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When a man considers a vasectomy he should think that it cannot be undone, and thus “unreversible”. But in reality a vasectomy can be undone with great care and understanding. When a vasectomy is undone it is called a “vasectomy reversal”. Whether or not it will work well enough to return adequate sperm to the semen will not be known for some time after the procedure, and there is no guarantee that it will work.
There are a couple of factors that determine the likelihood of successful vasectomy reversal:
1) How long it has been since the vasectomy
2) How the surgeon does the repair
3) How well the vasectomy heals
4) Presence of anti-sperm antibodies and assorted anatomic signs at surgery
The longer the time since vasectomy the lower the chance of success. If less than 3 years the sperm returns 97% of the time and there is a 76% pregnancy rate. Sperm return and pregnancy rate cannot be the same because so many factors go into pregnancy. On the other hand, if it has been more than 15 years the sperm returns only 76% and there is only a 30% pregnancy rate.
For the repair there are one-layer and two-layer repairs of the vas deferens. In almost all studies the two layer repair, done with a microscope, gives the best result. The inner layer of the vas is reattached first, making the tube aligned properly in the center of the vas deferens. The outer layer reinforces the first.
If anti-sperm antibodies are present as a result of the body dissolving sperm trapped by vasectomy then the sperm after vasectomy reversal are at risk of being attacked by the immune system and may not be able to do their job well for pregnancy. This is one reason the pregnancy rate is lower. Sperm granulomas and other signs of the fluid in the vas deferens at surgery can suggest positive or negative outcomes as well, but these only are seen during surgery and can’t help you make the decision to get a reversal.
In general vasectomy is hard to undo. Done right it requires a microscopic two-layer technique in the hands of the most experienced Urologist. It is not covered by insurance, so it will require that the entire surgery be paid for up front, and there is no guarantee of success. Nonetheless, many men have reversed their vasectomy and gone on to father many more children afterwards.