Around six per cent of men will ask for a vasectomy reversal, and there are many reasons why a man might want this done. They might have got into a new relationship and find themselves wanting more children. Or they might decide to start a family later in life.
Whatever the reasons, it is possible to have a vasectomy reversal.
We spoke toDr Deborah Lee from Dr Fox Online Pharmacy to find out more about vasectomy reversals, what's involved in the procedure, the success rates and the risks involved.
What is a vasectomy reversal?
Reversing a vasectomy is often a difficult surgical procedure. It involves locating the cut or damaged ends of the vas deferens (this is the thick-walled tube in the male reproductive system that transports sperm cells from the epididymis, where the sperm are stored prior to ejaculation) and connecting them back up again, or removing the device that was used to occlude it (Vas clip vasectomy).
There are two surgical procedures that can be undertaken:
• A vasovasostomy – in which the cut ends of the vas deferens are sewn back together.
• A vasoepididymostomy – in which the vas deferens is attached to the epididymis, the place where sperm are stored - because an additional blockage in this region has been located. This is a more complex procedure.
What is involved in a vasectomy reversal procedure?
A vasectomy reversal may be a difficult procedure. The operation can take three to four hours, and an operating microscope is needed. Several small incisions are made in the scrotal area.
It can be done with a local, or a general anaesthetic. The success of the operation depends on what the surgeon finds when the area is opened up in terms of scar tissue. They will check if there is sperm inside the vas, and if sperm are absent, will check for any blockages that may have developed at other sites closer to the testicles.
Can anyone have a vasectomy reversed?
In principle, anyone can go forward for a vasectomy reversal, although this has to be done privately, so you may want to consider the financial impact this could have before going ahead.
It's also worth remembering that the vasectomy reversal procedure is not always successful. Age however is not a factor, as it is for women, and even older men can have a vasectomy reversal.
If the female partner has also got blocked Fallopian tubes, either through infection or due to having undergone female sterilisation, couples are probably more likely to achieve a pregnancy using an assisted reproduction technique, such as in vitro fertilisation (IVF).
What risks are involved?
The pain after the procedure is said to be similar to that from the initial vasectomy. Around 25 per cent said it was worse, and 25 per cent said it was better, than the original procedure.
After the operation, there will be some swelling and bruising which settles down over a couple of weeks.
You will be advised to use ice packs on the area, wear firm, well-fitted underwear, and take appropriate pain relief.
In the short term, there are risks of bruising, swelling, bleeding, and infection.
In the longer term, there are small risks of chronic testicular pain, and the development of more scar tissue, which could cause the vas deferens to become blocked.
You will be asked to give a sperm sample six to eight weeks after the procedure to check for the presence of sperm and assess viability. If the sperm count is low, you will be asked to repeat it in three months.
Neither vasectomy nor vasectomy reversal is a cause of erectile dysfunction.
How long does it take to recover from?
Typically, recovery after a vasectomy reversal takes five to 14 days. Sexual intercourse is not advised for four weeks.
You should not drive until you are confident you are in control of the vehicle and can do an emergency stop.
You should have seven days off work, but longer if you have a physically strenuous job.
How likely is it to work? And what if it doesn't work?
The success in terms of being able to do this is strongly linked to how long ago the vasectomy was undertaken. The longer the time since the vasectomy, the greater the amount of scar tissue.
The NHS states that the success in terms of conceiving a baby after a vasectomy reversal is
• 75 per cent if the reversal is done within three years of the vasectomy
• 55 per cent if the reversal is done between three to eight years after the vasectomy
• 40 - 45 per cent if the reversal is done between nine to 14 years after the vasectomy
• 30 per cent if the reversal is done between 15-19 years of the vasectomy
• Less than ten per cent if the reversal is done after a vasectomy that was performed 20 years earlier.
The chance of pregnancy also depends on the age and fertility of the female partner.
Another factor that affects the success of the procedure is the presence of anti-sperm antibodies. These develop due to sperm leaking into the bloodstream after a vasectomy. Many pregnancies are achieved despite the presence of anti-sperm antibodies, meaning their significance is unclear.
Can it be carried out on the NHS, or do you have to go private?
Vasectomy reversal is not offered as an NHS procedure.
One London clinic is currently charging an average figure of £3,339 for a vasectomy reversal procedure.
Meet the expert
Dr Deborah Lee - MB ChB, FFSRH, MFFP, MRCGP, DRCOG, Dip GUM, Dip Colp, LOC Med Ed Sexual and Reproductive Health Doctor and a menopause specialist.