Vasectomy Reversal Procedure

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Vasectomy Reversal

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery). This procedure is not effective in all cases, with the success rate depending on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. There is evidence that men who have had a vasectomy produce abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility.

In one study, vasectomy reversal was found to be 75% effective for reducing the symptoms of chronic post-vasectomy pain.

In order to allow a possibility of reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization.

Vasectomy Reversal

“VV” vs. “VE”

Vasovasostomy (VV) and vasoepididymostomy (VE) are very different operations. Since the aim of VV is to reconnect the vas where it was severed at the time of vasectomy, it is a true “reverse vasectomy”. A VV can often be performed by lifting the vas tubes out of the scrotum through a small incision, just as they were lifted out at the time of the vasectomy. The vasectomy site will be either a gap or a nodule (lump), but either way, the objective is to freshen the ends on either side of the vasectomy site and suture them back together. Left and right sides can usually be repaired in turn through the same 1/2- to 1-inch vertical incision in the center of the scrotum, all under local anesthesia in a doctor’s office. The procedure is performed under magnification using optical loupes or a microscope, 10 -18 sutures are used on each side, and it takes 3-4 hours.

A VE is different in a number of ways. (1) Since the epididymis is attached to the testes, VE requires delivery of the testes, that is, the testes must be taken out of the scrotum while the connection between the epididymis and vas is made. This requires an incision larger than that needed for VV. (2) Also, the portion of the vas between the vasectomy site and the epididymis is not used, so the gap that must be bridged is longer, requiring that the upper section of vas be “mobilized” to provide the needed length. In order to do this, the surgeon must usually make two incisions, one left and one right, which can be extended up toward each groin to allow for dissection and loosening of higher portions of the vas. (3) Finally, the epididymal tubes are much smaller than the vas tubes. A microscope must be used, the connection between epididymis and vas (VE) is often not as strong as the connection between vas and vas (VV), and the success rate of VE is not as high as the success rate of VV. A VE is more technically demanding than a VV, and some surgeons who are excellent at VV’s may not perform VE’s frequently enough to be comfortable with them.

Most doctors would agree that delivery of the testes through bilateral (both sides) incisions is beyond the scope of an office environment and that general anesthesia and a formal operating room in a hospital or ambulatory surgery center should be used. In addition, since the success rate (return of sperm to the semen) with bilateral VE is only about 65%, one should consider using a surgical facility in which sperm can be harvested, evaluated and frozen at the time of the VE so that sperm is available for in-vitro fertilization if the VE fails. Saving sperm at the time of VV is much less practical for two reasons: (1) the sperm seen at the time of VV are usually not motile (active) and therefore not acceptable for freezing and in-vitro fertilization, and (2) the success rate of VV when sperm are seen coming from the lower end is very high.

VV VE
testes not seen must be delivered
gap length usually short usually long
incisions one, short, midline two, longer, left and right
magnification loupes or microscope microscope necessary
anesthesia local works fine general advisable
procedure location office or operating room operating room
sperm storage not practical advisable
fees surgeon surgeon, anesthesia, facility

Which men need a VE?

Ah … that’s the big question. We know that the longer the interval in years between vasectomy and reversal, the greater the likelihood of a secondary obstruction in the epididymis. But some men have secondary obstruction after only two years and some do not have it after 30 years. Wouldn’t it be nice if we could determine with certainty which men need a VE before they have their surgery? Unfortunately, we cannot.

Physical Exam
There are a few clues on physical exam: (1) An epididymis that is very enlarged, firm, and tender is more likely to be obstructed than one which is small, soft, and non-tender. (2) A nodule (lump) at the vasectomy site may be “sperm granuloma”, a place where sperm leaking from the lower end of the severed vas are being recycled. If the inflammation needed to recycle sperm is taking place at the vasectomy site, it is not taking place upstream, thereby sparing the epididymis and reducing pressure within it. So a vasectomy site lump is a good thing, but not all lumps are granulomas … some are just knots of the suture or clips used during the vasectomy. (3) Some surgeons believe that high (away from the testes) vasectomy sites are a good sign … more vas on the testis side of the vasectomy site to absorb the back pressure.

