Vasectomy Reversal (Vasovasostomy / Vasoepididymostomy)

Vasectomy reversal is surgery that reopens the vas deferens after a vasectomy, so sperm can reach the semen again. The vas deferens is the duct that a vasectomy cuts. The surgeon places very fine sutures under a microscope. The surgery has two forms. The first form rejoins the two cut ends of the duct (vasovasostomy). Most men need this form. The second form applies when the blockage lies higher up, in the epididymis, the coiled duct behind the testicle (vasoepididymostomy). The surgeon then joins the vas deferens to an open channel above the blockage. This second type of blockage is more common when many years have passed since the vasectomy. The surgeon examines the fluid during surgery and selects the method at that point. The method cannot be selected in advance.

Results depend strongly on the time since the vasectomy. One study reviewed 1,469 of these operations across five centers. For first-time operations, sperm returned to the semen in 865 of 1,012 men (86%). Pregnancy followed in 421 of 810 couples (52%). Time since the vasectomy changed both figures. Under 3 years: 97% had sperm return and 76% of couples conceived. 3 to 8 years: 88% and 53%. 9 to 14 years: 79% and 44%. 15 years or more: 71% and 30%.¹ The age of the female partner also affects the chance of pregnancy after this surgery.² Her age and his years since vasectomy are therefore weighed together.

Vasectomy reversal is the restorative answer to a vasectomy. It treats the blockage itself. ICSI bypasses the blockage instead. In ICSI, sperm are retrieved with a needle or a small incision and injected into an egg in a laboratory. The duct stays closed. The couple still cannot conceive naturally. The woman must also undergo ovarian stimulation with drugs, egg retrieval and embryo transfer, and each of these carries its own risks. When the couple receives counseling together and the woman has no major fertility problem, reopening the duct treats the cause.

Both partners need a full evaluation before any surgical decision. Male factors, female factors, and the couple's own goals all shape the picture.