What Are the Predictors of Success Before Vasectomy Reversal Surgery?

What are the predictors of success before vasectomy reversal surgery?

Aside from determining if a vasectomy reversal procedure is right for you and your partner, you may also be wondering about the likelihood of success based on your individual circumstances. In general, vasectomy reversal success has two measures: if sperm has returned to semen and if pregnancy is able to be achieved. But even before vasectomy reversal recovery, there are several factors that can strongly influence vasectomy reversal success.

Predictor of Success #1: The Surgical Procedures Used in Your Vasectomy Reversal

During a vasectomy, the vas deferens are cut so sperm is unable to move through the epididymis to the prostate. This is the tube that provides passage for the sperm from the testes to where they can join the seminal fluid prior to ejaculation. To restore the flow of sperm through the vas deferens, two different surgical approaches can be taken, vasovasostomy or vasoepididymostomy. Vasectomy reversal success rates largely depend on which procedure is used.

The type of surgery your urologist performs depends on a few factors: how long ago the vasectomy procedure was performed, the quality of fluids in the vas deferens and if the sperm is being blocked in another area outside of the vasectomy site.

Vasovasostomy is the operation most frequently performed for vasectomy reversal. It entails stitching the cut ends of the vas deferens together. A vasovasostomy is the surgery of choice for vasectomy reversal as it results in a higher rate of success than the other more complex type of vasectomy reversal surgery, a vasoepididymostomy.

If excessive inflammation or scarring has occurred in the epididymis, sperm may be blocked from getting to the vas deferens. If a blockage has occurred in the epididymis, merely connecting the two cut ends of the vas deferens (as is done in a vasovasostomy) will not solve the problem. To bypass the blockage in the epididymis, a vasoepididymostomy is required.

If the vasovasostomy procedure is performed, sperm appears in the semen in approximately 85 to 97 percent of men. Approximately 50 percent of couples subsequently achieve a pregnancy.

Following microsurgical vasoepididymostomy, sperm appears in the semen in approximately 65 percent of men. Approximately 20 percent of couples subsequently achieve a pregnancy. A vasoepididymostomy is necessary in approximately one-third of cases, and the need for it can only be definitively determined during surgery.

Predictor of Success #2: The Presence of Sperm During Your Reversal Surgery

Because a man’s body continues to produce sperm even after a vasectomy, your surgeon should find sperm in the side of the vas deferens still connected to the epididymis roughly 85 percent of the time.

If that’s not the case, there may be a blockage in the tube that allows sperm to move out of the epididymis. This would affect the success of your vasectomy reversal if not corrected. Fortunately, your urologist will be able to check for any blockages during your procedure and in more than half of all cases immediately remove the blockage so full fertility is restored post-surgery.  However, the full return of sperm into the vas deferens can take up to a year.

Predictor of Success #3: Timeframe Between Surgeries

The length of time between a vasectomy and vasectomy reversal does have a correlation with success. As you can guess, the longer you wait between procedures, the lower your chances are for sperm returning and pregnancy occuring. The good news is that no interval of time is considered too long to perform vasectomy reversal surgery.

The below data show the chance of sperm returning and pregnancy rates for 1,247 men who specifically underwent a vasovasostomy procedure.

Success rates for men who underwent vasectomy study

This study highlights that despite long periods of time from vasectomy to reversal surgery (even greater than 15 years), vasectomy reversal can still result in successful pregnancies.

Predictor of Success #4: The Skills of Your Vasectomy Reversal Surgeon

A vasectomy reversal is a highly specialized surgery. Choosing the right surgeon with expertise and experience in this type of procedure is crucial.

Some surgical procedures are more routine than others – not necessarily because they are easy but because they are more common. Most urologists have performed countless vasectomies, but the same is not true of vasectomy reversals. While urologists in the U.S. perform around half a million vasectomies each year, only about 4-5 percent of vasectomy patients ever decide to have a vasectomy reversal.

Your decision of choosing the right vasectomy reversal surgeon should not be taken lightly. Do your research, ask questions, and carefully review the qualifications of any surgeon you are considering for this important procedure.

So, What Are My Chances for Success?

Most men who have vasectomy reversal can achieve restoration of sperm to the seminal fluid. However, many things can influence the rate of vasectomy reversal success. These include the timeframe between your vasectomy and vasectomy reversal, whether viable sperm is still being produced, and the skill of the urologist performing the vasectomy reversal. This is a delicate and complex surgery and a qualified doctor will have completed numerous successful reverse vasectomies. Placing your care in the hands of a urologist with the right qualifications is the first step in predicting a positive outcome for your vasectomy reversal surgery.

If you want to find out more about vasectomy reversals or other men’s health issues, contact Dr. Harry Fisch in New York to request a consultation.

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