Vasectomy & Vasectomy Reversal
A vasectomy is considered a permanent method of birth control. A vasectomy prevents the release of sperm when a man ejaculates. During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen that is ejaculated from the penis. An egg cannot be fertilized when there are no sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. (This also happens to sperm that are not ejaculated after a while, regardless of whether you have had a vasectomy.) Because the tubes are blocked before the seminal vesicles and prostate, you still ejaculate about the same amount of fluid. It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. You must use another method of birth control until you have a semen sample tested and it shows a zero sperm count. Otherwise, you can still get your partner pregnant.
Vasectomy reversal reconnects the pathway for the sperm to get into the semen. Most often, the cut ends of the vas are reattached. In some cases, the ends of the vas are joined to the epididymis. Using microsurgery is the best way to do this surgery. A high-powered microscope used during your surgery magnifies the small tubes 5 to 40 times their size. Your urologist can use stitches much thinner than an eyelash or even a hair to join the ends of the vas. After you’re asleep, your urologist will make a small cut on each side of the scrotum. Your urologist will trim the scarred ends of the vas where they were closed by the vasectomy. Your urologist will take fluid, (“vasal fluid”) from the vasal end closest to the testis. Your doctor will check to see if it has sperm in it. At this point, there are 2 types of reversal procedures you can have:
If there is sperm in the vasal fluid it shows that the path is clear between the testis and where the vas was cut. This means the ends of the vas can then be joined. The term for reconnecting the ends of the vas is “vasovasostomy.” When microsurgery is used, vasovasostomy works in about 85 out of 100 men. Pregnancy occurs in about 55 out of 100 partners.
If there is no sperm in the vasal fluid, it may mean back pressure from the vasectomy caused a form of “blowout” in the epididymal tube. This “blowout” can lead to a block. Your urologist will need to go around the block and join the upper end of the vas to the epididymis instead. This is called a “vasoepididymostomy” and it serves the same purpose as the vasovasostomy. Vasoepididymostomy is more complex than vasovasostomy, but the results are nearly as good. Sometimes vasovasostomy is done on one side and vasoepididymostomy on the other.