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.
Success rates with vasectomy reversal will range from about 40 percent to over 90 percent. Many factors affect whether a reversal is successful in achieving pregnancy, including time since a vasectomy, partner age, definition of success, and surgeon experience and training.
Mayo Clinic's approach
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's 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 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 in certain situations.
- Chronic pain. Persistent pain after vasectomy reversal is very 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.
- The procedure is most successful when performed by a surgeon who has done the procedure many times.
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 tight-fitting 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 three to four hours. You may need additional time to recover from anesthesia. Ask your doctor when you can expect to go home after surgery.
What you can expect
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 examination 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.
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 an epidural, spinal or local anesthetic.
Vasectomy reversal is more difficult than a vasectomy. It requires specialized skills and expertise. Doctors performing this surgery usually will re-attach 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.
You probably won't know ahead of time which technique 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 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.
During the procedure
During surgery, your doctor will make a small cut (incision) on the underside of 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 is thick or pasty, or if it contains no sperm or partial sperm, scar tissue may be blocking sperm flow. In this case, your doctor may choose to perform a vasoepididymostomy.
After the procedure
Immediately after surgery, your doctor will cover the incisions with bandages. You'll put on tight-fitting undergarments, such as an athletic supporter, and apply ice 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 any 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 it during 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 two to four 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 sex for two to three weeks after surgery.
If your doctor finds sperm during surgery, you may choose to have some frozen in case your vasectomy reversal doesn't work (cryopreservation). If you're not able to father a child through sexual intercourse, you may still be able to have children through assisted reproductive techniques such as in vitro fertilization.
For more information on determining whether freezing sperm at the time of your vasectomy reversal is appropriate for you, go to "Costs & insurance" on the Care at Mayo Clinic page.
About six to eight weeks 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 usually appear in the semen after a few months, but it can sometimes take a year or more. The likelihood of achieving pregnancy depends on various factors, including the length of time that passed since the vasectomy 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, which 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 retrieved during a semen analysis during your vasectomy reversal. If you didn't have sperm frozen or you do not have any sperm in your ejaculate, in vitro fertilization may still be possible using sperm retrieved directly from your testicle or epididymis.
How can I find out my predicted success rate?
There are many factors that contribute to a successful outcome. To receive an estimate of your anticipated success rate, please email VasectomyReversal@mayo.edu and request a questionnaire.
Once your responses are received, they will be compared to a database of success rates to give you estimates of the chance of return of any sperm, sperm counts considered within "normal" range, pregnancy rate and risks of later failure after an initial success. It typically takes 1 to 2 business days to receive an email back once you submit the form.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Frequently Asked Questions
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 only require surgery within the scrotum, in some cases, a reconstruction is required inside of 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 (robotic-assisted intra-abdominal repair of the vas deferens) is required. Very few surgeons have experience with both traditional microscopic and robotic-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 following vasectomy reversal are often oversimplified. Some surgeons only operate 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 only report outcomes if a vasovasostomy is performed on both sides and exclude results from more complex, and less successful, procedures.
Similarly, the definition of success is not consistent between surgeons. Some will call a vasectomy reversal successful if one sperm is seen at any point after the procedure, while others require over 1 million sperm to be considered a success. This is important because a normal sperm count is considered to be more than 39 million sperm per ejaculation, with 40 percent of those sperm being motile.
It's important to know that over time a percentage of men with an initially successful reversal 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 techniques (ART)?
Benefits of vasectomy reversal include the minimally invasive nature of the procedure, lower cost, natural conception, ability to father more than one child without additional procedures, option to freeze sperm at the time of reversal and ease in retrieving sperm if assisted reproductive techniques (ART) are desired in the future.
Disadvantages 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 with ART include greater control of the timing of pregnancy, ability to perform 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 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 following 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 stimulatory medications.
ART may be a better option if your partner is older (particularly older than 37 to 40 years of age), it's been several years since your vasectomy (more than15 years), you only want one child and you want to have chromosomal testing.
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.
In addition, procedures to retrieve and store sperm from the testicle may cost an additional $2,500 to $4,000 plus $275 to $500 a year 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.
For more information on which approach might be right for you, please email VasectomyReversal@mayo.edu and request a questionnaire.
Dec. 18, 2018