Vasectomy Reversal

Who it’s for

The strongest candidate had his vasectomy within the last ten years or so and has a female partner in her early or mid thirties with reassuring fertility tests. In that picture reversal offers good odds, natural conception, and the chance of more than one child from one operation.

The longer the gap since the vasectomy, the more likely a pressure blowout has blocked the epididymis further back. That calls for a harder join, and the odds come down, though reversal still works for many men fifteen or twenty years on.

Where the female partner is in her late thirties or beyond, or her own tests show reduced reserve or blocked tubes, the waiting time matters more than the operation. Sperm retrieval with ICSI is usually the better route there, because IVF would probably be needed anyway.

Eligibility is straightforward: an examination, a check that the female partner has been tested, and stopping smoking. A semen analysis beforehand is not usually needed, since the result after a vasectomy is known.

Before you book anything

Get the female partner's fertility tests done at the same time as your own consultation. Her results decide between reversal and retrieval as much as your vasectomy does, and having both in hand makes the choice clear.

How it’s done

The operation is done under general anaesthetic with an operating microscope. The surgeon makes a small incision on each side of the scrotum, finds the scarred ends of the vas left by the vasectomy, and trims them back to healthy tissue.

Then comes the decision that can only be made in theatre. The surgeon draws a drop of fluid from the testicular end of the vas and looks at it under a microscope. Clear or cloudy fluid with sperm in it means the road behind is open. If so, the two ends of the vas are stitched together in layers with sutures finer than a hair. That is a vasovasostomy, often shortened to VV.

Thick, pasty fluid with no sperm means there is a blockage in the epididymis, usually from years of back-pressure. Joining vas to vas would not help. Instead the surgeon connects the vas directly to a single tubule of the epididymis above the blockage. That is a vasoepididymostomy, or VE, and it is one of the most demanding joins in microsurgery.

Each side is decided separately, so one man can have a VV on one side and a VE on the other. Many surgeons also freeze any sperm found during the operation as a backup for ICSI.

At the consultation

Ask whether the surgeon is ready to do a vasoepididymostomy on the day if the fluid calls for it. Not every surgeon who does reversals does both joins, and you want the decision made on the fluid rather than on what the surgeon offers.

After vasectomy reversal

Expect a sore, bruised scrotum for a week or so. Supportive underwear day and night, ice packs in the first couple of days, and simple painkillers cover most of it. Desk work is realistic within a few days.

The joins are delicate, so the rules matter more than the discomfort. No ejaculation for two to four weeks, no heavy lifting, running or cycling until the surgeon clears it. Breaking those rules early is the most common avoidable reason a join fails.

Then comes the waiting. Sperm usually reappear within three months after a VV, and can take six to twelve months after a VE. A first semen analysis at around two to three months shows whether things are moving.

The first month

Treat the no-ejaculation rule as part of the operation itself. Agree it as a couple before the day, so the weeks pass without temptation chipping away at the surgeon's careful work.

Vasectomy reversal scars

Most surgeons make one short incision on each side of the scrotum, or a single line down the middle. They are closed with dissolving stitches.

Scrotal skin heals very well. Within a few months the lines are hard to find in the folds, and a firm lump under the skin for a few weeks is normal scar tissue settling.

Risks and complications

The early risks are bruising, a haematoma that occasionally needs draining, wound infection, and pain that outlasts the first week. All are uncommon.

The later risk is the join closing over. Scar tissue can narrow a join months after sperm first appear, and counts drop again. It happens in a minority of men, more often after a VE, which is why freezing a sample once sperm return is sensible insurance.

The risk specific to this decision is time spent waiting. A reversal that takes a year to show sperm can cost a female partner in her late thirties some of her best IVF months. That is the reason her age sits at the centre of the choice.

Vasectomy reversal results

Published series show sperm returning after a vasovasostomy in most men, often more than eight or nine in ten, falling as the years since the vasectomy climb. Pregnancy rates are lower than that, because they also depend on the female partner, and commonly sit somewhere around half to two thirds where she is young and well.

After a vasoepididymostomy the odds are lower and slower, with sperm returning in a smaller majority of men in experienced hands. That is still a good outcome for an operation that would otherwise mean IVF.

What tends to disappoint is a count that returns low, or sperm that move poorly at first. Both often improve over the first year. If they do not, the sperm can still be used for IUI or ICSI.

Alternatives to vasectomy reversal

The real alternative is surgical sperm retrieval with ICSI. After a vasectomy, production is normal and a needle almost always finds sperm, so retrieval is reliable. But it means an IVF cycle every time you want a pregnancy, and the female partner carries most of that treatment.

Reversal wins when the vasectomy was fairly recent, the female partner is young with good tests, and you might want more than one child. Retrieval with ICSI wins when she is older, has her own fertility issues, or when the vasectomy was so long ago that a VE is likely. I have sat in on many of these consultations, and the couples who decided well were the ones who brought both sets of results to the same table.

Vasectomy reversal cost

Reversal is usually priced as a single package covering the surgeon, anaesthetist, theatre and the day bed. Ask whether the price changes if a vasoepididymostomy is needed on one or both sides, because some surgeons charge more for it.

Freezing any sperm found during the operation, and the yearly storage after, are often extra. So are the follow-up semen analyses.

When comparing against retrieval with ICSI, compare one reversal against the number of IVF cycles you would realistically need. For a couple wanting two children, reversal often comes out ahead. Bangkok is a strong choice here, with experienced microsurgeons in the major private hospitals and prices well below the US.

Read more: Male Fertility

Choosing a clinic for vasectomy reversal

This is microsurgery, and the surgeon's hands matter more than anything else. Ask how many reversals they do a year, and what proportion of their patients have sperm back at six months. A specialist will know both figures.

Ask whether they are trained to do a vasoepididymostomy, and how often they end up doing one. A surgeon who only does vasovasostomy may join the vas regardless of what the fluid shows. Ask too whether they freeze sperm found during the operation.

The question that reveals the most is what they would advise a couple with your numbers. Ask it with the years since your vasectomy and your partner's age in front of them. Every good surgeon I have put this to will discuss sperm retrieval with ICSI as openly as their own operation.

When you consent

Ask for sperm found during surgery to be frozen as a backup. It costs little at the time and gives you an ICSI option without a second operation if the join struggles.

Frequently asked questions

How long after a vasectomy can it be reversed?

There is no hard limit, but the odds fall as the years pass and a harder join becomes more likely. See who it's for.

Will I know which operation I had?

Yes. The surgeon decides between a VV and a VE in theatre, from the fluid in the vas, and will tell you afterwards. See how it's done.

How soon will sperm come back?

Usually within three months after a VV and up to a year after a VE. See afterwards.

Is reversal or sperm retrieval better?

It turns on the years since your vasectomy and the female partner's age and fertility. See alternatives.

Should we freeze sperm after a reversal?

Yes, once sperm return. Joins can narrow over time, and a frozen sample keeps an ICSI option open.