A vasovasostomy is an operation to reverse a vasectomy, in the hope of restoring fertility to a male patient. The surgeon reattaches the two pieces of the vas deferens that were severed during the vasectomy. A number of factors influence the success of the procedure, and patients who have had a vasovasostomy are able to successfully conceive children about half of the time.
In the male reproductive system, sperm cells are created in each testis. They pass from the testis to another structure in the scrotum, called the epididymis, where they mature in anticipation of ejaculation. During sexual intercourse, sperm travel from the epididymis through a tube called the vas deferens, where they are mixed with various secretions to form semen. The semen travels to the urethra where it is ejected from the body.
During a vasectomy, a surgeon severs each of the vasa deferentia and ties them off. Vasectomy is considered to be a permanent form of birth control, but changing life circumstances may cause a desire to reverse it. Most men who seek vasectomy reversal do so after remarriage or the death of a child. A small minority do so because of physical pain resulting from the operation, or just because they change their mind.
Vasovasostomy is the most common form of vasectomy reversal. It is almost always performed by a urologist. Patients usually receive general anesthesia, because any movement can be disastrous for the results of the surgery. Sometimes an epidural is used. The surgeon begins by making a small incision on the side of the scrotum and taking a sample of fluid from the vas deferens on the side nearest the epididymis.
If the sample is clear and contains sperm, then the procedure continues normally. If the sample is cloudy or contains no sperm, then a blockage in the vas deferens or epididymis is likely. In that case, a more complicated procedure called an vasoepididymostomy will usually need to be performed. In a vasoepididymostomy, the piece of vas deferens closest to the urethra is attached directly to the epididymis.
Assuming that the fluid sample is good, the scar tissue is removed from the ends of the two pieces of the vas deferens, and the urologist stitches them together. Most of the time, a microscope is used because the anatomy involved is so small. The incision is then closed. The surgery usually takes two to four hours, and most vasovasostomy patients go home the same day. They should refrain from sex and rigorous activities for up to four weeks.
A vasovasostomy may fail for any number of reasons. Length of time from the original surgery is the most important factor; reversals are more likely to succeed if performed within 10-15 years of the vasectomy. A surgery may also fail because the urologist fails to create a watertight seal between the two pieces of the vas deferens. The use of a microscope, called microsurgical vasovasostomy, improves the odds of success.
If the surgery is successful, it will take about two months for sperm to reappear in the semen. Between 30% and 75% of men are able to successfully conceive after their vasovasostomy, depending on the length of time from their original vasectomy. If the surgery fails, it may be possible to perform in vitro fertilization using sperm removed directly from a testis or epididymis.