That said, success rates and time frames vary significantly depending on how many years have passed since the vasectomy, whether the couple has had a child together in the past, the skill of the surgeon, and what kind of repair is required. Vasectomy reversal surgery is only one option for having biological children. IVF with ICSI (intracytoplasmic sperm injection) is another way couples can conceive. ICSI can be used either as an alternative to a reversal or as a next-step if surgical repair isn’t successful. Sometimes, IVF offers the best chances for success. “A vasectomy reversal is possible, but the results are poor if more than five years have passed—IVF will offer a higher success rate,” explained Dr. Edward Marut, a reproductive endocrinologist with Fertility Centers of Illinois.
How Vasectomy Reversal Works
Before we discuss vasectomy reversal, it’ll help to have a quick review of how a vasectomy works. In the male reproductive system, immature sperm cells are created in the testicles. From the testicles, they move into the epididymis, a tightly coiled tube-like organ that sits on top of the testicles. As the sperm cells enter and move through the coiled tubes, they develop into mature sperm cells and, eventually, remain stored there until it’s time to move into the next organ, the vas deferens. The epididymis connects to the vas deferens, which is a thin muscular duct. When a man ejaculates, sperm move from the storage end of the epididymis into and through the vas deferens. The vas deferens move sperm to the urethra, where, during ejaculation, it gets mixed with a fructose-rich fluid (from the seminal vesicles) and prostate fluids (produced in the prostate).
Procedures
During a vasectomy, the vas deferens is cut. This prevents sperm from getting mixed with the other seminal fluids. It takes a few months post-vasectomy for sperm cells to be eliminated from the tubal system. With a vasectomy reversal, the vas deferens ends are reconnected (vasovasostomy). The muscular tube-like organ is very thin—no more than the thickness of a spaghetti strand. Therefore, surgical re-connection is a delicate, complicated procedure. Sometimes, the re-connection of the severed vas deferens ends isn’t possible. This is more likely if many years have passed since the procedure. In this case, the surgeon can connect the vas deferens directly to the epididymis (vasoepididymostomy). Vasoepididymostomy is a complicated procedure, taking twice the surgical time as a vasectomy (four hours instead of two). Sometimes, reversal success rates can be higher with a vasoepididymostomy, though it may take longer for sperm to return to the ejaculate.
Which Procedure Do You Need?
Will you need a vasovasostomy or a vasoepididymostomy? It’s impossible to say before surgery. During the procedure itself, your doctor will check the end of the vas deferens on the testicle side to see if there are sperm cells present. If not, this indicates a blockage has formed between the opening and the epididymis. Your surgeon would then perform a vasoepididymostomy.
Semen Analysis
Post vasovasostomy, it may take up to three months for sperm to be present in the ejaculate. However, sometimes it takes only a couple of weeks. Post vasoepididymostomy, it may take six months to a year for sperm cells to return. Your doctor will order a semen analysis three months post-procedure (if pregnancy doesn’t occur in the meantime) to check if sperm have returned.
Why People Get a Vasectomy Reversal
One in 20 men will decide to reverse a vasectomy. While vasectomy is considered to be “permanent” birth control, there are many reasons why a man may change his mind after having the procedure. Some possible reasons include:
Deciding they want more childrenRemarrying and wanting to have a child with their new partnerHaving a child pass awayNot having success with IVF-ICSI (the other option for having children after a vasectomy)Experiencing post-vasectomy pain (a possible complication of vasectomy, which may be alleviated by reversing the procedure)Regretting the original decision, for whatever reason (not necessarily because they plan to have more children)
Before You Schedule a Vasectomy Reversal
The skill of your surgeon is the key to improving your chances of success. You want someone who performs vasectomy reversals on a regular basis. Research has found that experience and frequency matter.
Choosing a Surgeon
Ask your urologist how many reversals he has done in the past year and what his success rates are. Also, confirm that they have microsurgical training and are members of the Fellow of the American College of Surgeons (FACS). You will also want to confirm that your doctor has experience with performing vasoepididymostomies, especially if your vasectomy was done more than seven years ago. Remember that it’s impossible to know whether you need more complicated surgery until your doctor starts the procedure. It’s worth traveling to get a more experienced doctor.
Fertility Testing
Something else you should do before you decide on a reversal is ensuring your female partner has basic fertility testing. If there are female fertility factors, it may make more sense to skip the reversal procedure and go straight to the IVF option. “Men should speak to a urologist who specializes in fertility care and does vasectomy reversal and testicular biopsy for IVF, as well as a reproductive endocrinologist to coordinate the care,” says Dr. Marut. The age of your female partner also matters, especially if she is age 37 or older. With female fertility declining quickly after age 35, it may not be recommended to wait a year to see if the reversal was successful. Ovarian reserve testing can help you and your partner make a decision on this, with the input of your doctor.
Consider Sperm Preservation
Lastly, consider asking your surgeon to retrieve and cryopreserve sperm cells during the procedure. This means additional cost, and you may never use those frozen sperm. However, if the reversal isn’t successful, you’ll have a head start on the IVF-ICSI option.
How Quickly Will Pregnancy Occur?
