DEAR MAYO CLINIC: Is it possible to have a successful reverse vasectomy nine years after the vasectomy was done? What should I expect as far as recovery? I am 42 years old.
ANSWER: For most men, vasectomy reversal is a viable option at any time. But the amount of time since your vasectomy can have an effect on the likelihood of the procedure’s success. The type of surgery you require to achieve the reversal makes a difference, too. It’s also important to take into consideration other factors that can have an impact on fertility, such as your partner’s age.
The purpose of vasectomy reversal is to allow sperm to travel from the testicles into the semen. There are two ways a vasectomy reversal can be performed. The first is a simpler repair called a vasovasostomy. In this procedure, the ends of the vas deferens (tubes that carry sperm from the testicles into the semen that were cut apart during a vasectomy) are sewn back together. The second procedure, known as epididymovasostomy, is more complex. It involves attaching the vas deferens directly to the small organ at the back of each testicle that holds sperm, called the epididymis.
It is hard to predict before a vasectomy reversal which technique will be required. At the beginning of the procedure, the surgeon takes a sample of the fluid inside the vas deferens. If it contains sperm, then the simpler technique usually can be used. If it does not contain sperm, scar tissue may be blocking the flow of sperm from the testicles. In that case, the more complex procedure usually is necessary.
The closer you are to the time you had your vasectomy, the more likely it is you will be able to have the simpler procedure. That procedure tends to have a successful outcome more often than the complex procedure. In general, the success rates for vasectomy reversal decline with each year after a vasectomy for about 12 to 15 years. At that point, the success rate levels off.
It is important to note, though, that the definition of success for vasectomy reversal varies widely. While some physicians consider one sperm at any time after surgery to be a measure of success, others define success as a live birth. In general, a return of sperm is seen in more than 70 percent of men who undergo a complex repair on both sides and in more than 95 percent in those who have simple repairs on both sides.
Although pregnancy rates depend on various factors, including partner fertility and age, successful pregnancies occur in more than 75 percent of men undergoing reversal within three years of a vasectomy, compared to approximately 30 percent in those beyond 15 years.
Before you move forward with vasectomy reversal, consider your partner’s fertility, too. Fertility declines in women during the late 30s and beyond. If your partner is older than that, then it may be worthwhile to consider other techniques to help you conceive, such as in vitro fertilization. If she is younger, and she has no other fertility issues, then vasectomy reversal generally is considered the better option, especially if you are interested in having more than one child.
Recovery following vasectomy reversal is similar to that of a vasectomy. Activity usually is restricted for several weeks to allow for healing. In some cases, that may include not having sex. If you require the more complicated repair, that could result in the testicle sitting slightly higher in the scrotum after surgery. As with any surgery, vasectomy reversal carries a small risk of bleeding and infection.
If sperm is able to flow from the testicle into the semen after surgery, and if no other barriers to fertility exist for you or your partner, time to achieving pregnancy after a vasectomy reversal typically ranges from about 12 to 17 months. — Landon Trost, M.D., Urology, Mayo Clinic, Rochester, Minn.