- Can a vasectomy be reversed?
The simple answer is yes.
But unfortunately simple questions don't obviously
have a simple answer to this.
My name is Dr. Weng Chan.
I'm a Fertility Specialist, Melbourne IVF, as well
as an Obstetrician Gynecologist and a Laparoscopic surgeon.
There are many different reasons why a couple
choose to have a vasectomy
and afterwards choose to have a vasectomy reversal.
That might be changes
to the dynamics of a family
or someone may choose to start a new family
and this can affect the choice of what one chooses to
help them fall pregnant in the future as a result.
The important thing to decide, well
why you choose to have a vasectomy reversal really depends
on multitude of factors
and that important things to also consider is whether
or not there's any pre-existing male factor issues such
as difficulty falling pregnant in the past.
If it is any, been any fertility management
on the male partner point of view,
as well as not to forget the one and most important factors,
the female side of things.
The success of a vasectomy reversal often depends a lot
on the females factors more often than not.
And this can include the age of the partner.
If the woman is above 37, above 40 sometimes,
the options of assisted reproductive technologies
might be a better option.
The other reasons also might depend on how fast
does the couple one to start conceiving
and starting a family.
The preexistence of other female issues, such as PCOS
or Polycystic Ovarian Syndrome, endometriosis,
tubal issues can also so play an important part.
And this all needs to be addressed
with your fertility specialist as a whole,
and not just just dealing with the issue of whether
can sperm be obtained
because the other option is to obtaining a sperm.
And this can include a simple
fine needle testicle biopsy to obtain sperm.
Once you've made your decision to have a vasectomy reversal
often the next step is to see a fertility specialist
or a surgeon or urologist who specializes
in reversing the previous surgery.
Often there's a consultant about this
and will explain the process to you.
Now, the process of reversing vasectomy is quite simple
and it's not a major surgery.
It involves connecting the previous obstruction
in the vas deferens and checking at the same time
whether there's any blockage there 'cause
before the vasectomy obstruction site
or just beyond the obstruction site and during the process
they make certain also that the tubes are painted.
This involves microsurgery
which can take about a couple of hours
and it's done often under a general
it's done under general anesthetic
and often it's done as a day procedure.
Once a couple have decided to consider
a vasectomy reversal as the choice of management,
the next step will be to discuss this further
with a fertility specialist
or urologist or a vasectomy reversal specialist.
The process of a vasectomy reversal is quite simple,
it involves a day procedure in the majority of cases
and is that under a general anesthetic.
The process involves basically getting rid
of the obstruction with the surgery
and reconnecting the tubes out of vas basically
and to rule out any obstruction that may occur just before
or after down the track from the tube point of view.
It's done as a day procedure as mentioned
and the man is recommended to go home and get a good rest
for a week or two and at least avoid any strenuous work
because as a result of the very fine surgery
where the tubes reconnected with very fine sutures
these can sometimes be disrupted.
And the aim is to avoid this happening.
The surgeon may recommend not to have intercourse
for the first two weeks or so
and then they will do a test to check
whether the sperm is obtained from a semen analysis
from ejaculation and different surgeons may also
recommend when to start conceiving.
So, as I mentioned, basically
this is a question that you would discuss with your
doctor who reverses the vasectomy.
What's the success of reversal vasectomy ?
The main factor can affect they can affect this
is basically the time since the onset of
the actual primary surgery to basically cut the vas deferens
or the vasectomy, when did it occur?
The longer it is potentially the success rate can go down.
The issue is whether or not, what is the measure of success?
Is it patency of the tube
or the ability to achieve a pregnancy?
So in the majority of cases, up to 90%
even the tubes can be reconnected and it can work
but the pregnancy rates can be a bit lower.
It can be between 70 to 30%
depending on the timeframe, this has been done.
What is the success of a vasectomy reversal?
The success of a vasectomy reversal really depends on
how long ago was the vasectomy first done.
The closer to it when the surgery was or should be done
the highest success rate, and it can be up to 90%
in the first two years or so.
Over time, the success rate
of maintaining the patency can actually drop
and reversal rates can be down to 70%
but the issue is not really about, is it a patency issue?
'Cause the main factor we need to think about
is about achieving a pregnancy.
So I think that we have to bear in mind is
what is the measure of success, patency or pregnancy?
The pregnancy rates can be lower.
And assuming that there's no female factor issues involved
the rates of success initially can be
up to 70% to dropping to about 30% over time.
Now, why is this?
There may be other factors.
There might be microscopic damage to the testis,
and as a result, there might be sperm antibodies
that are formed.
There might be a lower sperm count that occurs
or there can be a combination of factors also.
Now all of this takes time to rule out and make sure
that there isn't issues and to investigate further.
And this all also affects the success
of the partner achieving a pregnancy
because this time is affected.
For some people the ability to conceive also deteriorates
from a female point of view also.
The other issue is also sometimes the ability to
to cause a reanastomosis or rejoin the tubes
might not be fully achievable
and then the question is whether or not one would pursue
another repeat surgery
and this will be discussed again
with the reversal specialists or whether
or not they choose to do other options such
as assisted reproductive technologies, such as IVF and ICSI
as a result.
The alternative of obtaining sperm for these people
might include a simple three procedures
a procedure case done under local anesthetic
where there's a fine needle aspiration
of testis is to get the sample.
And often there's enough sperm collected in this
simple procedures to allow for a couple of cycles of IVF
and to start a new family for some people.
And that process might be less arduous
and sometimes very cost-effective for them also.
So the choice to choose a vasectomy reversal
or approaching someone also for assisted reproductive
options really boils down to
what the visions of the couple are.
Obviously, if a person is wanting to conceive naturally
or if they're trying to want the use
of any medications and so on
then vasectomy reversal is obviously a very good option.
Some people have personal beliefs or religious beliefs where
assisted reproductive options may not be an option for them
and again, a vasectomy is an option.
But for others where time is a factor,
or if there's any other additional issues
from a female point of view of feminine pointers,
such as, you know genetic testing and so on,
that might be required.
Then assisted reproductive options are a very viable
and a very successful option.
And in today's climate also a very cost-effective option
compared to having the surgery done to reverse vasectomy.
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