What exactly is a vasectomy reversal?
Vasectomy reversal involves reconnecting the ends of the vas deferens tubes which were cut or sealed off during vasectomy. The vasectomy reversal procedure (also known as reverse vasectomy, vasovasostomy, vasoepididymostomy) is performed in our outpatient surgery center and patients return to home by the evening on the day of surgery. Approximately 6% of the 600,000 men undergoing vasectomy annually in the United States decide to have their vasectomy reversed. Matthew Wosnitzer, M.D., with extensive male reproductive training, is devoted to performing microsurgical vasectomy reversal with the best outcomes at the Center for Male Health and Reproduction of Connecticut.
Why is it best to perform vasectomy reversal with an operating microscope?
Our fellowship-trained male infertility surgeon, Matthew Wosnitzer, M.D., uses a Leica™ operating microscope to perform vasectomy reversals. This ensures precise and water-tight reconnection (anastomosis) and realignment of the vasal ends to allow sperm to flow again following vasectomy reversal. The central opening of the vas (vasal lumen) which is reconnected is 300-400μm (3/100’s of a centimeter) in diameter and this is best visualized and accurately reattached with the operating microscope. Sometimes, there is increased scar at the operative site if there were additional attempts at scrotal surgery or vasectomy reversal. Also increased time since vasectomy can make the surgery more difficult (especially more than 15 years after vasectomy). Longer obstruction duration can lead to increased epididymal back-pressure and damage leading to additional obstruction closer to the testis (in the epididymis). This type of obstruction requires a special procedure called a vasoepididymostomy to bypass the obstruction in the epididymis and includes reconnection (anastomosis) of the vasal lumen to the even smaller 150-250 μm epididymal tubule lumen. All possible techniques that the reversal procedure may require are optimally performed with microscopic magnification.
What parts of the male reproductive tract are relevant to vasectomy reversal?
The vas deferens is the plumbing or tube that carries sperm from the testicle and epididymis. The epididymis is the back part of the testis (where additional sperm maturation occurs following production in the testis). Sperm are produced in the testicle, and then travel to the epididymis for additional maturation. From the epididymis, the vas carries sperm toward the ejaculatory ducts, which empty into the urethra (urine channel) and out of the body. After vasectomy, the vas deferens (tube connecting testis and epididymis to the ejaculatory duct and urethra) on both left and right sides is cut. This leads to blockage of the male reproductive tract called obstructive azoospermia. See “Anatomy 101″ in our blog for additional explanation of vasectomy reversal. The options for men following vasectomy include vasectomy reversal or sperm retrieval with IVF/ICSI. Vasectomy reversal is considered to be more cost-effective and is the approach of choice when the obstructive duration since vasectomy is short, patients desire multiple children, and the female partner has normal fertility. The ultimate decision is deeply personal and in the hands of the couple based on social, religious, and financial considerations.
What factors influence the outcome after vasectomy reversal?
Following vasectomy, the vas may be reconnected with excellent success depending on several factors. Certainly, fluid quality from the vas during surgery, shorter time (<15 years) after vasectomy, presence of sperm granuloma (lump of leaked sperm and immune cells that appears along the vas or epididymis following vasectomy), increased microsurgeon experience, all lead to better outcomes if reversal is desired. Also, factors such as previous surgery to the pelvic/groin area, female partner age, and past fertility history of both male and female partner may have effects.
Vasectomy reversal is technically done in one of two ways depending on where the blockage is located. The first, and most common way is vasovasostomy (reconnecting the vas ends) after removing the vasectomy blockage site. The second and more complex way, which is only done when there is obstruction of the epididymis, is called vasoepididymostomy, (or VE for short). VE reconnects the upper vas end to the epididymis, which is the cap on the back of the testis (where late sperm maturation occurs). See diagrams of each procedure below, followed by additional information.
Vasal fluid examined during surgery helps to determine the type of vasectomy reversal to perform. For vasal obstruction, vasectomy reversal by vasovasostomy is the procedure of choice, while for epididymal obstruction the procedure of choice is vasoepididymostomy. The vasectomy reversal anastomosis, whether vasovasostomy or vasoepididymostomy, uses the microdot technique (pioneered at Weill Cornell Medical College), which is essentially a blueprint to allow for the best and most precise reconnection possible.
Can you describe the details of the vasectomy reversal procedure?
Additional vasectomy reversal procedure details including microsurgical vasovasostomy and vasoepididymostomy at the Center for Male Health and Reproduction of Connecticut can be read by clicking here for our summary.
We are pleased to discuss additional aspects of vasectomy reversal including microsurgical technique, indications, and financing of vasovasostomy and vasoepididymostomy at the Center for Male Health and Reproduction in Connecticut. We welcome patients from Connecticut, New York, New Jersey, Rhode Island, Massachusetts, Pennsylvania, Delaware, Maryland, Washington DC, throughout the United States, and internationally. Please contact us for additional information.
- Microsurgical vasectomy reversal requires precise and water-tight reconnection of healthy tissue (with good blood supply) at the vas ends to provide a canal (a fraction of a centimeter) for sperm to flow.
- Intraoperative vasal fluid quality is one of the key factors in decision to perform vasovasostomy (vas-to-vas) or vasoepididymostomy (vas-to-epididymis) reconnection is performed.
- The Microdot technique provides a blueprint to allow tension-free anastomosis using multiple layers of 10-0 and 9-0 sutures for either vasovasostomy or vasoepididymostomy.