The decision

You and your partner have decided you want a child. But you've had a vasectomy, a procedure that made you sterile (unable to father a child). You're now considering surgery to reverse your vasectomy. You and your partner should seriously discuss with your doctor what your options are and the issues involved before you proceed with reversal.

Factors to consider

When deciding on vasectomy reversal, you should consider these factors:

The procedure is not guaranteed to restore your fertility. The most important factor is the length of time since the original vasectomy was performed. The more time has passed, the less likely fertility will be restored.

Even if sperm are restored to the semen, pregnancy is not guaranteed. During the time you were infertile your body may have created sperm antibodies. These substances may prevent you from fathering a child, even if your sperm count returns to normal.

The reversal procedure

Your doctor can give you specific instructions on how to prepare for the procedure. In general, avoid aspirin for seven to 10 days before the procedure, and ask your doctor whether to stop taking any other medications. And bring a set of clean underpants with you to the hospital or clinic.

During the procedure

To keep you comfortable and help you relax you'll be given anaesthesia. You may receive local or regional anaesthesia, which means you'll be awake but relaxed, or general anaesthesia, which means you'll sleep during the procedure.

Once the anaesthesia takes effect, the doctor makes an incision in your scrotum. The cut ends of each of the vasa deferentia are lifted out and examined under magnification. A section of each cut end may be removed. The end closer to the testicles will be cut until fluid flows freely. This fluid may be looked at under a microscope to find whether sperm are present. If sperm and fluid flow, the two cut ends are sewn together.

If necessary, the vas may be attached directly to the epididymis (see our vasectomy topic for more on the anatomy). When both vasa are reconnected, the incisions in the scrotum are sutured closed.

After the procedure

You may need to stay in the hospital for several hours. When you are allowed to go home, have someone available to drive you. Any discomfort you feel is usually mild. If you need it, a pain reliever may help.

Healing

You can do several things to aid your recovery:

• Stay off your feet as much as possible for the first day to lessen the chance of swelling. An ice pack or bag of frozen peas placed on your scrotum for short periods can help keep swelling down.
• Wear snug cotton briefs or an athletic support.
• Avoid heavy lifting or exercise for at least two weeks.
• Ask your doctor how long to refrain from sex. You may notice blood in your semen - this is normal.
• Ask your doctor when you can return to work.

Risk and complications

Problems after vasectomy reversal are uncommon, but include the following:

• Risks associated with general anaesthesia.
• Infection. Some signs are fever, chills, drainage from the incision site and pain.
• Internal bleeding of the scrotum. Symptoms include increasing pain, excessive swelling, a large blue-and-black area, or a growing lump.
• Failure of the procedure to restore fertility.

Restoring the flow of sperm

Before your vasectomy, sperm travelled through your reproductive system and were released during ejaculation. During the vasectomy, the sperm pathways were cut. To reverse your vasectomy, those pathways need to be restored to allow sperm to travel out of your body once again.

How the procedure works

After your original vasectomy, your testes continued to release sperm, but these sperm were blocked from travelling to the penis. During a vasectomy reversal, the two cut ends of the vasa deferentia are reconnected. If the procedure is successful, sperm can once again travel to the penis and leave the body during ejaculation.

A second chance at parenthood

About two to three months after the reversal procedure, your sperm count will be checked. It will be checked again every two to three months until the sperm count is within normal range or a pregnancy results. The average wait for a pregnancy is 12 months, so patience is often necessary. If more help is required, new types of fertility treatment may still give you a second chance at parenthood. Ask your doctor for details.

Original material provided by StayWell/KRAMES, and kindly reviewed by Dr John Russell.