Vasectomy reversal is surgery to undo a vasectomy. It reconnects each tube (vas deferens) that carries sperm from a testicle into the semen. After a successful vasectomy reversal, sperm are again present in the semen, and you may be able to get your partner pregnant.
Pregnancy rates after vasectomy reversal will range from about 30 percent to over 90 percent, depending on the type of procedure. Many factors affect whether a reversal is successful in achieving pregnancy, including time since a vasectomy, partner age, surgeon experience and training, and whether or not you had fertility issues before your vasectomy.
Mayo Clinic's approach to vasectomy reversal
Mayo Clinic in Rochester, Minn., is ranked No. 1 for urology in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals in the nation for urology by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for urology.
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Why it's done
Men decide to have a vasectomy reversal for a number of reasons, including loss of a child, a change of heart or remarriage. A small number of men have a vasectomy reversal to treat testicular pain that may be linked to a vasectomy.
Infertility — Not just a female condition
Almost all vasectomies can be reversed. However, this doesn't guarantee success in conceiving a child. Vasectomy reversal can be attempted even if several years have passed since the original vasectomy — but the longer it has been, the less likely it is that the reversal will work.
Vasectomy reversal rarely leads to serious complications. Risks include:
- Bleeding within the scrotum. This can lead to a collection of blood (hematoma) that causes painful swelling. You can reduce the risk of hematoma by following your doctor's instructions to rest, use scrotal support and apply ice packs after surgery. Ask your doctor if you need to avoid aspirin or other types of blood-thinning medication before and after surgery.
- Infection at the surgery site. Although very uncommon, infections are a risk with any surgery and may require treatment with antibiotics.
- Chronic pain. Persistent pain after vasectomy reversal is uncommon.
How you prepare
When considering vasectomy reversal, here are a few things to think about:
- Vasectomy reversal may be expensive, and your insurance might not cover it. Find out about costs ahead of time.
- Vasectomy reversals are generally most successful when they're done by a surgeon who is trained in and uses microsurgical techniques, including those that make use of an surgical microscope.
- The procedure is most successful when performed by a surgeon who does the procedure regularly and who has done the procedure many times.
- The procedure occasionally requires a more complex type of repair, known as a vasoepididymostomy. Make sure that your surgeon is able to perform this procedure if it's required.
When choosing a doctor, don't be afraid to ask questions about how many vasectomy reversals the doctor has done, the type of techniques used and how often the vasectomy reversals have resulted in pregnancy. Also ask about the risks and potential complications of the procedure.
Food and medications
Make sure you know what steps you need to take before surgery. Your doctor will probably ask you to stop taking certain medications, including blood-thinning medications and pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB, others), because they can increase your risk of bleeding.
Clothing and personal items
Bring tightfitting undergarments, such as an athletic supporter, to wear after surgery. This will support your scrotum and hold bandages in place.
Arrange for someone to drive you home after surgery. Surgery generally takes about two to four hours, or longer. You may need additional time to recover if the procedure is done with general anesthesia. Ask your doctor when you can expect to go home after surgery.
What you can expect
A vasectomy reversal reconnects the severed vas deferens, the tube that carries sperm from each testicle. During a vasectomy reversal, the severed ends of the vas deferens are reattached to one another. In some cases, the vas deferens may be attached directly to the epididymis — the part of the testicle where sperm matures.
Before the procedure
Before vasectomy reversal surgery, your doctor will likely want to:
- Take your history and perform a physical exam. Your doctor will want to make sure that you don't have health concerns that could complicate surgery.
- Check to see whether you can produce healthy sperm. For most men, having fathered a child before is proof enough. In rare cases, if your doctor is unsure whether you are producing healthy sperm, you may need additional testing.
- Confirm that your partner is capable of having a child. Your doctor will want to see whether your partner has any fertility problems, especially if your partner has never had a child or is older than age 40. This may require a gynecological exam and other tests.
Doctors usually perform vasectomy reversals at a surgery center or hospital. The procedure is generally done on an outpatient basis — without an overnight stay. Some surgeons are able to do the surgery in the clinic, but you'll want to make sure that the surgeon is able to do a more complex repair (vasoepididymostomy) in the clinic, if that becomes necessary.
