Vasectomy Reversal

  • John P. Mulhall
  • Peter J. Stahl
  • Doron S. Stember
Chapter

Abstract

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.

Keywords

Insurance Coverage Tricyclic Gabapentin Azoospermia 

Suggested Reading

  1. Belker AM, Thomas AJ, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145(3):505–11.PubMedGoogle Scholar
  2. Brannigan RE. Vasectomy reversal: indications and outcomes. J Urol. 2012;187(2):385–6.PubMedCrossRefGoogle Scholar
  3. Goldstein M, Tanrikut C. Microsurgical management of male infertility. Nat Clin Pract Urol. 2006;3(7):381–91.PubMedCrossRefGoogle Scholar
  4. Hsiao W, Goldstein M, Rosoff JS, et al. Nomograms to predict patency after microsurgical vasectomy reversal. J Urol. 2012;187(2):607–12.PubMedCrossRefGoogle Scholar
  5. Jarow JP, Sigman M, Buch JP, Oates RD. Delayed appearance of sperm after end-to-side vasoepididymostomy. J Urol. 1995;153(4):1156–8.PubMedCrossRefGoogle Scholar
  6. Jarow JP, Oates RD, Buch JP, Shaban SF, Sigman M. Effect of level of anastomosis and quality of intraepididymal sperm on the outcome of end-to-side epididymovasostomy. Urology. 1997;49(4):590–5.PubMedCrossRefGoogle Scholar
  7. Pierpaoli S, Mulhall JP. Vasectomy reversal in the age of intracytoplasmic sperm injection. Curr Opin Urol. 1998;8(6):531–4.PubMedCrossRefGoogle Scholar
  8. Practice Committee of American Society for Reproductive Medicine. Vasectomy reversal. Fertil Steril. 2008;90(5 Suppl):S78–82.Google Scholar
  9. Shridharani A, Sandlow JI. Vasectomy reversal versus IVF with sperm retrieval: which is better? Curr Opin Urol. 2010;20(6):503–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • John P. Mulhall
    • 1
  • Peter J. Stahl
    • 2
  • Doron S. Stember
    • 3
  1. 1.Sexual and Reprodictive Medicine Program Department of Surgery Division of Urology, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of UrologyColumbia University College of Physicians & SurgeonsNew YorkUSA
  3. 3.Department of UrologyBeth Israel Medical Center Albert Einstein College of Medicine of Yeshiva UniversityNew YorkUSA

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