Surgery Online

How can you reverse a vasectomy?

introduction

A vasectomy is the severing of both sperm ducts in the man's testicles, which is usually carried out when family planning has been completed.
However, this intervention can also be reversed. In some cases the cause is a change of partner and the desire to have children again, sometimes the feeling of being no longer "potent" is difficult for the man to endure.
As a result, a urologist is consulted to restore fertility. This procedure is called a vasovasostomy or refertilization, i.e. a merging of both severed ends of the spermatic duct.

When is repatriation possible?

A vasovasostomy is potentially always possible. However, there are factors that can limit the success of the procedure.
Basically, the longer it has been since the vasectomy, the more difficult it is to undo it.

After several years, the sperm ducts that are no longer used become scarred and no longer pass through. The backlog of the sperm can also cause pressure-related scarring to form in the tubules of the epididymis themselves. During the vasovasostomy, patency is checked. If this is no longer the case, a connection between the end of the vas deferens near the body and a canal of the epididymis itself can be established (so-called tubulovasostomy).
However, this procedure is significantly more complex and is usually only performed by specialized surgeons.

Another criterion for whether or not fertility can be restored is the size of the spermatic duct that was removed during the original vasectomy. If the ends of the vas deferens are too far apart, a vasovasostomy is also more difficult.

preparation

A vasovasostomy does not require any special preparation. In an initial meeting between the patient and the urologist, the background to the planned operation should be discussed. It is just as important to provide comprehensive information about the procedure and its risks and chances of success.

Since, in contrast to vasectomy, refertilization is often performed under general anesthesia, a discussion with the anesthetist is required to clarify any risks.

Please also read: General anesthesia - procedure, risks and side effects

Course of the Op

Since a precise microsurgical procedure is required for refertilization, the procedure is carried out under general anesthesia.
After the patient sleeps, the skin is opened either through the scars from the vasectomy operation or through an incision in the middle fold of the skin of the scrotum (testicle).

The separated ends of the vas deferens must be exposed and the overgrown stumps cut open on both sides. If seminal fluid is already leaking on the testicle side, patency can be assumed and the vasovasostomy can be started.
To do this, the two ends are sewn together again in an anatomically correct manner, layer by layer, under a magnifying glass.
If there is any doubt about the patency of the spermatic duct, a tubulovasostomy is performed, in which the spermatic duct is sewn directly to a canal in the epididymis. Then the skin is closed again and a sterile, firm bandage is applied.

Aftercare

Follow-up care of the surgical wounds is usually not necessary, unless there are signs of complications.
In order to check the success of the re-fertilization, a spermiogram is made, i.e. an examination of the ejaculation for the presence of sperm, their number and mobility.

Full success can only be foreseen after about six months, but a first spermogram is usually examined after two to three months.

Risks

The risks of a vasovasostomy or tubulovasostomy are the same as with any minor surgical procedure.
The surgical wounds can bleed or become infected, but some surgeons use prophylactic antibiotics for a few days around the surgery. Due to the small size of the cuts and the highly sterile conditions in the operating room these days, these complications are quite rare.
Wound healing disorders or injuries to other structures, e.g. Nerves in the operating room. In contrast to the post-vasectomy pain syndrome, a "post-vasovasostomy syndrome" is not known.
General anesthesia also carries certain risks, which should be clarified in advance. Patients with pre-existing cardiovascular diseases or high drug consumption should speak to their anesthetist in detail.

Read more about this: Risks of general anesthesia

What does the op cost?

The costs for a refertilization with a specialist are around 2000-3000 €.
This makes the operation significantly more expensive than the previous vasectomy. This is because a vasovasostomy is a more laborious procedure that requires more time, equipment, and expertise.
Special, expensive thread material for microsurgical operations is used to reconnect the two stumps of the vas deferens, as is a surgical microscope.
The procedure takes about two hours, which is more than four times the length of a vasectomy.

In addition to the surgeon, the presence of an anesthetist is also necessary for general anesthesia. Due to the anesthesia, the patient has to be monitored longer after the operation, which also costs time and money. All of these things add up, making refertilization an expensive proposition.
This is not the only reason why a vasectomy should be carefully considered and, ideally, final.

Does the health insurance company bear the costs?

No, the costs for a refertilization are not covered by the health insurance companies. Both vasectomy and vasovasostomy are procedures that are performed voluntarily and without medical necessity. Therefore, the health insurance companies do not see themselves in a position to cover the costs.

In rare cases in which the male sterility is not due to a vasectomy but, for example, inflammation-related scarring of the vas deferens, a private health insurance company may cover re-fertility treatment, provided that fertility treatments are part of the tariff.
In the case of statutory health insurance companies, assumption of costs is almost always excluded.

What is the probability of success?

The probability of success of a re-fertilization depends on several factors. Since it is not a trivial operation, such an operation should be performed by a specialist surgeon in order to maximize the chance of success.
The time since the vasectomy also has an impact on the chances of fathering children again. The longer, the lower the chances of success.

However, there are regular cases in which vasectomies more than ten years ago have been successfully reversed. As a rule, doctors shy away from giving numbers for a probability of success. However, there are statements that speak of 80-95% success.