Operative findings
When the vasectomy site is investigated and the lower end is freshened, the fluid that may drain from the lower end is an important clue. If the fluid contains sperm, the likelihood of an upstream obstruction is very low and the likelihood of sperm reappearance in the semen after VV is very high. If the fluid contains no sperm, especially if it is thick or creamy and packed with white blood cells (pus cells), the likelihood of an upstream obstruction is very high and the likelihood of sperm reappearance in the semen after VV is very low. No fluid at all is a relatively poor sign, and watery fluid, even though devoid of sperm, is a relatively good sign.

There are three approaches to vasectomy reversal:

(1) A surgeon may perform a bilateral VV through a single incision in the office or in a facility, regardless of the lower end fluid findings, because (a) most patients have good lower end fluid findings and do not need a VE, (b) some patients enjoy return of sperm to the semen and cause a pregnancy even when lower end findings are adverse, and (c) VV’s are technically less demanding and more likely to remain open than VE’s.

(2) A surgeon may perform all reversals under general anesthesia through two incisions in an operating room with a lab ready to accept sperm for storage. By delivering the testes, the surgeon can work with excellent exposure and go right to a VE on one or both sides he or she feels that fertility would be better with a VE.

The problem with approach number 1 is that when there is epididymal obstruction on both sides (which occurs about 17% of the time on average), the procedure fails and the patient has paid full fee for a procedure from which he has derived no benefit. In addition if the patient chooses to undergo a subsequent VE, the VV has caused some scarring and loss of upper end length in the process of trimming and suturing the upper end, making the subsequent VE more challenging and perhaps less likely to succeed.

One problem with approach number 2 is that all patients pay for the operating room and anesthesia when most would have achieved success in an office environment. When even the most liberal criteria for performing a VE rather than a VV are used (as was done in a recent study), 75% of men in an operating room had a VV on both sides and 8% of men had a VV on one side. Since the VV techniques used in the office and operating room are so similar, these 83% of patients may have enjoyed a return of sperm to the semen at a much lower cost, an important consideration for an operation not covered by most insurance carriers. Another problem with approach number 2 is that after the larger bilateral incisions patients may take longer to recover than after a single smaller incision and perhaps need more time before returning to work.

(3) A third approach is an attempt to address the problems above. Patients have their procedure in the office. The first step of the procedure is to explore one vas on the testis side of the vasectomy site through a small midline incision. This lower end is opened and the fluid evaluated. If findings are favorable, proceed with VV. If findings are very unfavorable (no fluid or thick fluid with no sperm), no connection is made and for that side the patient is charged an exploration fee much lower than a VV fee. The upper end is left unharmed, there is minimal scarring, and the patient can undergo a VE and sperm harvesting in an operating room at a later date. If the lower end fluid findings are equivocal (watery or thin fluid but no sperm), the patient and doctor can make a decision together about whether to proceed. Then the other side is managed the same way. Most patients, regardless of the interval between vasectomy and reversal, will have favorable findings on both sides, will have a VV on both sides, and will experience a return of sperm to the semen.

Approach number 3 makes the most sense for men whose intervals are short (less than 10 years) and who have no adverse physical findings. Why spend thousands of dollars for an operating room and anesthesia when the likelihood of success with an office procedure is so high? Approach number 2 may make sense when the interval is long. Approach number 1 has, for this practice, provided the results summarized in the page with Results Charts. However, since early 2005, this practice has utilized approach number 3.

Whichever approach is used, vasectomy reversal takes about 3-4 hours. Postoperatively, a dressing is held in place with an athletic supporter. A small soft drain may be left in the scrotum for one to two days to allow egress of blood and thereby prevent swelling.

Microscopic Vasectomy Reversal

More than 300 patients undergoing microscopic vasovasostomy have been carefully studied in an effort to determine the factors which affect the recovery of fertility after an accurate microscopic reanastomosis. The over-all pregnancy rate in an unselected group of early patients was 71%. Recovery of fertility correlated with the return of normal sperm counts and with the quality of seminal fluid in the vas deferens on the testicular side of the obstruction at the time of vasovasostomy. The three most important factors influencing return of fertility after vasovasostomy are (1) a meticulous microscopic technique for reconnection, (2) the duration of time the vas deferens has been obstructed, and (3) the presence of absence of a sperm granuloma at the site of the vasectomy, venting the long-term pressure buildup which otherwise would occur. The presence of a sperm granuloma at the vasectomy site generally ensured the presence of good quality sperm in the vas fluid at the time of vasovasostomy and the recovery of a good sperm count postoperatively. If all three of these factors are favorable, vasectomy should be reversible for most patients.
Source: Silber SJ.: Fertility and Sterility. 1977 Nov;28(11):1191-202.

