Vasovasostomy

Vasovasostomy (literally connection of the vas to the vas) is the surgery by which  vasectomies are reversed in males.

In most cases the vas deferens can be reattached but, in many cases, fertility is not achieved. There are several reasons for this, including blockages in the vas deferens, and the presence of autoantibodies which disrupt normal sperm activity. If blockage at the level of the epididymis is suspected, a vaso-epidymostomy (connecting the vas to the epididymis) can be performed.

Return of sperm to the ejaculate ranges from roughly 30 to 90 percent, and may depend greatly on the length of time from the vasectomy. Generally, the shorter the interval, the higher the chance of success. The likelihood of pregnancy is somewhat lower (30 to 60 percent), and can depend on female partner factors.

Over half of men who have undergone a vasectomy develop anti-sperm antibodies. The effects of anti-sperm antibodies continue to be debated in the medical literature but, there is agreement that antibodies reduce sperm motility.

The procedure is typically performed by urologists. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional anesthesia.

Vasovasostomy is typically an out-patient procedure (patient goes home the same day).

Prognosis Determining the prognosis for each patient may involve a pre-operative examination of the vasectomy sites and consideration of the time interval between vasectomy and reversal. If there are no granulomas at either vasectomy site, the prognosis may then be based on the time interval since the vasectomy. If the interval since the vasectomy is less than fifteen years, the prognosis will likely be 70% or better.