicle.
  • Anti-sperm antibodies – these can sometimes develop after the vasectomy and are formed if sperm leaks into the surrounding tissue and the body perceives the sperm as alien cells and tries to attack them. In rare cases, very large amounts of anti-sperm antibodies are formed, and all sperm is damaged as it’s made.
  • Scar tissue – this can sometimes build up at the site of the vasectomy reversal and cause a blockage making it difficult for the sperm to get out.

It’s not all doom and gloom however, as some men who have their vasectomy reversal more than twenty years after the vasectomy achieve success and are able to give normal sperm samples. This is due to the absence of the above situations occurring and the skill of the surgeon who does the reversal.

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