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Vasectomy-Reversal-Overview-Things To Know

By Inder Walia

Excellence in the medical field is represented now and again, when health is restored, lives are saved, new lives are brought forth and more. Some call it miracles, some call it magic and some just ascribe it to the advancement of medical science. Today Vasectomy reversal is possible! Nothing less than a miracle, it is a gift of science to mankind.

Vasectomy is the most effective long-term contraceptive method. It is conducted in the first place when an individual makes the decision of not wanting to father any more children in his remaining life span. However, different reasons such as remarriage, untimely demise of a child, desire to become a father etc, may trigger the need of vasectomy to be reversed. Twenty years ago the idea would have been unthinkable. However, today it is not only possible but millions of people find their lives enriched by the squeals of little babies, thanks to vasectomy reversal!

Before going in for a vasectomy reversal, it is advisable to be armed with a thorough understanding of the procedure, various surgical techniques, vasectomy risks, post vasectomy complications and recovery details. The procedure of conducting a vasectomy reversal is called a vasovasoctomy in medical terms. This is a kind of outpatient microsurgery conducted usually by a urologist, under the influence of local, spinal, epidural or general anaesthesia.

The first point to consider when deciding upon the micro-surgical reversal technique of vasovasostomy is the selection process of a vasectomy reversal doctor. Surgeons with extensive training in microsurgery and who perform many vasectomy reversals each year, obtain the best results.

Now to answer the main question- how is vasectomy reversal conducted? Vasovasostomy is essentially a two-step procedure. The first thing the surgeon needs to ascertain is the availability of sperm by examining a drop of fluid removed from the testicular end of vas deferens. Depending on the kind of sperm found, the appropriate type of microsurgical reconstruction needs to be performed.

The second step is to meticulously place sutures to sew the two ends of vas deferens. The channel within the vas deferens, which carries the sperm flow, is only 0.2 to 0.3 millimetres in diameter, which is roughly the size of a pinpoint. Thus, the procedure is to be carried out under a microscope that makes for better visualization, magnifying structures 20 times their actual size. This helps avoid imprecise suture placement. To ensure a leak proof connection, one-layer, two-layer or even three layer sutures may be drawn.

The majority of men who undergo vasectomy have epididymal blowouts, which are caused due to build up of pressure in the epididymis, the tube that carries sperm from the testicles to the vas deferens. The increased pressure results in a leak. The procedure used to suture epididymal blowouts is called Microsurgical Vasoepididymostomy.

Vasectomy reversal has been known to have successfully worked for patients up to 30 years following vasectomy with pregnancy occurring as early as a few months post reversal. If a vasectomy reversal is not successful due to scarring at the surgery site or imprecise suture placement or any other reason, it does not entail a complete loss of hope to reverse vasectomy. Redo vasectomy reversals have been conducted all over the world with considerable success.

Vasectomy reversal is a lifeline that has brought hope, joy, and laughter into several hearths and homes, and it shall continue to do so until science comes up with a new technology to replace this one. Till then, vasovasostomy is every vasectomized mans best bet to become fertile again.

Article Source: http://EzineArticles.com/?expert=Inder_Walia
http://EzineArticles.com/?Vasectomy-Reversal-Overview-Things-To-Know&id=416373

Vasectomy and Pregnancy

By Inder Walia

Post Vasectomy fertilization is a possibility! Renewed patency is bliss for some and an impediment for others. The risk is low but cases of pregnancy after vasectomy have been recorded. Several studies conducted to map the incidence of pregnancy after vasectomy vary by a few numbers. One study revealed only 3 cases of pregnancy out of 3,178 vasectomized men who were tested. The point to remember is that even if no sperm is found in a semen analysis post vasectomy reversal, it does not completely rule out the presence of motile sperm, which may later contribute to pregnancy.

The reasons behind pregnancy after vasectomy could be technical error, the reopening of the occluded passageway that carries sperm or the presence of residual motile sperm in the seminal vesicles even after vasectomy. The restoration of the sperm channel may happen early or late. An early recanalization (spontaneous reconnection of the vas deferens) may be detected in the post-vasectomy specimens. However, late recanalization is said to occur when several post vasectomy specimens do not show any sperm, which is discovered years after when the pregnancy has already occurred.