Your doctor may use general anesthesia to make you unconscious during surgery. Or your surgeon may give you an anesthetic that keeps you from feeling pain but doesn't put you to sleep — such as a local anesthetic.
Vasectomy reversal is more difficult than a vasectomy and is usually done using microsurgery, in which a surgeon uses a powerful surgical microscope to magnify the vas deferens as much as 40 times its size. This type of surgery requires specialized skills and expertise.
Doctors performing this surgery usually will reattach the vas deferens in one of two ways:
- Vasovasostomy (vas-o-vay-ZOS-tuh-me). With this procedure, the surgeon sews back together the severed ends of each tube that carries sperm (vas deferens).
- Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the small organ at the back of each testicle that holds sperm (epididymis). A vasoepididymostomy is more complicated than a vasovasostomy and is generally chosen if a vasovasostomy can't be done or isn't likely to work.
The decision to perform a vasovasostomy versus a vasoepididymostomy depends on whether sperm are seen when fluid from the vas deferens is analyzed at the time of surgery.
You probably won't know ahead of time which procedure is needed. In most cases, the surgeon decides during the operation which technique will work best. Sometimes a combination of the two surgical techniques is needed — a vasovasostomy on one side and a vasoepididymostomy on the other. The longer it has been since your vasectomy, the more likely you are to need a vasoepididymostomy on one or both sides.
During the procedure
During surgery, your doctor will make a small cut (incision) on your scrotum. This will expose the tube that carries sperm (vas deferens) and release it from surrounding tissues.
Next, the doctor will cut open the vas deferens and examine the fluid inside. When sperm are present in the fluid, the ends of the vas deferens can be connected to re-establish the passageway for sperm.
If the fluid contains no sperm, scar tissue may be blocking sperm flow. In this case, your doctor may choose to perform a vasoepididymostomy.
Robot-assisted surgery has been used for vasectomy reversal, but usually is required only in select cases.
After the procedure
Immediately after surgery, your doctor will cover the incisions with bandages. You'll put on tightfitting undergarments, such as an athletic supporter, and apply ice for 24 to 48 hours to reduce swelling.
You may be sore for several days. If your doctor places bandages over the incisions after your surgery, ask when it's OK to take them off. Any stitches should dissolve in seven to 10 days.
After you return home, take it easy and try to limit activities that might cause the testicles to move around excessively. As the anesthetic wears off, you may have some pain and swelling. For most men, the pain isn't severe and gets better after a few days to a week.
Your doctor may also give you the following instructions:
- Wear an athletic supporter for several weeks at all times, except when showering. After that, you'll need to continue to wear one when you exercise.
- For the first two days after surgery, avoid anything that might get the surgery site wet, such as bathing or swimming.
- Limit any activities that may pull on the testicles or scrotum, such as jogging, sporting activities, biking or heavy lifting, for at least six to eight weeks after surgery.
- If you have a desk job, you'll probably be able to return to work a few days after surgery. If you perform physical labor or have a job that requires much walking or driving, talk to your doctor about when it's safe to go back to work.
- Don't have sexual intercourse or ejaculate until your doctor says it's OK. Most men need to refrain from ejaculating for two to three weeks after surgery.
Although it's usually not required or recommended, you may choose to have sperm frozen (cryopreservation) in case your vasectomy reversal doesn't work. If you're not able to father a child through sexual intercourse, you may still be able to have children through assisted reproductive technology such as in vitro fertilization.
For more information on determining whether freezing sperm at the time of your vasectomy reversal is appropriate for you, see "Costs and insurance" on the vasectomy reversal Care at Mayo Clinic page.
Sometime after surgery, your doctor will examine your semen under a microscope to see if the operation was successful.
Your doctor may want to check your semen periodically. Unless you get your partner pregnant, checking your semen for sperm is the only way to tell if your vasectomy reversal was a success.
When a vasectomy reversal is successful, sperm may appear in the semen within a few weeks, but it can sometimes take a year or more. The likelihood of achieving pregnancy depends on various factors, including the number and quality of sperm present and the female partner's age.
If the vasectomy reversal doesn't work
Vasectomy reversals sometimes fail if there is an underlying issue with the testicle that cannot be recognized during surgery or if a blockage develops sometime after surgery. Some men have a second-attempt vasectomy reversal surgery if the procedure doesn't work the first time.
