As a urologist that specializes in male infertility, I get countless questions about vasectomies and vasectomy reversals every day. Do they work? Are they painful? Can I have a baby “naturally” again? What about the risks and complications? Many men—and women—ask these questions because they are rightfully concerned about themselves or their spouse. One of their main concerns is how the procedure will affect their ability to have a child again or relieve post-vasectomy pain. As a doctor, my goal is to give my patients the best care and to support them throughout treatment. Health education is part of this process. If you’ve ever wondered exactly what happens during a vasectomy or have no idea what a reversal procedure is, here are answers to those questions and more.
What is a vasectomy?
A vasectomy is a great form of birth control. It involves dividing the vas deferens, the sperm duct that transports sperm from the testicle to the ejaculatory ducts. This procedure can be done several ways—with or without clips, cauterization, or a scalpel. Regardless of how it is done, the goal is to disrupt the passage of sperm. After the procedure, you will still have semen in your ejaculate—but it will be void of sperm.
What is a vasectomy reversal?
This process involves reconnecting the vas deferens after a vasectomy. The vas is a very small tubular structure measuring 3 to 5 millimeters. Because we are dealing with small, delicate structures, a reversal requires microsurgical techniques. The suture used to perform the reversal is finer than human hair. There are two ways to reconnect the tubes: simple and complex. Simple reversal is when the vas is reconnected where it was divided. Complex reversal is when one end of the vas is connected to the epididymis, the organ close to the testicle where sperm mature. Whether you get a simple or complex reversal depends on when you underwent a vasectomy, the appearance of fluid seen during the procedure and your surgeon’s expertise. It’s important to choose a surgeon skilled in both simple and complex reversal. You also should keep in mind that the outcomes of both procedures differ. The simple reversal has a more than 90-95% chance of sperm returning, compared to a 50-60% chance for complex reversal.
Why reverse a vasectomy?
There are many reasons a man would undergo a reversal, including a new relationship, a change of heart, loss of wife or child, and chronic post-vasectomy pain. Medical research and technological advances now have made vasectomy reversal a safe and worthwhile option for anyone considering it either to regain fertility or for post vasectomy pain.
My problem is pain after vasectomy. Can you help?
Post-vasectomy pain affects up to 15% of all men that have had a vasectomy. The symptoms can vary from minor irritation in the scrotum to intractable pain in the testicle, groin, abdomen or penis. The pain may even affect sexual activity and sensation. In this case, it is critical to speak with an expert on post-vasectomy pain to see if a reversal is a good option for you.
How does vasectomy reversal work?
The procedure is generally done on an outpatient basis and can take two to three hours. We administer general anesthesia to ensure minimal movement. The procedure begins with a small incision into the scrotum and isolation of the vas at the site of its division. We then analyze the fluid from the end closer to the testicle. If doctors see sperm, then we perform a simple reversal. If there is no sperm, then we may perform a complex reversal. We also use a robotic platform or microscope to help reconnect the ends. Once the procedure is complete, we close the incisions and reverse the anesthesia.
What should I expect after a vasectomy reversal?
Every surgeon will have unique post-operative instructions. In general, you should rest for a few days after the procedure. You may experience swelling and pain around the incision. Scrotal support and light activity are recommended for at least four weeks. In a few weeks, your doctor will give you the okay to start ejaculation to allow sperm to flow through the tubes again. He or she may perform a semen analysis to confirm the presence of sperm in your ejaculate—with follow-up tests every few months to ensure there are no obstructions. There is a small risk of scarring at the reversal site, so checking for sperm is critical to ensure continued fertility.
When will we achieve a pregnancy?
We generally see sperm in the ejaculate six to eight weeks after the procedure. However, it sometimes can take longer. Achieving a pregnancy after vasectomy reversal depends on many factors, including your partners’ age, time elapsed since your vasectomy, type of reversal performed, and concentration of sperm on the semen analysis. It can take up to one year to achieve a pregnancy.
Why choose The PUR clinic for this procedure?
The PUR Clinic has committed our practice to male infertility and chronic groin and testicular pain. We take a personalized approach to your challenges and tailor our interventions to your needs. We have pioneered many technological advances for vasectomy and reversal, and have the world’s largest series of robotic-assisted procedures for infertility and chronic groin and testicular pain. Our surgeons are dual fellowship trained and leaders in the field.
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