The above discussion relates to natural vasectomy reversal, which may not always come as a pleasant surprise! Thus, it is recommended to continue using contraceptives such as birth control pills for at least six months post vasectomy. This is because a minimum of twenty ejaculations after vasectomy have been found to contain viable sperm. On the other hand, there are couples, which after vasectomy may be desirous of more children and that chance pregnancy may not happen to them. Thats where the Vasectomy reversal procedure by a specialist comes into the picture!

Vasectomy reversal pregnancy rates are defined by factors such as the success rate of complicated epididymal surgeries that have to be conducted on most reversals. Besides, the sperm count, quality and fertility has also been noticed to decline progressively with the years after vasectomy. However, reversals performed even 20 or more years after vasectomy have known to succeed after epidiymal surgeries. Besides, new techniques of microsurgical epididymal surgery are contributing to an increase in the success rate of pregnancy after vasectomy reversal.
There are several success stories of pregnancies after vasectomy that have brightened the lives of several people. Success rate varies with the methodology used, the experience and expertise of the vasectomy doctor and the years between vasectomy and the reversal attempt. It takes an average of 12 months, and at the most 2-3 years between vasectomy reversal and the pregnancy to occur. Thus, if you decide to have another child years after vasectomy, youve got hope. So do millions of people across the globe who want to grow their families. Vasectomy reversal helps you achieve the delight, happiness and pleasure of parenthood!

Article Source: http://EzineArticles.com/?expert=Inder_Walia
http://EzineArticles.com/?Vasectomy-and-Pregnancy&id=427752

Vasectomy Reversal

Who asks for vasectomy reversal and why?

G Howard

Of the 76 men requesting reversal of vasectomy who were interviewed at Charing Cross Hospital between June 1978 and September 1981, 31 were still married. These men had decided to have a vasectomy during a crisis-a recent pregnancy or financial stress being the commonest reason. Most wanted another child but others wished to be “put back to normal,” and a few hoped reversal would help their marriage. Forty-five (59%) were divorced or separated and felt disadvantaged in courtship or remarriage by being infertile, many wives or partners being “desperate” for a pregnancy. A greater number of requests for reversal came from men who had been under 35 at the time of vasectomy and who were more likely to have been divorced, especially if there had been a teenage pregnancy. The risks of regret after sterilisation appear to relate to immaturity at the time of the vasectomy and to be as great for young men as for young women.

Source: Br Med J (Clin Res Ed). 1982 August 14; 285(6340): 490492.

What to Expect after Vasectomy Reversal Surgery

By Inder Walia

An effective vasectomy reversal is a result of expertise and experience! The microsurgical technique of multi-layer 10-0 suturing achieves the highest success.
The surgery involves surgical removal of fluid from the testicular end of vas deferens to check for colour, consistency, volume and presence of motile sperm. Once the health of the fluid is established, the two severed ends of vas deferens are reconnected to allow for unobstructed flow of sperm into the fluid that is eventually ejaculated at orgasm.

The operation, as described above, is conducted under a general anaesthetic and takes an average of two hours to complete. In another couple of hours the anaesthesia wears off and one may return home the very same day! Oral medication, as prescribed by the doctor, is good to relieve mild discomfort. It is advisable to rest and lie down as much as you can for the next few days. Within three weeks youll be up and about, performing normal activities and resuming a healthy sexual life. However, do avoid strenuous activity and wear a jockstrap for support.

Complications after vasectomy reversal are uncommon, but you

may expect bleeding from the incision made on the scrotum,

a scar that heals with time and

a rare infection that may be recognized by heightened pain and discomfort. In the case of any of the above post vasectomy complications, please contact your vasectomy reversal expert immediately!

You will be required to visit your vasectomy reversal doctor within five days after surgery for a follow up. Subsequently, visits for semen analysis would be requested every two or three months. The semen may at the beginning show very low sperm count with impaired motility. However, with time, the sperm count and motility improves, until it becomes absolutely normal in eight months time.

Fibrosis, which is a condition characterized by gradual scarring at the reversal site, causes loss of all sperm in the ejaculate in approximately 6% of the men who get a vasectomy reversal. Thus, storing sperm after vasectomy reversal is a good idea!

Very few pregnancies occur within the first few months of a vasectomy reversal. The average time is twelve months, while it may take several years to show any success. If the pregnancy does not occur within three years after vasectomy reversal, medical investigations would be recommended.
Moreover, the instances of pregnancy after vasectomy reversal are not 100%. Even a normal semen analysis may not be a definite indication of achieving a pregnancy. This would be due to the development of antibodies against sperm, which is as common as 75% of all vasectomies performed. That of course, interferes with the process of fertilization.

