What is a Microsurgical Vasectomy Reversal?

Dave Slovak

Men produce sperm in their testicles, and this sperm is transported from the testicles to the urethra by the vas deferens. As a form of birth control, men can undergo a surgical procedure known as a vasectomy, in which the vas deferens for each testicle is severed and sealed. This process stops sperm from entering the semen during ejaculation, thus preventing a woman from getting pregnant. Although this surgery is considered permanent birth control, microsurgical vasectomy reversal is a procedure that can reverse the effects of the vasectomy. Following the reversal surgery, most men are able to produce ejaculate with sperm and impregnate a woman.

During a vasectomy, the vas deferens, which transport sperm from the testicles, are severed or sealed.
During a vasectomy, the vas deferens, which transport sperm from the testicles, are severed or sealed.

Men have two options when it comes to vasectomy reversal surgery: vasovasostomy and vasoepididymostomy. Vasovasostomy is the most common microsurgical vasectomy reversal procedure and involves the reconnection of the severed ends of each of the the vas deferens. This microsurgery is usually an outpatient procedure and is typically performed by a urologist. The ideal candidates for this particular microsurgical vasectomy reversal surgery are men with healthy and motile sperm in the vasal fluid, which the doctor examines through a microscope.

For those men who do not have healthy, motile sperm in the vasal fluid, the urologist may choose to perform a vasoepididymostomy. This type of microsurgery involves the connection of each of the vas deferens directly into the corresponding epididymis, which is the tube, one of which is attached to each of the testicles, where sperm are stored. The surgeon must create an opening in the wall of the epididymis on each testicle and suture the corresponding vas deferens to that opening. This procedure, like the vasovasostomy, is done on an outpatient basis by a urologist and usually takes a few hours to complete. Vasoepididymostomy, however, is a technically challenging procedure and is only performed by a few urologists.

Though both types of vasectomy reversal procedures are considered routine and safe, men can encounter complications with both. All surgeries carry some risk of infection or internal bleeding. Also, men may develop bruising in the scrotum during the recovery period, though some swelling is considered normal. If the vas deferens connection site is not properly sutured, sperm can leak from the area and create a granuloma, an inflammation in the area of the incision.

More than 60 percent of the microsurgical vasectomy reversal surgeries succeed in reversing the effects of the vasectomy and return sperm to the men’s ejaculate. Not all of the successful surgeries, however, will result in pregnancies. Scar tissue can form at the vas deferens connection site and cause a small blockage in the tube. Also, most men develop antibodies against their own sperm, and these antibodies can impair the movement and function of sperm.

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