Vasectomy and reversal

The vasectomy reversal takes 2 essential forms. The first and simpler procedure is the vaso-vasostomy. This involves putting the 2 cut ends of the vas back together. We perform this procedure when there is sperm at the testicular end of the vas at the time of the surgery. The finding of sperm at the end of the vas is a function of the time from vasectomy and whether or not there is a sperm granuloma. We perform the reversal with an operating microscope. We use 9-0 and 10-0 suture for the 2 layer anastamosis that we make.

The vaso-epididymostomy is a technically more difficult surgery. It is done when the epididymis is blocked and so the sperm never reaches the vas deferens. Therefore, if the vaso-vasostomy were done it would not be successful. The vaso-epididymostomy is also done with 9-0 and 10-0 sutures. 

While it is easy to report good success rates with the reversal operation, one must be cautious in interpreting the data. Success is typically considered a return of sperm to the ejaculate. This is reported as success even if there are small numbers of sperm. Unfortunately, this does not always translate to pregnancy rates. Remember if everything else is equal the older the female the harder to make her pregnant.