Several times a month a patient, who has had a reversal, will drop off a specimen to see if there are any sperm present. This evaluation takes just a minute to do. If sperm is present it means that the reversal mechanically is open and has been successful. This evaluation however doesn’t count the sperm, that would require a full semen analysis which is done through the hospital lab and quantitates the actual number of sperm present.
For the purposes of seeing if the reversal “worked or not” the in office check for sperm is sufficient. If there are no sperm and it has been three months post reversal this may either means that reversal is not open but probably more likely that the testicles have not “picked up the ball” and started producing sperm yet. It can take four to twelve months for the sperm to be produced in numbers sufficient for conception. The time to producing sperm by the testicles post vasectomy is large part dependent on the interval between the vasectomy and the reversal.
It is always a “drum roll” moment when the specimen is dropped off for me to evaluate and always rewarding to see sperm moving about so excited to be set free and get to work.
The following is not a post reversal sample but it shows what you want to see in the ejaculate after a reversal. It is also interesting how the maker of the video created the project.
Want to schedule a vasectomy reversal phone consultation?
I usually tell patients wait one week after a vasectomy and three weeks after a vasectomy reversal before resuming sexual activity. Other than the fact that the reversal is a more substantial procedure to recover from in time there is little difference in this particular regard. JM
Vasectomy Reversal Failure Rates and Success Rates Vary With:
The vasectomy reversal technique used.
The years between the vasectomy and the reversal attempt.
The experience and skill of the vasectomy reversal doctor.
Some of the best vasectomy reversal success rates reported in the literature for vasovasotomy are a patency rate of 99% with a pregnancy rate of 64%, not including couples where the woman was infertile. This means that in the hands of the surgeon who quoted these rates, he was able to restore sperm flow in the vas tube 99% of the time, and this allowed a pregnancy rate of 64%.
Not every time that sperm flow returns to the vas is pregnancy guaranteed. The expected vasectomy reversal success rates results for vasoepididymostomy in the hands of the same surgeon are lower, reportedly at 65% patency rate and a 41% pregnancy rate.
Factors influencing the success rate of reversal surgery include the following:
Time interval since vasectomy-The length of time passed since the vasectomy greatly impacts vasectomy reversal failure, as seen on this chart:
Years Between Vasectomy
Sperm Return
Pregnancy Rate
Under 3 years
97%
76%
3-8 years
88%
53%
9-14 years
79%
44%
Greater than 15 years
71%
30%
As previously noted, with longer intervals between vasectomy and reversal, there is an increased vasectomy reversal failure rate due to epididymal blockage as well as rupture and obstruction of the epididymal tubules.
Sperm granuloma-Sperm granulomas at the vasectomy site are a favorable prognostic sign and increase the likelihood of vasectomy reversal success.
Anti-sperm antibodies-Post-operative, sperm-bound antibodies result in a lower pregnancy rate or higher likelihood of vasectomy reversal failure.
Quality of vasal fluid-The vasal fluid quality is checked before a decision is made whether to proceed with a vasovasostomy versus vasoepididymostomy when reversing the vasectomy. If no sperm are present in the vasal fluid the gross appearance of the vasal fluid can help in determining between a vasovasostomy versus vasoepididymostomy. Cloudy, water soluble fluid indicates the best case for eventual return of sperm to the semen (higher vasectomy reversal success rate). Thick white greasy toothpaste-like material indicates the worst prognosis (a higher vasectomy reversal failure rate).
Microsurgical Vasectomy Reversal Technique-The vasectomy reversal technique and the doctor`s judgment and experience are important factors for success. Given that choosing the vasectomy reversal doctor is one of the few choices controlled by the patient, it may become an important factor in determining the vasectomy reversal success rate.
Associated conditions-Any condition that impairs sperm production for example a varicocele may lower postoperative pregnancy rates (increase vasectomy reversal failure rate).
A vasectomy reversal consult is free and easy to schedule 24/7. Leave your number below and we’ll call with an appointment.
This week I don’t have to go into work. We had Christmas Eve and Christmas Day with the munchkins and then they headed to their mom’s house for a week. We picked them up Monday morning and we have them until Wednesday morning when they get dropped off at school. Our break routines are always […]
If nothing else…this article is interesting. Although the most common cause of desiring a vasectomy reversal is a male who has had children and a vasectomy has remarried someone with no children. This study showed that %17 of the time a reversal is desired by a couple who have had a vasectomy and now desire more children. Their success rate is higher than if the male remarries and has a reversal.
Vasectomy Reversal Better With Same Partner as Prior to Vasectomy
Urology – July 30, 2015 – Vol. 32 – No. 12
Vasectomy reversal success in regard to clinical pregnancy is improved if the patient has the same partner before and after vasectomy.
Article Reviewed: Higher Outcomes of Vasectomy Reversal in Men With the Same Female Partner as Before Vasectomy. Ostrowski KA, Polackwich AS, et al: J Urol; 2015;193 (January): 245-247.
