From the Guidelines
Vasectomy reversals are moderately effective, with success rates ranging from 40% to 90% depending on several factors, including the time elapsed since the original vasectomy, as noted in the 2012 AUA guideline 1. The effectiveness of vasectomy reversals can be influenced by various factors, such as:
- The time elapsed since the original vasectomy, with higher success rates when performed within 10 years of the vasectomy
- The surgeon's experience and technique, with vasovasostomy and vasoepididymostomy being the two main surgical techniques used
- The patient's age and overall health
- Whether the female partner has fertility issues After a reversal procedure, sperm typically returns to the ejaculate in about 85% of men, but pregnancy rates are lower, averaging around 50-60% 1. It is essential to discuss the potential risks and complications of vasectomy reversals with patients, including the risk of surgical complications such as symptomatic hematoma and infection, which occur in 1–2% of cases, as well as the potential for chronic scrotal pain associated with negative impact on quality of life, which occurs in about 1–2% of men 1. Even after successful reversal, it may take several months to a year for sperm count and quality to improve sufficiently for conception, and some men may need to consider sperm extraction with in vitro fertilization as an alternative if reversal fails. The procedure is typically performed on an outpatient basis under general or local anesthesia, with recovery taking about two weeks before returning to normal activities. Options for fertility after vasectomy include vasectomy reversal and sperm retrieval with in vitro fertilization, which are not always successful and may be expensive 1.
From the Research
Effectiveness of Vasectomy Reversals
- The effectiveness of vasectomy reversals can be measured by patency and pregnancy rates, with studies showing varying degrees of success 2, 3, 4.
- A study published in 2021 found that vasectomy re-reversal was effective in restoring the obstruction in more than half of the patients, with a patency rate of 66.67% 2.
- Another study from 1999 reported overall patency and pregnancy rates of 79% and 31%, respectively, after microsurgical reconstruction following failed vasectomy reversal 4.
- Factors that may influence the success of vasectomy reversals include the presence of spermatozoa in the vas deferens fluid, age of the patient, and elapsed time between vasectomy and reversal 2, 4.
Predictors of Success
- History of conception with the current partner has been identified as a predictor of future conception after vasectomy reversal 4.
- The presence of spermatozoa in the vas deferens fluid has also been associated with the success of vasectomy reversal 2.
- Other factors, such as smoking history and obstructive interval, have not been found to correlate with postoperative success 4.
Challenges and Considerations
- Vasectomy reversal is a technically challenging procedure that requires specialized skills and equipment 3, 5.
- The use of robotics and novel techniques has emerged in recent years to aid in the success of vasectomy reversal surgery 3.
- Pre-operative management algorithms can help ensure appropriate counseling and preparation for men seeking vasectomy reversal 5.
- Microsurgical reconstruction following failed vasectomy reversal can be associated with high patency and moderate pregnancy rates, but requires familiarity with microsurgical techniques 4.