Changing Your Mind After a Vasectomy
A vasectomy is a minor procedure that involves cutting the vasa deferentia, which are the two tubes that carry sperm to the ejaculatory ducts, where they become part of semen. After surgery, sperm are still produced but are unable to move, so they die and are absorbed back into the body.
Men can still ejaculate semen, minus the sperm, and have sex as normal, but conception cannot ensue. A vasectomy is the most effective form of birth control after abstinence, and in the United States, more than 500,000 men opt to undergo the procedure every year.
After a vasectomy, 6 to 10 percent of men seek a reversal, and this change of heart may occur months or years after the original procedure. The reasons to reverse a vasectomy most often include remarriage or making a decision with a partner to have more children.
How reversal works
A vasectomy reversal, or a vasovasostomy, quite literally reverses a vasectomy by reconnecting the severed ends of each vas deferens. Like a vasectomy, it can be performed under local or, most commonly, general anesthetic by a board-certified urologist.
In more complex cases, the cut end of the vas deferens has to be attached directly to the epididymis, where the sperm is stored. This is called an epididymovasostomy and should only be performed by an experienced specialist.
Risks of a reversal include infection, bleeding and, uncommonly, chronic pain. Some restrictions on activities (including sex) and tight clothing are recommended for a few weeks. After that time, you can begin trying to conceive again.
While nearly all vasectomies can be reversed, not all men are able to father a child after a reversal. Pregnancy rates afterward range from 30 to 90 percent. Factors responsible for this extremely wide range include the age of the individual and his partner, time passed since the vasectomy, fertility issues prior to the vasectomy, health of the sperm, and the surgeon's precision and skill in carrying out the procedure.
Success rates for conceiving a child are as high as 95 percent if the vasectomy was done in the previous 10 years, but chances of conception begin decreasing for procedures performed more than 15 years earlier.
In the rare event that a reversal is unsuccessful, a second reversal attempt may be an option.
Another option to vasectomy reversal, especially if a couple is interested in only one additional pregnancy, is aspirating the sperm directly from the testis or epididymis. The sperm can then be injected into the cervix or used with in vitro fertilization (IVF). The use of in vitro fertilization with frozen sperm, or cryopreservation, may also be a consideration.
Effects on health
A vasectomy reversal has very few negative side effects. You'll experience some pain after the procedure; many men say it's about the same amount as after the original vasectomy. Beyond that, you'll be back to normal activities, including sex, in a matter of a few weeks.
Neither a vasectomy nor a reversal should impact your sexual health. They do not cause erectile dysfunction, changes in erections, or hinder the ability to ejaculate.
Consult a board-certified urologist with training in microsurgical techniques for vasectomy reversals. Be open and upfront with them about your short- and long-term goals and concerns. Ask for a breakdown of the pros, cons and alternatives, as well as their recommendations.
Be sure to ask how many vasectomies they have performed and the success rates of the reversals they have carried out.
It's worth noting that vasectomy reversals typically are not covered by insurance and cost anywhere from $5,000 to $15,000, plus additional fees.
Do some research online—find dedicated sites and support groups—and listen to the experiences of other men who have gone through a reversal. If you're comfortable doing so, reach out to family and friends for support and a sympathetic sounding board. It's much easier to make decisions when you have all the information you need.
If you have a long-term partner, discuss your motivations with them, the pros and cons, and alternatives. Consider how many more children you may want and whether IVF is a likely option if you want more than one. Ask for their thoughts and concerns, and agree on the best plan of action to help you both reach your personal health goals as well as your reproductive goals as a couple.