Background: Vasectomy reversal is requested by around 6% of men who previously had undergone a vasectomy and desire subsequent fertility. Frequently, this is due to a new relationship; however, some couples desire another child or may have lost a child. Two small prior studies have suggested improved pregnancy rates following vasectomy reversal with the same partner as before vasectomy.
Objective: To determine if clinical pregnancy and birth rates are higher for men undergoing vasectomy reversal with the same female partner.
Design: Retrospective review of a prospectively collected database.
Methods: All patients from a single surgeon were reviewed from 1978 to 2011. Obstructive interval, surgery type, vasal fluid character, and sperm character were recorded. Men either self-reported pregnancy and birth rates or completed a survey response. All patients had at least 12 months of follow-up data.
Results: Over the time frame, 3135 men underwent vasectomy reversal; 17% (524 men) undergoing vasectomy reversal had the same female partner. A total of 258 (49%) responded to the survey, and 89% (229) underwent bilateral vasectomy reversal. The average patient and partner age was significantly higher in the same partner group compared to the new partner group, although the same partner group had a significantly shorter obstructive interval at 5.65 years versus 9.23 years. Overall, the clinical pregnancy rate for men with the same partner was 83% compared with 60% in men with a new partner. After regression, this maintained an odds ratio of 2 and was significant.
Conclusions: Men undergoing vasectomy reversal with the same partner experience a higher pregnancy rate compared men with a new partner.
Reviewer’s Comments: This article supports prior articles by Kolettis et al and Goldstein et al. The larger number of patients provides an excellent dataset even though it is a single surgeon. The success rates are substantially higher and maintain significance, even after controlling for ages and obstructive interval. It is also useful to have typical data of a 60% pregnancy rate for those with a new partner. Many patients are interested in “success” following surgery, and this is not solely a desire to have sperm return to the ejaculate. There are limitations, however, because the survey results were returned by only 49% of patients, leaving the potential for reporting bias. Overall, this information is useful when counseling patients with the same partner as prior to vasectomy.(Reviewer–Gregory Lowe, MD).
Author: Ostrowski KA, Polackwich AS, et al Author Email:hedgesja@ohsu.edu
Even after prolonged obstructive intervals of 15 to 20 years, vasectomy reversal offers better or comparable success rates to intracytoplasmic sperm injection.
Article Reviewed: Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years. Kolettis PN, Sabanegh ES, et al: Urology 2002; 60 (November): 885-888.
Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years.
Many institutions recommend a vasoepdidymostomy if no sperm are seen in the fluid of the transected vas deferens at the time of the reversal. The article below begs to differ.
Vasovasostomy Recommended When Only Sperm Parts Noted
Urology – November 30, 2006 – Vol. 22 – No. 04
Vasovasostomy can and should be performed when only sperm parts are noted intraoperatively in the transected vas.
Article Reviewed: Outcomes for Vasovasostomy Performed When Only Sperm Parts Are Present in the Vasal Fluid. Kolettis PN, Burns JR, et al: J Androl; 2006; 27 (July/August): 565-567.
Outcomes for Vasovasostomy Performed When Only Sperm Parts Are Present in the Vasal Fluid.
Objective: To determine vasovasostomy outcomes in instances in which only sperm parts are present intraoperatively in the vasal fluid, rather than in full sperm. Design: Retrospective review of outcomes from 3 institutions with experienced male reproductive microsurgeons for men undergoing vasovasostomy in cases where only sperm parts were noted in fluid from the transected vas.Participants: 34 men who underwent bilateral (n=31) or unilateral (n=3) vasovasostomy. Methods: Men who were identified with sperm parts (sperm heads or sperm with partial tails) in the vasal fluid bilaterally or sperm parts on 1 side with intravasal azoospermia on the contralateral side when the vas was transected during vasovasostomy were included in the study. Microsurgical vasovasostomy was performed using either a modified 1-layer technique or a formal 2-layer technique. Results: The overall patency rate was 76% (26 of 34 men), and the pregnancy rate was 35% (7 of 20). Analyzing 8 procedures that did not result in sperm in the ejaculate, 2 had only an occasional sperm head bilaterally from the transected vasa, and 1 had observed an occasional sperm head on 1 side and contralateral intravasal azoospermia. Excluding these 2 cases, the patency rate was 84% (26 of 31). Conclusions: These results are similar to or better than those of epididymovasostomy outcomes, and argue that vasovasostomy should be performed in cases where only sperm parts are noted intraoperatively in the transected vas.Reviewer’s Comments: Mounting evidence supports that vasovasostomy can and should be performed when only sperm parts or even clear fluid is noted intraoperatively in the transected vas. (Reviewer–Craig S. Niederberger, MD).
Over the years men have told me they were having a vasectomy because their wife told them that, “I’ll want to have sex more if I don’t have to worry about getting pregnant.” One such patient, a neighbor, stopped me in my drive way three months after his vasectomy to tell me, “She lied!”