Thus, the procedure of a vasectomy reversal is uncomplicated. Consult your urologist about all the other options available. It is definitely worth giving your family the chance of a baby!

Article Source: http://EzineArticles.com/?expert=Inder_Walia
http://EzineArticles.com/?What-to-Expect-after-Vasectomy-Reversal-Surgery&id=421020

Vasectomy and its Microsurgical Reversal

In our series the overall pregnancy rate after vasovasostomy in an unselected group of early patients was 71%. Recovery of fertility correlated with the return of normal sperm counts and with the quality of vas fluid on the testicular side of obstruction at the time of vasovasostomy. The three most important factors in our group influencing return of fertility after vasovasostomy were a meticulous microscopic technique for reconnection, the duration of time the vas deferens has been obstructed, and the presence or absence of a sperm granuloma at the site of vasectomy. The presence of a sperm granuloma at the site of vasectomy virtually ensured the presence of good quality sperm in the vas fluid at the time of vasovasostomy. If all three of these factors are favorable, vasectomy may be reversible for more patients.
Source: Silber SJ.: The Urololic Clinics of North America. 1978 Oct;5(3):573-84.

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Vasectomy Reversal

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Sperm Granuloma and Reversibility of Vasectomy.

Ninety-two consecutive patients who had undergone bilateral vasectomy 1 month to 28 years earlier were studied at the time of vasectomy reversal for sperm output, dilatation of the vas-deferens lumen, and sperm granuloma. Thirty-nine men had unilateral or bilateral sperm granuloma. The presence of of a sperm granuloma virtually assured normal sperm in the vas fluid no matter how long ago the vasectomy was performed. In the absence of a sperm granuloma, the interval since vasectomy had an important influence on the quality of vas fluid. The presence of a sperm granuloma was associated with significantly less dilatation of vas-deferens lumen at the testicular end. The site of the vasectomy and the amount of vas deferens removed did not influence sperm quality. A sperm granuloma on only one side resulted in normal spermatozoa in the vas fluid on that side, whereas the side without the sperm granuloma had abnormal spermatozoa or no spermatozoa in the vas fluid. It is concluded that when sperm granuloma follows vasectomy it vents the high pressure otherwise created by vasectomy and prevents disruption of sperm output in the vas fluid.
Source: Silber SJ.: Lancet. 1977 Sep 17;2(8038):588-9. Links

Vasectomy and its Microsurgical Reversal

In our series the overall pregnancy rate after vasovasostomy in an unselected group of early patients was 71%. Recovery of fertility correlated with the return of normal sperm counts and with the quality of vas fluid on the testicular side of obstruction at the time of vasovasostomy. The three most important factors in our group influencing return of fertility after vasovasostomy were a meticulous microscopic technique for reconnection, the duration of time the vas deferens has been obstructed, and the presence or absence of a sperm granuloma at the site of vasectomy. The presence of a sperm granuloma at the site of vasectomy virtually ensured the presence of good quality sperm in the vas fluid at the time of vasovasostomy. If all three of these factors are favorable, vasectomy may be reversible for more patients.
Source: Silber SJ.: The Urololic Clinics of North America. 1978 Oct;5(3):573-84.

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Vasectomy Reversal

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What to Expect after Vasectomy Reversal Surgery

By Inder Walia

An effective vasectomy reversal is a result of expertise and experience! The microsurgical technique of multi-layer 10-0 suturing achieves the highest success.
The surgery involves surgical removal of fluid from the testicular end of vas deferens to check for colour, consistency, volume and presence of motile sperm. Once the health of the fluid is established, the two severed ends of vas deferens are reconnected to allow for unobstructed flow of sperm into the fluid that is eventually ejaculated at orgasm.

The operation, as described above, is conducted under a general anaesthetic and takes an average of two hours to complete. In another couple of hours the anaesthesia wears off and one may return home the very same day! Oral medication, as prescribed by the doctor, is good to relieve mild discomfort. It is advisable to rest and lie down as much as you can for the next few days. Within three weeks youll be up and about, performing normal activities and resuming a healthy sexual life. However, do avoid strenuous activity and wear a jockstrap for support.

Complications after vasectomy reversal are uncommon, but you

may expect bleeding from the incision made on the scrotum,

a scar that heals with time and

a rare infection that may be recognized by heightened pain and discomfort. In the case of any of the above post vasectomy complications, please contact your vasectomy reversal expert immediately!