You may also be able to father a child through in vitro fertilization by using frozen sperm. Sperm may be retrieved directly from the testicle or epididymis either at the time of the reversal surgery or at a later date. Doctors don't usually recommend freezing sperm at the time of reversal surgery, as it may be an unnecessary extra procedure.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
How do I pick a surgeon?
Several factors are important when selecting a male fertility surgeon and health care team, including experience, surgical abilities, technology and support staff.
Because vasectomy reversal is a very specialized procedure, the training and experience of your surgeon will likely have the biggest impact on your overall outcomes. Surgeons who have the most training to treat male infertility are urologists who have received specialized fellowship training in microsurgery and male fertility.
Although the majority of vasectomy reversals will require surgery only within the scrotum, in some cases, a reconstruction is required inside the abdomen. This sometimes occurs when the vas deferens has become blocked from causes other than a vasectomy, such as after a hernia repair. In these cases, often the traditional repair of the vas deferens cannot be performed, and a more complex procedure (robot-assisted intra-abdominal repair of the vas deferens) is required. Very few surgeons have experience with both traditional microscopic and robot-assisted techniques required to perform a successful repair in cases such as this.
When choosing a doctor, don't be afraid to ask questions about how many vasectomy reversals the doctor has done, the type of techniques used and how often the vasectomy reversals have resulted in pregnancy.
How can I compare success rates between surgeons?
Given the complexity of couples' fertility, success rates with vasectomy reversals are difficult to define. In addition, the most important measure of success — a healthy baby — is not commonly reported in studies.
Reported success rates after vasectomy reversal are often oversimplified. Some surgeons operate only on men who are more likely to have a successful outcome (younger men with less time since the vasectomy), which may artificially increase reported success rates. Some surgeons report outcomes only if a vasovasostomy is performed on both sides and exclude results from more-complex, and less successful, procedures.
Similarly, the definition of success isn't consistent among surgeons. Some will call a vasectomy reversal successful if one sperm is seen at any point after the procedure, while others require 5 million or more swimming sperm to be considered a success.
It's important to know that over time a percentage of men with initially successful reversals will experience a failure with few or no sperm in the ejaculate. It's not clear why this happens, but it may occur even several months after an initially successful procedure.
What are the advantages and disadvantages of vasectomy reversal and assisted reproductive technology (ART)?
Benefits of vasectomy reversal include the minimally invasive nature of the procedure, lower cost, natural conception, the ability to father more than one child without additional procedures, the option to freeze sperm at the time of reversal and ease in retrieving sperm if assisted reproductive technology (ART) is desired in the future.
Disadvantages of vasectomy reversal include the possible need for another reversal (if the initial reversal is unsuccessful), occasional inadequate sperm counts to achieve a pregnancy and limited data on long-term success rates.
Advantages of ART include greater control of the timing of pregnancy, the ability to perform an ART procedure with low sperm counts and optional chromosomal testing on the embryo to be implanted. Disadvantages are costs, possible need for multiple cycles, moral or ethical concerns, and the need to repeat ART each time pregnancy is desired.
What should I consider when deciding on vasectomy reversal vs. ART?
Individual priorities will ultimately determine which procedure you choose.
In general, vasectomy reversal tends to be one of the least expensive options for achieving a pregnancy after vasectomy. You might opt for vasectomy reversal because of moral or religious preferences, financial limitations, the desire for more than one child or the desire to avoid ovulation-inducing medications.
ART may be a better option if your partner is older (especially if older than 37 to 40 years of age), if you want only one child, and if you want to have chromosome testing done.
Costs for ART are generally higher. While costs vary significantly throughout the U.S., the current estimated costs are approximately $15,000 for the first cycle and $5,000 for subsequent cycles at Mayo Clinic's campus in Rochester, Minnesota. Often more than one cycle is required to achieve a successful pregnancy.
Procedures to retrieve and store sperm from the testicle may require additional costs, including a $250 to $500 yearly expense to store the frozen sperm.
Success rates with each cycle depend on several factors, including the quality of sperm and age and health of the mother.
Dec. 31, 2019