Does Vasectomy Reversal Work If You Change Your Mind?
Key takeaways:
A vasectomy is a highly effective, permanent form of birth control. You should only get one if you do not plan to have children in the future.
In some cases, you can reverse a vasectomy. But it is difficult and expensive to reverse and may not result in pregnancy.
A vasectomy reversal can be costly, because most insurance carriers don’t cover the procedure.
Each year about 500,000 vasectomies are performed in the U.S. But sometimes, people who have had a vasectomy decide they may want to reverse it. It’s estimated that up to 6% of people who have had a vasectomy decide that they would like to have the surgery reversed. Getting remarried, the death of a loved one, or having access to more resources are common reasons that people may seek a reversal.
While a vasectomy reversal is possible, it can be a difficult and expensive procedure. Most insurance companies won’t cover the surgery, so the out-of-pocket costs can reach over $15,000.
What is a vasectomy?
A vasectomy is an effective, permanent form of male birth control. It’s a surgical procedure that you should only have if you don’t want to father any children in the future. It is so effective, that only 15 out of 10,000 people get pregnant if their partner has had a vasectomy.
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In the procedure, the tubes that carry sperm from the testes to the urethra are cut and blocked off. These tubes are the vas deferens. Once cut, the vas deferens no longer allow sperm to be ejaculated, and this prevents pregnancy.
Can you reverse a vasectomy?
The simple answer is yes. A vasectomy can be reversed. But it isn’t always successful. Also, not all urologists perform vasectomy reversals. Only those who have special training with a surgical microscope are able to do them. It is one of the most technically difficult surgeries because the vas deferens are small and delicate. To get the best results, you have to find a surgeon who is properly trained to do vasectomy reversal surgery.
How does reversing a vasectomy work?
A vasectomy reversal is a simple and safe procedure that is almost always done as an outpatient. General anesthesia is recommended for the procedure. Once you are asleep, the surgeon will make a small incision on each side of the scrotum (the sac that covers the testes). The surgeon will find the cut ends of the vas deferens and take some fluid to look for sperm. This fluid sample is from the part of the tube closest to the testis.
If there are sperm present, the two ends of the vas deferens can be sewn back together. This is called a vasovasostomy (VV). If no sperm are seen, it may mean that backflow from the vasectomy has damaged or blocked the vas deferens. In this case, the surgeon may choose to do a vasoepididymostomy (VE). With this method, the open end of the vas deferens is sewn to the epididymis instead. The epididymis is the area of the testes that stores sperm before release, so this helps to bypass any blockage.
After a successful VV procedure, about 55% of partners will become pregnant. Even though VE is a more complicated procedure, its results are similar to the VV procedure. Some urologists may choose to do VV on one side and VE on the other.
What is recovery like after a vasectomy reversal?
After surgery, you may have mild pain much like you had with your vasectomy. And you might need to use over-the-counter medications, such as acetaminophen or ibuprofen. If that doesn't work, your provider may give you prescription pain medication for a few days. You will also need to:
Apply intermittent ice packs for 24 hours
Use supportive underwear or scrotal support (a jockstrap) for a few weeks
Avoid having sex or ejaculating for up to 3 weeks
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Healing usually happens fairly quickly. Most people are back at work and doing light activities within a week. But it may take up to 4 weeks before you're cleared to do heavy work. Your provider will help you decide the right amount of time you need to heal completely.
You will need to return to your urologist about 6 to 8 weeks after your surgery. This is to make sure healthy sperm are making it into your semen. If no sperm are present, your provider may prescribe steroids to lower inflammation and raise your sperm count. You will need to return every 2 to 3 months until your provider can see sperm or your partner gets pregnant.
What are the risks and side effects of a vasectomy reversal?
A vasectomy reversal is a relatively safe procedure. But every surgery has its risks. After a vasectomy reversal, possible issues and side effects can include:
Scrotal hematoma: This is a rare issue of bleeding under the surface of the skin. This needs treatment quickly to prevent scarring and damage to the vas deferens.
Infection: This is also rare. But if you have redness, swelling, or drainage from the incision, you may have an infection. This is usually treated with antibiotics and steroids. Your provider may also order an ultrasound to look for an abscess.
Swelling after surgery: Some swelling after surgery is normal. Your surgeon will tell you how much swelling to expect. If you use the jockstrap and ice packs as directed, they will help control the swelling. If the amount of swelling is greater than expected, let your surgeon know.
Excessive pain after surgery: The pain after a vasectomy is usually mild and doesn’t last more than a week or two. If the pain is severe or followed by swelling, drainage, or fever, let your provider know right away.
What is the likelihood of a vasectomy reversal not being successful?
This can vary. Depending on the type of reversal, sperm can take up to 18 months to return to your semen. Even though sperm may be present, there's still a chance that the reversal will fail. Attempting a reversal less than 10 years after your vasectomy results in the best chance of success. After 15 years, the chance of a pregnancy happening drops off greatly.
Other reasons that a vasectomy reversal may not be successful include:
Antisperm antibodies (the body sees sperm as foreign and will attack healthy sperm)
Blockage in the epididymis
Repeated blockage at the reattachment site
Partner infertility
With the VV procedure, the chance that a blockage will occur is just over 10%. For the more complicated VE procedure, the risk of blockage goes up to 20%. If an obstruction blocks the vas deferens on both sides, your partner will not be able to get pregnant.
Who is a good candidate for a vasectomy reversal?
There are a few factors that may raise the likelihood for a successful reversal. The best candidate for a vasectomy reversal is one who:
Wants to father children
Had a vasectomy less than 15 years ago
Has a partner who is less than 40 years old
Other factors that influence how likely you are to conceive after a reversal include:
The skill of the surgeon: Surgeons that perform more than 15 reversals per year, may have higher success rates.
Prior pregnancy in your partner: If your partner has been pregnant before, they are more likely to get pregnant after your vasectomy reversal.
The same partner: Your chance of pregnancy is greater if you are with the same partner you had before the vasectomy, and if you’ve conceived before.
Are there alternatives to reversing a vasectomy if I want children?
If you don’t want a vasectomy reversal or if it doesn’t work, intracytoplasmic sperm injection (ICSI) is an option.
ICSI is a form of in vitro fertilization (IVF). In this procedure, the urologist collects sperm from the testes using a needle. The collected sperm are then used to fertilize your partner’s eggs. The pregnancy success rates aren’t as high as vasectomy reversal though. And ICSI can be just as costly. The procedure can also cost upwards of $15,000.
The bottom line
Some circumstances may cause you to consider reversing your vasectomy, such as getting remarried or getting better access to resources. While it is a difficult surgery, a successful reversal is possible in some cases. But it can be a costly procedure though, because most insurance companies don't cover it. If you are thinking about getting a vasectomy reversal, talk to your provider to see if you are a good candidate.
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References
Kirby, E. W., et al. (2017). Vasectomy reversal: Decision making and technical innovations. Translational Andrology and Urology.
Machen, G. L., et al. (2020). Prednisone after vasectomy reversal may improve semen parameters: One institution's experience. Canadian Journal of Urology.
National Cancer Institute. (n.d.). Vas deferens.
Patel, A. P., et al. (2016). Vasectomy reversal: A clinical update. Asian Journal of Andrology.
Ramasamy, R., et al. (2011). Vasectomy and vasectomy reversal: An update. Indian Journal of Urology.
Rayala, B. Z., et al. (2013). Common questions about vasectomy. American Family Physician.
Urology Care Foundation. (n.d.). What is vasectomy reversal?
Urology Care Foundation. (2020). What is a vasectomy?