You will be required to visit your vasectomy reversal doctor within five days after surgery for a follow up. Subsequently, visits for semen analysis would be requested every two or three months. The semen may at the beginning show very low sperm count with impaired motility. However, with time, the sperm count and motility improves, until it becomes absolutely normal in eight months time.

Fibrosis, which is a condition characterized by gradual scarring at the reversal site, causes loss of all sperm in the ejaculate in approximately 6% of the men who get a vasectomy reversal. Thus, storing sperm after vasectomy reversal is a good idea!

Very few pregnancies occur within the first few months of a vasectomy reversal. The average time is twelve months, while it may take several years to show any success. If the pregnancy does not occur within three years after vasectomy reversal, medical investigations would be recommended.
Moreover, the instances of pregnancy after vasectomy reversal are not 100%. Even a normal semen analysis may not be a definite indication of achieving a pregnancy. This would be due to the development of antibodies against sperm, which is as common as 75% of all vasectomies performed. That of course, interferes with the process of fertilization.

Thus, the procedure of a vasectomy reversal is uncomplicated. Consult your urologist about all the other options available. It is definitely worth giving your family the chance of a baby!

Article Source: http://EzineArticles.com/?expert=Inder_Walia
http://EzineArticles.com/?What-to-Expect-after-Vasectomy-Reversal-Surgery&id=421020

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Vasectomy Reversal

Basics of Vasectomy Reversal

After vasectomy, sperm are still made by the testes, but since the vas tubes have been blocked, they cannot exit in the usual way. On each side, sperm can still enter the epididymis (the very long coiled tube behind the testis where sperm normally become mature) and the lowermost portion of the vas tube upstream from the obstruction imposed by the vasectomy. After vasectomy, the very fine tubes of the epididymis can become blocked. There are two possible explanations for this.

In the epididymis, white blood cells in the normal testicular circulation ingest and recycle the trapped sperm. This increased white blood cell activity is a chronic inflammation by definition. Inflammations can lead to scarring, and scarring in a very fine tube like the epididymis can cause obstruction. For example, inflammation of the liver (hepatitis) can cause scarring of the liver (cirrhosis); inflammation of joints (arthritis) can cause scarring with stiffness and decreased range of motion. The longer the duration of the inflammation, the greater the likelihood of scarring and obstruction, and this can occur in the epididymis, just as it can in any organ.

An alternative explanation for obstruction in the epididymis after vasectomy is that pressure increases upstream from the vasectomy site and can cause a “blowout” in the fine tubes of the epididymis, resulting in leakage of sperm and local inflammation and blockage.

Whatever the explanation for the obstruction in the epididymis (scarring or blowout), its likelihood is roughly proportional to the number of years that have gone by since the vasectomy. After an interval of only 1-3 years, the epididymis is rarely blocked, but after an interval of 20 years, the likelihood of secondary obstruction may be over 30%. Fixing the vas where it was divided at the time of the vasectomy (vasovasostomy or “VV”) will not correct the secondary obstruction upstream in the epididymis. That requires a more elaborate procedure called a vasoepididymostomy or “VE”, in which the portion of the vas tube above or “downstream” from the vasectomy site blockage is connected to the portion of the epididymis “upstream” from the secondary obstruction.

Microscopic Vasectomy Reversal

More than 300 patients undergoing microscopic vasovasostomy have been carefully studied in an effort to determine the factors which affect the recovery of fertility after an accurate microscopic reanastomosis. The over-all pregnancy rate in an unselected group of early patients was 71%. Recovery of fertility correlated with the return of normal sperm counts and with the quality of seminal fluid in the vas deferens on the testicular side of the obstruction at the time of vasovasostomy. The three most important factors influencing return of fertility after vasovasostomy are (1) a meticulous microscopic technique for reconnection, (2) the duration of time the vas deferens has been obstructed, and (3) the presence of absence of a sperm granuloma at the site of the vasectomy, venting the long-term pressure buildup which otherwise would occur. The presence of a sperm granuloma at the vasectomy site generally ensured the presence of good quality sperm in the vas fluid at the time of vasovasostomy and the recovery of a good sperm count postoperatively. If all three of these factors are favorable, vasectomy should be reversible for most patients.
Source: Silber SJ.: Fertility and Sterility. 1977 Nov;28(11):1191-202.