Tubular Reversal

A vasectomy is a permanent birth control process, while a vasectomy reversal (tubular reversal or vasovasostomy), as the name suggests, is restoration of one’s fertility. It is also conducted for removal of blockages (due to hernias, birth defects and vasectomies) in the vas deferens and in the epididymis (sperm bank).

DIAGNOSIS

Diagnosis involves pre-surgical examinations to determine one’s fertility before vasectomy, check for sperm antibodies in the semen, check of the vasectomy sites and evaluation of the time gap between vasectomy and the reversal.

THE PROCEDURE

The reversal, generally done by an urologist, aims at reconnecting the tubes (vas deferens) that were cut during a vasectomy. It can also involve a bypass process called the vasoepididymostomy, wherein the inner and outer layers of the vas deferens are stitched to the epididymis. Both are outpatient procedures of 2 to 4 hours (another couple of recovery hours) with spinal or general anesthesia. The surgery is tougher and longer in blockage patients.

POST SURGICAL CARE

There is may be some pain after surgery. One can get back to normal life, including sex, within 3 weeks. Semen testing is done after 6 weeks, 12 weeks and every 3 to 4 months, along with constant checking to make sure that the scar tissue from the surgery does not block the vas or epididymis.

COMPLICATIONS

Risks of tubular reversal include:

EFFECTIVENESS

To begin with, if there is no sperm in the semen, a year after the surgery, the process is a failure. Success is determined by the time interval between the vasectomy and the reversal. The possibility of a reversal actually declines over time, with the success rate being higher in the first 10 years after vasectomy and the highest success within 3 years of vasectomy. In patients with blockages the success is determined by the time span that the vas and seminal tubules have been blocked.

Over time, additional blockages can also develop, with or without anti-sperm antibodies. Over half of men who undergo the process develop these antibodies, which affect the sperm's ability to impregnate the partner.

Generally tubular reversal reports an overall pregnancy rate of more than 50% and 30% if it is done 10 years after vasectomy. In cases, more than 15 years since vasectomy, the sperm return rate to the ejaculate range is 70% and the pregnancy rate is 30%.