Vasectomy Reversal

A major decision in many men’s lives is whether or not they want to have more children. Beyond normal contraception (which aren’t 100% guaranteed) men can elect to have a vasectomy. The doctor makes a small incision in the scrotum and cuts the vas deferens, ceasing the flow of sperm into the semen.
But what happens if you change your mind? A vasectomy reversal can be attempted even if a long time has passed since the actual vasectomy. The surgery is more complicated than the initial vasectomy and only approximately half of vasectomy reversals are successful (though some doctors claim to have a 99% success rate among their patients).

There are a number of reasons for men to make the decision to have a vasectomy reversal. Some elect to have the surgery because of the death of a child, the remarriage to a new partner, or a sufficient improvement in finances that makes it feasible to raise another child. There are some men who choose a vasectomy reversal to ease testicular pain.

So how is a vasectomy reversal performed? The patient is placed under anesthesia and a one to two inch incision is made in the scrotal skin over the site where the old vasectomy was done. The ends of the vas deferens are located and taken from the surrounding scar tissue. A drop of fluid from the testicular end is taken and placed under a microscope on a glass slide. This step determines how the doctor will proceed. Since the testes continue to produce sperm after being separated from the rest of the unit, doctors look to see if the sperm is still whole and healthy. If the fluid only contains sperm parts, the procedure may not produce the best results. The third option is the least desirable one, where the fluid is thick, pasty and contains no sperm. This indicates a rupture has occurred in the epididymis, causing scar tissue blockages in the testicular end of the vas. If these blockages are not found and removed, the surgery will fail.
If there’s healthy sperm found, a vasovasostomy may be performed. Basically the doctor sews the ends of the tubes that carry the sperm, the vas deferens, back together. If the blockages mentioned earlier are found, a vasoepididymostomy may be performed. In this case, the doctor will attach the vas deferens directly to the epididymis. You will not know what is needed ahead of time as these decisions are made during surgery.

As with any surgery, there are risks to consider. Bleeding within the scrotum can occur, causing a hematoma that brings painful swelling. To reduce this risk, avoid aspirin before and after the surgery. Following the doctor’s instructions on rest will also lower this risk. Infection is also possible, though not common if you follow the doctor’s orders for cleanliness. Damage to nerve endings may also occur, which reduces fertility.

Another possible risk is inflammation. Sperm may leak into the scrotum, causing the immune system to form an inflammatory mass called a sperm granuloma. According to the Mayo clinic, “Granulomas usually occur sometime after surgery and can be a sign that the vasectomy reversal wasn’t successful.” If you experience fever, swelling that worsens or won’t reduce, difficulty urinating, a marble sized lump in your scrotum, and/or bleeding from the incision site that continues after pinching the site between two gauze pads for 10 minutes, contact your doctor immediately.

So how does one prepare for a vasectomy reversal? The doctor may check to see if you are producing healthy sperm before the procedure even begins, to see if the procedure is worth going through. Your female partner may also be subjected to fertility tests to determine if a child can be produced if the vasectomy is reversed anyways. Before you choose a doctor, shop around. Ask doctors how many of reversals he or she has performed and how many of his or her patients have successfully fathered children after the procedure is done. Meet with the doctor you choose to discuss the procedure, risks, and potential complications and bring your partner along so they know how to aid you after the procedure (if their presence is appropriate).

For two weeks before and after the surgery, avoid aspirin and ibuprofen (Advil, Motrin, etc) as they increase your risk of bleeding. If you experience any pain, take Tylenol as instructed. Your doctor may ask you to clean and shave your scrotum before the surgery and to bring a clean athletic supporter (jock strap) with you to wear after the surgery. The whole procedure takes two to four hours and is outpatient, but you’ll need recovery time from the anesthesia so arrange for someone to drive you to and from the facility (usually a center or a hospital).

After the surgery, take it easy. Do not bathe or swim for the first two days after the procedure and refrain from sports and heavy lifting for at least two weeks. If you have a desk job, you may be able to return after three days of rest, but the doctor will determine when you can resume work if your job is physically strenuous. Refrain from sexual intercourse or ejaculation for at least four weeks after the reversal and you’ll need to wear your jock strap for several weeks (except when bathing) for several weeks. Before going under the knife, make absolutely sure that you wish to have this procedure done. While a vasectomy is very straight forward, a reversal is considerably more involved and can cost around $10,000 or more. Since it’s an elective surgery, most insurance companies do not cover it. Only you can determine if it’s all worth it!

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