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I’ve had a vasectomy. What do I do now?

Welcome to our Vasectomy Reversal Site. How do you know whether vasectomy reversal is the choice for you? By taking the time to learn as much as you can about the procedure, you can make the best decision that resonates with what is important to you and your partner.

Click here to to determine what type of vasectomy reversal you may need.

How many men have a vasectomy reversal?

Every year in the US, half a million men have a vasectomy. As many as 6% or 30,000 will have vasectomy reversal to restore their fertility potential annually.

The Anatomy: What is down there in my scrotum?

The testicle is the “production factory” where sperm are made. The epididymis (the smaller organ that lies behind the testicle) is a delicate “refinery” where last minute adjustments and final touch-ups are made on the sperm. The vas is the “plumbing pipe” that carries the sperm out to the penis. You have a vas for each of your testicles.

A Vasectomy: What exactly did my doctor do “down there”?

A vasectomy is when the “plumbing” is disconnected from the system. The vas or the “pipe” on each side of your scrotum is divided, and the cut ends are capped off using some combination of surgical thread (suture), metal clips or heat. With the plumbing from each of your testicles capped off, sperm cannot travel to your ejaculate and you are now “shooting blanks.”

 

Vasectomy

Vasectomy Reversal: What’s the brief explanation?

A vasectomy reversal is the act of restoring things back to the way they were before your vasectomy. We “hook the plumbing back up” so that sperm can once again flow up to your penis. To do so, we locate where your doctor did the vasectomy and find the cut ends of the vas that were “capped off”. We then check to see if sperm are coming out of the pipe from the testicle (this tells us if the plumbing is wide open between the vasectomy site and the testicle). Based on this information, the type of vasectomy reversal that gives you the best chances of restoring sperm to your ejaculate and establishing a pregnancy can be chosen.

Vasectomy Reversal: Alright, let’s have some more details.

This surgery is performed on an outpatient basis with general anesthesia, regional anesthesia or local anesthesia with sedation. This means that you can generally return home within a few hours of the completion of the procedure.

The procedure begins by locating where your doctor did the vasectomy. A tiny opening is made in the scrotum over the vasectomy site. The”disconnected pipes” or the cut ends of the vas are found. The vas ends are “uncapped” and then we look for sperm. Specifically, we collect the fluid that drips out off the pipe coming from the testicle. We place it on a glass slide and examine it under a microscope at 400x magnification (Ask your surgeon if he will do this “intraoperative microscopic vasal fluid examination” for you. It is important since it tells the surgeon which type of procedure will be best for you.)

 

Microscopic Evaluation of Fluid from the Vas to Look for Sperm

If sperm are found or if there is a ton of watery fluid, it means that the plumbing is wide open back to the testicle, and the more simple type of vasectomy reversal called a vasovasostomy can be performed. The vas ends are brought back together using tiny surgical threads to make the connection (see below for more details: Vasovasostomy: Modified 1-layer versus the 2-layer technique. Which one do I pick?) If no sperm are found or the fluid is not watery and abundant, it means that the plumbing back to the testicle may not be open due to another area of blockage. (You are probably thinking.What? How can there be another area of blockage back near the testicle if my doctor only did a vasectomy?…Keep reading on).

 

The “More Simple” Vasectomy Reversal: A “Vasovasostomy” to reconnect the pipes at the vasectomy site.

When the vas is cut and the ends are “capped off” during a vasectomy, the flow of sperm comes to an abrupt stop. Instead of a “multi-car pileup”, it is a “multi-sperm pileup.” As sperm start backing up, there is an increase in “back pressure” that is transmitted back towards the testicle. The testicle is strong enough to withstand this increase in back pressure but the narrow plumbing within the delicate epididymis is not (You may recall that the epididymis is the “refinery” behind the testicle where the last minute tiny adjustments are made to the sperm).
If the “back pressure” is high and the epididymis isn’t strong enough, the tiny pipes within the epididymis can actually burst. The human body reacts to this “blow out” by sealing off the area with scar tissue. While this takes care of the leak, the scar also stops the flow of sperm past this point in the epididymal plumbing.

 

An Epididymal “Blow-Out” Causing Obstruction

What does this mean to you? With an epididymal “blow out”, the plumbing is now blocked at two spots (at the vasectomy site and at the epididymis). To allow for sperm to flow past both blocked areas, a more complex “bypass” procedure called a “vasoepididymostomy” needs to be performed. The plumbing is rerouted so that it bypasses both areas of blockage. This is the vasectomy reversal procedure that requires your surgeon to have fellowship training.

 

The “More Complex” Vasectomy Reversal: A “Vasoepididymostomy” to bypass the obstruction at the vasectomy site and in the epididymis.

 

The “More Complex” Vasoepididymostomy: Extremely fine threads are used to connect the vas to an epididymal tubule.

Why do men who have had vasectomies want to restore their fertility?

The predominant reason for this is divorce and remarriage. Other reasons include death of a partner or child, religious beliefs, post-vasectomy pain syndrome, a new desire to increase family size and impaired masculinity.

Are there different types of vasectomy reversals?

For the more simple vasovasostomy, there are two techniques that are commonly used: the modified 1-layer technique and the 2-layer technique. As it sounds, the modified 1-layer brings the cut ends of the vas together in one layer of surgical threads. The “modified” part means the connection is reinforced on the outside with some more superficially placed sutures.

The 2-layer is more challenging because the cut ends of the vas are brought together in more than one layer. The inner channel of the vas is only half a millimeter in diameter. Using surgical thread that is only 1/3 the thickness of an eyelash, the surgeon brings the inner channel together. Then this layer is reinforced by a second layer. The degree of surgical precision and accuracy needed for the 2-layer technique requires significant training such as a fellowship in male fertility.

 

Multi-Layered Technique for Vasovasostomy

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