Can you reverse a vasectomy?

Posted on 1 March 2022

Couples who are uncertain they’ll want more children sometimes see vasectomy as the ideal form of contraception in the belief that it’s reversible. But if this is the reason prompting you to undergo the surgery in the first place, take time to reconsider.

A vasectomy reversal (vasovasostomy or vasoepididymostomy) is neither simple nor guaranteed to be successful, warns Dr Dries van den Heever, a urologist at Mediclinic Paarl and Mediclinic Stellenbosch. “This is a microsurgical procedure that is technically challenging,” he explains.

Such a description is likely to raise alarm bells when applied to any type of surgery – but patients often consent to undergo a difficult procedure if the results are worthwhile. Unfortunately, though, this isn’t always the case with a vasectomy reversal, as luminal patency – the unblocking of the tubes leading from the testes – is not assured.

What’s more, even if the procedure is successful, there’s no guarantee of paternity. Dr Van den Heever says this is often because sperm quality deteriorates in the period between the initial procedure and its reversal. “If a vasectomy was performed more than 10 years before the reversal, the possibility of conception is greatly reduced,” he explains. In fact, the chance of conception stands at just 20-30% in high-volume centres (where the particular procedure is performed most regularly). And that’s looking at the best outcomes.

One reason for this is that couples who decide it’s time to try for another child after a vasectomy – either because they have “empty nest syndrome” or have remarried – tend to be a little older. And, as Dr Van den Heever points out, conception becomes far more complicated once a man has turned 40. The age of the potential mother is also a factor, as fertility in both partners decreases with age.

Other issues that may affect the success of a reversal include the surgical technique used during the first procedure. The ability to conceive may be further hindered by the presence of anti-sperm antibodies and/or a secondary epididymal obstruction, which occurs when the epididymis – the tube that stores and carries sperm – becomes blocked.

For all these reasons, it’s vital that couples considering a vasectomy undergo counselling prior to the procedure, says Dr Van den Heever. “It’s critical to understand that although there may be some instances where reversal is possible, they should think of this as a permanent procedure.”

Remember, however, that although a vasectomy reversal may not be the best option, avenues are still open to couples who’d like another child. Dr Van den Heever advises discussing procedures such as testicular sperm retrieval and in-vitro fertilisation (), which carry similar costs but are generally more successful.

“A vasectomy is a safe, effective method of contraception – but it’s also permanent. Any decision to have one should therefore be thought through carefully,” Dr Van den Heever says. “If, however, you’ve gone through with the procedure and now want to reverse it, look for a highly skilled microsurgeon who works at a high-volume centre, as this will improve your outcomes.”

 




Published in Prime

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