Vasovasostomy– For men who wish to conceive after vasectomy, reversal surgery (vasovasostomy) may restore fertility. In vasovasostomy the severed ends of the vas deferens (which were cut during vasectomy) are reconnected to reestablish the flow of sperm. The reversal procedure is difficult; it involves sewing together the two ends of both tubes, each with pinhead-sized openings.
Pregnancy Rates after Vasovasostomy. Pregnancy rates of over 50% have been reported after a vasovasostomy. One study reported that when successful conception occurs, it does at an average of one year after the surgery.
A successful reversal is more likely if the following conditions are present:
- The section removed during vasectomy was not long.
- The original procedure was performed on straight sections of the vas deferens.
- The pieces joined during the vasovasostomy are of equal size.
The closer in time the vasovasostomy is to the original vasectomy the better. In one large study, the pregnancy rates were 76% for those who had vasectomy less than three years before reversal surgery, decreasing to 30% for those who had vasectomy more than 15 years prior. The lower rates as time goes by are probably due to increasing chance for obstruction of the epididymis and the development of anti-sperm antibodies.
Reversal versus ART. Even though newer techniques such as ICSI are improving pregnancy rates after vasectomy, vasovasostomy is still a better choice than assisted reproductive technologies for most men who one children. In one study, the pregnancy rate for vasovasostomy was 52%, whereas success after ICSI was between 25% and 30%. In addition, a vasovasostomy does not pose a risk for multiple births and is much less expensive than ART. A 2000 study concluded that vasovasostomy was even a more cost-effective way to achieve fertility in men with partners above 37 years of age. Even for men who have failed vasovasostomy, a repeat procedure appears to be less expensive than embarking on fertility treatments at that time.
ART may, however, be a better approach than reversal for men with evidence of anti-sperm autoantibodies due to vasectomy. It may also be recommended in those whose vasectomy was conducted more than 15 years before, because the time elapsed since the original vasectomy may affect the success of retrieving sperm. In one study, pregnancy rates were highest in men who underwent sperm retrieval and ART within 10 years of their vasectomy (34%), intermediate in those who had undergone vasectomy 11 to 19 years earlier (25%) and lowest in men who had had a vasectomy at least 20 years earlier (8%). The age of men and women in the last group was higher than that in the 10-year or less group, so lower pregnancy rates would be expected, although time elapsed after vasectomy appeared to have an effect independent of age.