For couples who want children, the sense of yearning is strong and any obstacle to fertility seems daunting. That can be especially true for men who at one point had a vasectomy to ensure that they would have no more children, but who later have reason to change their minds.
When men come to me at the UCI Health Center for Urological Care to ask about a vasectomy reversal, it’s usually for one of two main reasons: Either they have divorced and have a new partner who wants children, or, tragically, the man and his wife have lost a child.
Each time, the men are naturally nervous about what the procedure will be like, and what its chances of success are.
Vasectomy reversal success rate
Though vasectomy reversals take around three hours, they are outpatient procedures with a quick recovery time, just like vasectomies are. And the success rate in reconnecting the vas deferens — the tube that was severed during vasectomy — is very high, about 90 percent.
But while that’s a reflection of a successful surgery, it does not always translate into the more important outcome couples seek — pregnancy. The chances of pregnancy within the couple of years after reversal are only around 40 percent to 50 percent.
Why some vasectomy reversals fail
Why is this? It depends on multiple factors:
- Age and time. Notably the age of the partner and, to a lesser extent, the time that has passed since the vasectomy.
- Original vasectomy. But the vasectomy itself may also be a factor. The original procedure might have caused a breach of the blood-testis barrier. If the patient’s blood is exposed to semen, the man’s immune system will generate antibodies to the sperm, rendering them less able to fertilize.
- Obstruction at vasectomy site. Another possibility: There can be a second, more distant obstruction on the abdominal side of the vasectomy site, keeping the sperm from making it through, although this can be determined during surgery. Part of the procedure also requires examination, with microscopic magnification, to look for active sperm on the testicular side of where the vas was severed. If it’s not there, a more complex procedure is required that connects the vas closer to the epididymis, the duct that wraps around the testicle and where sperm matures. The need for this procedure is more likely when eight or more years have passed since the vasectomy. It generally has lower success rates.
Other ways to restore fertility
There are other options for couples when a man isn’t a good candidate for a vasectomy reversal.
- A specialist can retrieve sperm through a procedure performed either in an operating room or the office, to be used for in vitro fertilization.
- Sperm also can often be harvested during the reversal itself and frozen, in case it will be needed later.
Finding the right urologist
Finally, it’s important for men seeking a vasectomy reversal to go to the right kind of urologist. Ideally, the urologist should be someone who has completed a fellowship in andrology, the medical specialty for men’s reproductive and urological health.
The success rates are significantly higher when the surgery is done under high-level magnification with a microscope. At the UCI Health Center for Urological Care, we use incredibly small sutures, and doctors need highly specialized training in order to maximize the chances for men who want to be fathers.