Some couples will get pregnant as quickly as a few weeks post-reversal. Others will take up to two years to conceive. More commonly, it takes six months to a year. The length of time ultimately depends on a number of factors. Factors that can influence sperm return include:
Which kind of vasectomy repair you neededHow long it takes for sperm to return to your ejaculateWhether there are any other fertility factors
Your doctor will schedule a sperm count (or semen analysis) test a few months post-procedure. If the results look good, and you have frequent enough sex during your partner’s fertile window (just before ovulation), you may get pregnant within a few months. If the semen analysis results aren’t good, your doctor will likely schedule another test two to three months later. It can take longer for sperm to return if you had a more complicated procedure. For example, it can take up to a year for sperm to return post-vasoepididymostomy.
Can We Improve the Odds?
Your odds of pregnancy success are primarily dependent on whether the surgical repair is successful and on the overall fertility of you and your partner. Much of this is out of your control. However, there are things you can do to slightly increase the chances of getting pregnant post-reversal. These are true for all couples.
Drop unhealthy habits. If you smoke, quit. If you’re a drinker, cut back. These bad health habits can negatively impact sperm quality. Keep your privates cool! The testicles sit outside of the body because sperm are sensitive to heat. Avoid hot tubs, long hot baths, seat warmers, and sitting for extended periods of time with your legs tight together. Try to eat healthily. Research has found that men who eat more sweets, junk food, red meat, refined grains, and energy drinks have lower sperm quality than men who eat more nutrient-rich foods. Have frequent sex. This is good for two reasons: Frequent sex makes it more likely you’ll have sex when your partner is ovulating (and more fertile). Secondly, frequent ejaculation will help move the sperm through the male reproductive system. Try to have sex when she’s ovulating. There are about six days each month that a woman can get pregnant, and only on two or three of the days is it very likely. Some couples get stressed out when they try to time sex for ovulation. If this is you, forget about it. However, if you’re up for the challenge, you can improve your odds if you aim for that fertile window. Use fertility-friendly lubricants. Your sperm can use all the help they can get. Regular lubricants can inhibit sperm movement, and even be toxic. Better to choose fertility-friendly options.
When Pregnancy Does Not Occur
If your partner doesn’t conceive right away, don’t panic. Even couples with normal fertility may take a few months to achieve pregnancy. That said, if many months pass and pregnancy doesn’t occur, don’t delay seeking help. This is especially true if your female partner is age 35 or older. Generally speaking, if you don’t achieve pregnancy within six months to a year post-surgery, see a fertility specialist. The next step might be fertility testing (or re-testing, if you’ve already both been evaluated in the past.) Then, fertility treatment options can be discussed. When reversal doesn’t lead to pregnancy, IVF with ICSI might be your best option.
Consider IVF
If vasectomy reversal is unsuccessful, or not recommended (due to female age or other fertility factors), IVF with ICSI is an alternative option. Sometimes, IVF is the best first choice. IVF is, however, a more expensive route and comes with more medical risks. In this circumstance, IVF is a better option to ensure success. If a couple wants to limit the number of children they have, IVF is also a better approach. If the woman is over age 37 and concerned about genetic abnormalities, IVF offers the option to genetically test embryos prior to treatment." — Dr. Edward Marut With IVF treatment, the female partner takes fertility drugs that stimulate the ovaries to produce many mature eggs. These eggs are surgically retrieved from the ovaries, via an ultrasound-guided needle through the vaginal wall. Most of the time, the male partner produces a semen sample via masturbation. The semen goes through a specialized cleaning process and is placed with the retrieved eggs in a petri dish. For men who don’t have sperm in their semen, this process won’t work. Instead, sperm cells can be retrieved from the male reproductive system surgically. This is known as sperm aspiration. How Sperm Aspiration Works This is an in-office procedure. Light sedation and a local anesthetic are used, and a needle aspirates sperm directly from the testicles or the epididymis. The medical terms for these procedures are PESA (percutaneous epididymal sperm aspiration) or TESA (testicular sperm aspiration.) If you went through an unsuccessful vasectomy reversal, and your surgeon was able to retrieve and cryopreserve sperm during the procedure, you may not need to have the aspiration procedure again. Retrieved sperm can’t be used with simple insemination and require IVF with ICSI. ICSI is a procedure where a single sperm cell is selected and directly “injected” into an egg. ICSI has additional costs and risks on top of conventional IVF. As with any IVF treatment, success is not guaranteed. Pregnancy success will depend on the age of the female partner and other fertility factors.
A Word From Verywell
Vasectomy reversal can be successful, but it is not guaranteed. For some couples, IVF with ICSI is a better option. For others, it’s worth trying vasectomy reversal first. Both procedures are rarely covered by health insurance and can cost several thousand dollars. Talk to both a urologist (with extensive experience in vasectomy reversal) and a reproductive endocrinologist before making a decision of what route to take. Also, be sure the female partner’s fertility is tested before any surgical decisions are made. It would be a waste of time and money to go with a reversal if IVF treatment was needed due to female infertility. If you’re open to using donor sperm, pregnancy can be achieved with insemination or IVF treatment. However, in this case, the child will not be genetically related to you.
