Vasectomy reversal at Hereford Hospital

What is a vasectomy reversal?

Also known as male sterilisation, a vasectomy involves cutting both of the tubes that carry sperm from your testicles to your penis. A vasectomy reversal is a more complicated procedure to reconnect the tubes.

There are two types of vasectomy reversal:

• Vasovasostomy – the ends of the tubes that carry sperm are reattached
• Vasoepididymostomy – these tubes are attached directly to the epididymis (where the sperm is stored) – this is a complex procedure that can be used if your epididymis is blocked.

What are the benefits of a vasectomy reversal?

Rejoining the tubes should allow sperm to mix with your semen, making you fertile again.

Some men have the procedure to treat testicular pain due to their vasectomy.

What are the chances of success?

There’s a 9 in 10 chance of becoming fertile if your vasectomy was within 3 years ago, and a 4 in 10 chance if your vasectomy was over 20 years ago.

That’s because the longer it is since you’ve had your vasectomy, the more likely it is for your epididymis to be blocked, since you carry on producing sperm after your vasectomy.

Also, even if the surgery successfully rejoins the tubes, there’s a chance you may not be able to conceive children naturally. This can be due to:

• scar tissue forming where the tubes are joined, blocking the sperm
• the quality of your sperm not returning to normal
• not being able to produce sperm due to complications.

Is a vasectomy reversal right for me?

There are a few reasons why men choose to reverse their vasectomies, including:

• Deciding to have children, or more children
• A new marriage
• Losing a child.

What happens during vasectomy reversal?

Vasectomy reversal is performed under general anaesthetic, so you'll be asleep. It usually takes 1–1.5 hours.

Before the procedure

There are a few things you can do in the lead up to the procedure to make sure everything goes as smoothly as possible:

• Let your doctor know about any medication you take and follow their instructions
• If you smoke, stop smoking several weeks before the operation
• Try to maintain a healthy weight
• Exercise regularly
• Don’t drink alcohol in the week leading up to the procedure
• Have a bath or shower on the day of the operation and make sure your scrotum is clean
• Shave your scrotum beforehand, or the healthcare team will do it for you in hospital.

When you arrive in hospital, you’ll meet your surgeon, anaesthetist (who’ll put you to sleep) and nurse (who’ll perform your health checks). You'll be able to ask any more questions you may have.

During the procedure

1. Once you're under anaesthetic, your surgeon will locate the site of your vasectomy and make two cuts about 3cm on each side of your scrotum
2. After examining each testicle they'll free up the tubes and remove any scar tissue
3. Your surgeon will then check the fluid that comes out of the tubes
4. If it contains sperm, they’ll perform a vasovasostomy – using a special microscope, they’ll line up each tube and stitch the ends of them back together
5. If they can’t find any sperm, the epididymis may be blocked so they’ll perform a vasoepididymostomy – they’ll stitch the tube directly to the epididymis
6. Your surgeon can also take some sperm from one of your testicles, which can be stored and used as part of IVF treatment if the operation fails
7. Finally, they’ll close the cuts with dissolvable stitches.

After the procedure

You’ll be taken to the recovery room where you’ll wake up. You shouldn’t feel any pain, but you might be groggy and slightly uncomfortable as you come around.

If you have a vasoepididymostomy, you may have drains (thin tubes) in your scrotum to drain off excess fluid.

When you’re ready, you’ll be taken to your room, where the healthcare team will look after you.

Recovery from vasectomy reversal

Your scrotum may be quite sore for 1–3 weeks, but you should be able to return to normal activities after about a week.

Short-term recovery

Back in your room, you may feel some pain as the anaesthetic wears off, which you can take painkillers for.

To ease discomfort and reduce bruising, you can:

• hold an ice pack against your scrotum
• wear a scrotal support or firm underwear.

If you have a vasoepididymostomy, you may need to stay overnight. If you have a standard vasectomy reversal, you should be able to go home the day of your procedure. If so, for the first 24 hours:

• you’ll need someone to take you home and stay with you overnight
• don’t drive, operate machinery, or do any potentially dangerous activities (like cooking) until you’ve fully recovered feeling, movement and co-ordination
• you shouldn’t sign legal documents or drink alcohol.

Managing your recovery at home

You should get plenty of rest for the first 24 hours, but then it’s important to stay active to avoid blood clots. You should also follow the instructions from our healthcare team on medication or special compression stockings.

Your testicles will probably ache for a few days, so take over-the-counter painkillers if you have any discomfort. Your scrotum may also be bruised and swollen, but this will go down after about a week.

Here are a few other things you can do to help you recover:

• Carry on wearing tight-fitting underwear for a week afterwards
• Gradually increase your activity with low-impact exercises like walking
• Avoid any strenuous activity or heavy lifting for at least 3 weeks after your surgery
• You can shower, but don’t have a bath for the first 5 days
• Do not ejaculate for the first week
• Wait 3–4 weeks until you have sex.

You should call your doctor if:

• the swelling doesn't go down
• you have discharge from your wounds
• you’re still in pain after 4 weeks.

Driving after a vasectomy reversal

Don’t drive until you’re confident you can control your vehicle and always check your insurance policy and with your doctor first.

Time off work

You should be able to return to work after about a week. If your work involves strenuous exercise, you may need to stay off work for up to 3 weeks.

Follow-up appointments

About 6–8 weeks after your surgery, you’ll need to return to the clinic to give a semen sample, which we’ll examine for sperm:

• If no sperm are present, or your sperm count is very low, we’ll ask you to return for another test after 3 months, as it may improve over time
• If your sperm count was high, but you and your partner are having problems becoming pregnant, you should get another test done, as scar tissue may have formed.

Please note this post-operative check may not be available in all Nuffield Health sites, so please check with your doctor.

Complications of vasectomy reversal

As with any operation, there is a small chance of complications, such as:

General complications could include:

• pain
• infection in the surgical wound
• bleeding

Specific complications of vasectomy can include:

• long-term pain
• bleeding within the scrotum
• damage to blood vessel
• scar tissue causing the tubes to block
• failure to restore fertility.

The healthcare team will do their best to minimise any risks. Make sure you discuss any concerns you have about these complications with your consultant.

Alternative treatment options

You may also want to consider the following alternatives to conceive a child:

• Intracytoplasmic sperm injection (ICSI) – this is a type of in vitro fertilisation (IVF). After removing your sperm and some your partner’s eggs, a single sperm is injected into one of her eggs in a lab. If the egg is fertilised and healthy, it can be put back into your partner’s womb to develop in the normal way
• Intrauterine insemination (IUI) – This involves injecting your sperm (or a donor’s sperm if there are problems with your sperm) into your partner’s womb.