Half a million men undergo vasectomy annually in the United States. Studies suggest that up to 6 % of such men will request vasectomy reversal. Divorce with remarriage is by far the most common reason for vasectomy reversal. Other reasons include a simple change in desire to have more children and death of a child. Unlike surgical sperm retrieval with assisted reproduction (which is the alternative treatment for patients who desire children after vasectomy), vasectomy reversal allows for natural reproduction, does not require hormonal manipulation of the female partner, and allows couples to have multiple children without additional treatment. This is the preferred strategy when the vasectomy is fewer than 15 years old and the female partner has normal fertility. Vasectomy reversal is among the most technically challenging surgical procedures in urology and should be performed using microscopic magnification. Outcomes depend largely upon the type of reconstruction (vasovasostomy (VV) vs. vasoepididymostomy (VE)) required and the technical expertise of the reconstructive microsurgeon. VE may be required in cases of secondary epididymal obstruction, which occurs when increased pressure in the epididymis after vasectomy causes rupture and subsequent scarring of the single epididymal tubule. Sperm return to the ejaculate after 70–99 % of vasectomy reversals, allowing for unassisted pregnancy in 30–80 % of couples. Outcomes of VV are far better than outcomes of VE due to the increased technical difficulty of VE and bypass of part of the epididymis during sperm transit after VE, where sperm gain much of their functional capacity.
KeywordsInsurance Coverage Tricyclic Gabapentin Azoospermia
- Practice Committee of American Society for Reproductive Medicine. Vasectomy reversal. Fertil Steril. 2008;90(5 Suppl):S78–82.Google Scholar