A vasectomy reversal is an increasingly common procedure to restore fertility after a past operation (a vasectomy).
The surgery may be performed either in an ambulatory surgery center or hospital, generally on a day-surgery basis. In most cases, the man arrives in the morning and leaves the hospital the same day.
Vasectomy reversal may be performed with local, regional or general anesthesia, depending on the preference of surgeon and patient. General anesthesia is commonly used because it affords maximum patient comfort considering the length and nature of the surgery.
There are two types of vasectomy reversals, and microsurgical vasovasostomy averages two to three hours, while vasoepididymostomy may take as long as five hours. The patient is then observed in the recovery room for an additional three hours. The length of surgery depends on the type of procedure, the amount of scarring present from prior surgery, the presence of and degree of inflammation, and the ease with which sperm can be identified in the vas deferens or epididymal tubule.
A vasectomy reversal is usually performed through incisions in the front of each side of the scrotum. The incision is vertical (up and down) so that it can be extended if more length is needed. If there is difficulty in locating the site of the vasectomy, if the vasectomy was performed at a very high scrotal level, or if a long segment of the vas deferens was removed, it may be necessary to extend the scrotal incisions up to the lower inguinal (abdominal) region. If a prior hernia procedure was performed, inadvertent blockage of the vas deferens may have occurred. If this is the case, an incision into the site of the prior hernia repair may be necessary.
Normal signs and symptoms after surgery include: slight swelling, bruising or discoloration of the scrotal area. These generally do not require a doctor’s attention. A sore throat, headache, nausea, constipation and general “body ache” due to the anesthesia and surgery may also be present. These symptoms usually resolve within a few days. Severe complications that require additional surgery are rare.
Postoperative complications that require prompt attention are wound infections and severe scrotal hematoma (black and blue bruised scrotum). A wound infection is present if you develop a fever or if your incision becomes warm, swollen, red, or painful. A hematoma is present if excessive bleeding under the skin occurs and is accompanied by a throbbing pain and a bulging of the incision site.
Discomfort after vasectomy reversal varies from patient to patient. In general, pain may be similar or slightly more severe than the pain experienced after the original vasectomy. Pain medication such as codeine is prescribed and is usually only necessary for one to two days after the surgery, after which acetominephin (such as Tylenol) or ibuprofen (such as Motrin or Advil) is all that is needed.
To decrease the pain and swelling after surgery, ice packs are recommended, which are placed on the scrotum for approximately ten minutes every half hour for the first post-operative day. A scrotal support is worn for four weeks after the surgery to decrease discomfort and lessen swelling. Normal strenuous activity can be resumed four weeks after the surgery if indicated by your physician.
In case you are wondering, it is generally best to wait three weeks after the surgery before resuming any type of sexual activity.
Post-op Semen Analysis
The first semen analysis is obtained one or two months after the surgery and again at two to three month intervals, either until sperm counts and motility are normal, or pregnancy occurs. Three months after a vasovasostomy the semen analysis often reveals a good sperm count with poor motility. After six months the count is usually stable or slightly improved and the motility is significantly improved. After a vasoepididymostomy, sperm usually takes longer to appear in the ejaculate, and in most cases takes at least four to six months to appear.
However, one thing to note is that studies have shown that, following initially successful reversal surgery, where good sperm counts and motility have been obtained, a significant number of men subsequently experience significant deterioration in sperm counts. Approximately 10% of men following successful vasovasostomy and approximately 20% of men following successful vasoepididymostomy will experience deterioration in sperm counts when followed for at least two years after surgery.
A decline in sperm counts after successful surgery can be caused by the formation of scar tissue which can occur from sperm leakage at the reversal site or from a disruption of the blood supply at the site of the surgery. In light of the 10 to 20% of patients that deteriorate after successful surgery, sperm banking should be a consideration, particularly after a vasoepididymostomy.
The average time from reversal surgery to conception is 12 months. Studies indicate that pregnancies after reversal surgery can occur from one month to 82 months after reversal surgery. Most pregnancies occur within 24 months of reversal surgery.
Still, it’s important to be aware that about 14% of men with vasovasostomies and 40% with vasoepididymostomies have no sperm in their semen after surgery. If sperm are not present in the semen by six months after vasovasostomy or by 12 to 18 months after vasoepididymostomy, then the reversal surgery is considered a failure. If surgery is unsuccessful you can consider reoperation or assisted reproductive techniques such as in-vitro fertilization (IVF) with intracytomplasmic sperm injection (ICSI).