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Vasectomy and vasectomy reversal

Highlights

Vasectomy

Vasectomy is a safe and effective surgical operation for male sterilization, a permanent form of birth control. Vasectomy works by interrupting the route that sperm take from the testicles (where they are produced) to the penis. After a vasectomy, the testicles still continue to generate sperm, but their movement is blocked.

Vasectomy does not affect a man's ability to perform sexually or his sexual satisfaction. It does not change male hormones, male sex characteristics, the sex drive, or semen production.

Vasectomy Surgery

Vasectomy surgery is a much simpler operation than female sterilization. It usually takes 20 minutes to perform and is done at a surgeon's office or outpatient surgery clinic. Local anesthesia is used and the man can return home the same day. In some states, a consent must be signed at least 30 days prior to vasectomy and re-signed on the day of the procedure.

After Surgery

You will feel sore for a few days, but discomfort can be eased by pain relievers and an ice pack. Normal activities can be resumed within a few weeks. For the first few months after vasectomy, some active sperm are still delivered to the semen so you will need to use birth control until a semen analysis confirms the absence of live sperm.

It takes, on average, about 3 months to clear sperm from the reproductive system. You will have a semen analysis (post-vasectomy semen analysis, PVSA) about 12 weeks after vasectomy to verify that no live sperm remain in the semen. You and your partner should continue to use other methods of birth control until the sperm count is zero.

Vasectomy Reversal

The decision to have a vasectomy should be carefully considered. A reversal procedure can be performed, but it does not guarantee restored fertility. In addition, these reversal procedures (vasovasostomy and vasoepididymostomy) are much more complicated surgeries than vasectomy. Insurance may not cover the cost of vasectomy reversal.

American Urological Association Guidelines

The American Urological Association (AUA) recommends that a man considering a vasectomy should meet with his doctor for a preoperative consultation. The AUA emphasizes that it is important for men to understand that a vasectomy is intended as a permanent form of contraception.

Introduction

Vasectomy is male sterilization. It is a method of permanent birth control for men. A man who has had a successful vasectomy cannot make a woman pregnant.

A vasectomy is surgery to block the vas deferens. These are the 2 tubes that carry sperm from the testicles (where sperm is produced) to the urethra (where sperm is ejaculated). After vasectomy, the testicles still continue to generate sperm, but their movement out of the testicles is blocked. Eventually the sperm die, and the body naturally absorbs them. During sex, semen is produced in the same amount as before vasectomy, but this fluid does not contain sperm.

Vasectomy should not be confused with castration. It does not affect a man's ability to perform sexually, or his sensation of orgasm and pleasure. It does not change male hormones, male sex characteristics, or sex drive. Testosterone continues to be produced in the testes and delivered into the bloodstream. Sperm form a very small portion of semen, so men notice no difference in the amount of semen produced during orgasm.

Pathway of sperm

The testicles (testes) are where sperm are produced in the scrotum. The epididymis is a tightly-coiled tube that lies against each testicle and connects ducts from the testicle to the vas deferens. Sperm from the testicles are collected and stored in the epididymis where they begin the process of maturation. When ejaculation occurs, rhythmic muscle movements propel the sperm forward. The sperm are forcefully expelled from the tail of the epididymis into the vas deferens. The vas deferens joins with the seminal vesicle to form the ejaculatory duct, which passes through the prostate and empties into the urethra.

The Male Reproductive System

Sperm and Ejaculation

The sperm's journey through the male body is long and complex:

Treatment

After deciding that permanent birth control is the best solution, a couple still has the option of choosing either vasectomy for the male or tubal ligation (female sterilization) for the female. Female sterilization is performed much more often than vasectomy, but vasectomy is a less complicated and less expensive procedure, and poses fewer risks for complications.

Vasectomy is very safe and is nearly 100% effective for preventing pregnancy. It does not protect against sexually transmitted infections (STIs). Condoms remain the best method of STI prevention for sexually active people.

Vasectomy does not affect sexual function or pleasure. It does not noticeably decrease the amount of semen produced during orgasm.

The decision to have a vasectomy should be carefully considered. A reversal procedure can be performed, but it is a major operation that does not guarantee restored fertility. In addition, these reversal procedures (vasovasostomy and vasoepididymostomy) are much more complicated surgeries than vasectomy. While currently in the United States most health insurance plans will cover all or part of the cost of a vasectomy, many insurance plans will not pay for the cost to reverse a vasectomy.

A vasectomy is usually performed by a urologist, a doctor who specializes in the male reproductive system.

Who Should Have a Vasectomy

Vasectomy may be a good choice for a man who:

Vasectomy may not be a good choice for a man who:

Sperm Banking

In rare cases, a man may choose to use sperm banking before a vasectomy. Sperm banking involves freezing (cryopreservation) and storage (cryobanking) of sperm. If a man later desires to have children, the sperm can be used for assisted reproductive technologies, usually intracytoplasmic sperm injection (ICSI) used in combination with in vitro fertilization.

Sperm banking does not guarantee a successful conception and pregnancy. Sperm can be frozen for many years, but even after several months some sperm cells lose their ability to function normally after being unfrozen. In addition, sperm banking is expensive and is typically not covered by health insurance plans.

Men who are considering vasectomy should not view sperm banking (or vasectomy reversal surgery) as a guaranteed option if they later change their minds. It is best to undertake vasectomy as a permanent sterilization procedure. If future fathering of children seems a possibly desirable scenario, it is wise to reconsider whether vasectomy is the right decision to make.