Vasectomy May Lead to Increased Sexual Intercourse Frequency
Urology – April 30, 2016 – Vol. 34 – No. 1
Vasectomy is not associated with decreased frequency of sexual intercourse.
Article Reviewed: Relationship Between Vasectomy and Sexual Frequency. Guo DP, Lamberts RW, Eisenberg ML: J Sex Med; 2015;12 (September): 1905-1910.
Background: Men often report the concern that having a vasectomy will impair their future sexual function.
Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.
Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.
Methods: Data were extracted from 2 cycles of the NSFG (2002 and 2006-2008) and analyzed. Men were included if they were previously sexually active and were aged >25 years. Female partners were also surveyed in the NSFG and were included if they were between 25 and 45 years of age. Sexual frequency was compared between men (or male partners of female respondents) who had a vasectomy and those who did not. The database captured sexual intercourse frequency over the preceding 4 weeks.
Results: A total of 5838 men met inclusion criteria, with 353 of these having a previous vasectomy. Men who had a vasectomy engaged in intercourse at a mean rate of 5.9 times per month compared to 4.9 times in men who had not had a vasectomy (P =0.0004). Additionally, men who had a vasectomy were less likely to have not engaged in any sexual intercourse in the preceding month. In the survey of female partners, 5211 women responded regarding their male partners, and 670 partners had a previous vasectomy. Again, men with a previous vasectomy had a higher frequency of sexual intercourse during the previous month (6.3 vs 6.0), although this difference was not statistically different (P =0.1341).
Conclusions:Vasectomy does not appear to negatively influence sexual frequency.
Reviewer’s Comments: The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy. Previous reports have investigated if vasectomy has any effect on sexual function and satisfaction, with most finding minimal to no effect on sexual function. In fact, some reports have demonstrated improved sexual function with improved sexual satisfaction, likely due to the loss of anxiety about unwanted pregnancy. The authors of this article demonstrate through objective survey results that sexual frequency does not decrease and may increase with vasectomy. While no explanation can be extracted from these data, the results are encouraging and can certainly be mentioned while counseling men before vasectomy.(Reviewer–Charles Welliver, MD).
Heart-Healthy Foods With Lower Saturated Fat Equals Sperm Health
Urology – May 30, 2013 – Vol. 30 – No. 5
Ongoing indirect evidence suggests that heart-healthy diets are associated with the potential to improve sperm parameters.
Article Reviewed: High Dietary Intake of Saturated Fat Is Associated With Reduced Semen Quality Among 701 Young Danish Men From the General Population. Jensen TK, Heitmann BL, et al: Am J Clin Nutr; 2013;97 (February): 411-418.
Background: Saturated fat consumption has been correlated with some cancers and cardiovascular disease. Yet, whether saturated fat is correlated with abnormal sperm parameters needs more research.
Objective: To determine the impact of dietary fat on semen parameters among 701 young Danish men without azoospermia.
Design/Methods: This was a cross-sectional study of men recruited from their military fitness exam (2008 to 2010). Three-month recall-validated 136-item food frequency questionnaire, single semen sample, and physical examination were conducted for each participant. Median age was 19 years and median body mass index (BMI) was 22.5.
Results:Men with a high intake of saturated fat had lower total sperm counts. Men in the highest quartile of saturated fat intake had a 38% significantly lower concentration and a 41% significantly lower total sperm count compared to men in the lowest quartile. There were no other significant correlations found between semen parameters and other forms of dietary fat intake.
Conclusions: Diet may be a partial explanation for the reported greater abnormalities observed in sperm counts from other studies of the general population. Reducing the intake of saturated fat may improve reproductive and overall health parameters.
Reviewer’s Comments: This is part of a continuing series of studies that suggest you are what you consume in your diet regarding certain areas of health and – to some extent – fertility. Second, this is a cross-sectional study, whether it is a semen sample or dietary questionnaire is not level 1 evidence. In fact, the correlation between food frequency questionnaires and reality is still far apart. I do not remember what I ate yesterday, let alone months ago. Yet, the beauty of a large questionnaire and this study is that these snapshots might reveal a hidden general pattern or overall behavior that can provide some answers. I found it interesting that a higher percentage of men with a very low BMI were more likely to consume more saturated fat (seems counterintuitive, right?). Yet, men consuming more saturated fat were slightly more likely to smoke, drink more alcohol, report a sexually transmitted disease, consume more overall calories, eat more omega-6 fatty acids, and probably had less muscle mass. And, although the authors did adjust for most of these parameters in their study – which they believe makes the theory of saturated fat being a marker of unhealthy overall behavior less likely – I disagree (>30% of the saturated fat was coming from cheese and dairy products). There is a pattern of behavior to suggest a less healthy lifestyle in those who consume more saturated fat, which is similar to what has been found in many prostate cancer studies and cardiovascular reviews.(Reviewer–Mark Moyad, MD, MPH).