Vasectomy Surgery

Vasectomy is a minor surgical operation that takes about 20 minutes. It is usually performed with local anesthesia in a doctor's office, outpatient surgery facility, or a family planning clinic.

You will be awake during the procedure but will not feel any pain. If you choose, you can have oral sedation to help you relax.

There are two basic types of vasectomy:

Before the Procedure

Before the surgeon starts the procedure, you will receive an injection of local anesthetic into your scrotum and vas deferens. Some surgeons offer "no-needle" NSV, which uses a jet injector to spray the anesthetic.

Conventional Vasectomy

A conventional vasectomy procedure is performed as follows:

No-Scalpel Vasectomy

Minimally-invasive techniques are now the preferred methods for vasectomy. The most popular of these, called NSV, has been in use since 1974.

NSV does not require a scalpel or incisions:

Less Common Vasectomy Procedures

The Pro-Vas vasectomy does not involve cutting the vas deferens. Instead, it uses a clip locked around the vas deferens to stop the flow of sperm. To date, there is insufficient evidence that the clip method is superior to other vasectomy methods. Many insurance companies consider this procedure to be experimental and will not pay for it.

Recovery

Vasectomy is a low-risk procedure. Pain or soreness typically lingers for a few days after the procedure, but this is normal.

The following are some tips to help speed recovery:

Semen Analysis

Vasectomy does not produce immediate sterility. After the vasectomy procedure, there are always some active sperm left in the semen for several months, so the risk for pregnancy persists. You are considered sterile if the results of a post-vasectomy semen analysis (PVSA) show that:

It takes, on average, about 3 months to clear the viable sperm from the reproductive system, but it may take some men as long as 6 months to become sterile. The doctor will perform a semen analysis about 8 to 16 weeks after vasectomy to verify that no live sperm remain in the semen. It is essential that the man and his partner continue to use other methods of birth control until his sperm count is zero. Several semen analyses may be performed to verify that there are no live sperm.

Many men who have vasectomies never bother to return for follow-up sperm testing (semen analysis). Without a follow-up test, men do not know whether the vasectomy was successful. Until test results verify that there are no sperm in the semen, men are at risk of fathering unwanted pregnancies. In addition to a lab test, there is an FDA-approved test kit (SpermCheck Vasectomy), which can be used at home.

If results of a semen analysis do not indicate sterility 6 months after vasectomy, the procedure may be considered a failure. Repeat vasectomy may be an option. Failed vasectomies are rare, and repeat vasectomies are needed less than 1% of the time.

Pregnancy rates after a successful vasectomy are very low, about 1 in 2,000. There are 2 main reasons for an unexpected pregnancy:

Complications

Serious complications are rare after vasectomy but can occasionally occur.

Short-term complications after the procedure may include:

Long-term complications are very rare but may include:

Reversal Surgery (Vasovasostomy and Vasoepididymostomy)

Although men should consider vasectomy a permanent decision, reversal procedures can restore fertility in some men who change their minds. Vasectomy reversal is also sometimes performed to provide pain relief for men who experience persistent post-vasectomy pain in their testicles.

Vasovasostomy Reversal Surgery Procedures

There are two types of vasectomy reversal surgical procedures:

These procedures help restore sperm flow so that sperm can be ejaculated out of the urethra. Both types of procedures are generally performed on an outpatient basis, and the man can return home the same day.

It is not possible to know in advance which procedure will be performed. The surgeon will make the decision whether to use vasovasostomy or vasoepididymostomy based on a fluid sample taken at the start of the operation. The fluid is removed from the vas end closest to the testicle and examined for its appearance and the presence of sperm:

Vasovasostomy uses several different surgical approaches. Usually a microsurgical technique is used, in which a microscope helps magnify the surgical area. Vasovasostomy takes 2 to 3 hours to perform. The man is given local anesthesia and a mild sedative. Some surgeons may prefer this to be done under general or spinal anesthesia.

Vasoepididymostomy is a more complex procedure due to the extremely tiny size of the tubes inside the epididymis. Microsurgical techniques and an experienced surgeon are critical for the success of this procedure. Vasoepididymostomy takes up to 5 hours to perform. The man is given either general anesthesia or an epidural block.

Recovery and Follow-Up

Pain after reversal surgery is usually not severe and can be controlled with acetaminophen (Tylenol, generic). A cold pack placed on the scrotum area can help relieve swelling. Your doctor may recommend that you wear a jockstrap for a few weeks to help provide compression and to keep the surgical incisions in place.

Most men can return to work and resume normal non-strenuous activities within a week, but may need to refrain from heavy lifting and other physical exertion for up to 4 weeks following surgery. Men need to wait several weeks before having sex.

The doctor will perform a semen analysis every 2 to 3 months after reversal surgery to check your sperm count. It generally takes about 2 months for sperm to reappear following vasovasostomy, and about 3 to 15 months following vasoepididymostomy. Either a stabilized sperm count, or pregnancy, indicates successful reversal surgery.

If reversal surgery is not successful, a repeat surgery can be performed. However, the success rates for repeat reversals are lower than for an initial reversal.

Pregnancy Results after Reversal Surgery

Success rates for vasectomy reversal vary, but are usually about 50%. It can take up to 1 to 2 years after reversal surgery for pregnancy to occur.

The time interval between the original vasectomy and the reversal procedure is the most important factor. The shorter the time between vasectomy and reversal, the better the chances for fertility recovery.

Resources

References

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Review Date: 2/27/2020
Reviewed By: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.