A vasectomy is a procedure that blocks sperm from leaving your testis (testicle) and mixing with your ejaculate (semen). Vasectomies drastically reduce the chance of pregnancy and are known to be a highly effective form of birth control.

Over 500,000 people assigned male at birth have this procedure done per year, but an average of 20% end up changing their mind and want to conceive a child. The simplest way to regain your fertility after a vasectomy is to have a vasectomy reversal, a procedure that about 2-6% of males in the United States undergo.

Depending on which type of procedure is done, vasectomy reversals have a fairly high success rate. However, they are a more complex surgical procedure than a vasectomy, and it can be challenging to find a urologist who performs this microsurgical procedure.

Vasectomy reversals are rarely covered by health insurance. Out of pocket, they can cost $5,000-$15,000. However, they offer many couples the chance to conceive a baby naturally after a vasectomy and are a good choice for many couples.

Most people who get vasectomies are happy with the results and don’t want to regain their fertility. However, up to one-fifth of people change their minds and want to conceive a child naturally. A vasectomy reversal allows someone to regain their fertility after a vasectomy.

There are many reasons why someone may want to regain their fertility. Life circumstances may change, and you can’t always predict how you’ll feel in your post-vasectomy years. Some of the reasons why people decide to undergo a vasectomy reversal include:

• The death or loss of a child
• A remarriage
• A divorce
• A change in finances or life circumstances
• A changed desire to have more children

Another common reason that people decide to undergo a vasectomy reversal is to decrease pain from post-vasectomy pain syndrome (PVPS). PVPS is not common, and there is no clear diagnostic definition for the syndrome. It’s thought to be caused by complications from vasectomy procedures, such as hematomas, hernias, and nerve impingement. Symptoms may include testicular pain, pain during sex, and pain with other daily activities.

You can ask your healthcare provider if a vasectomy reversal will reduce your post-vasectomy pain.

Two possible procedures may be performed when you have a vasectomy reversal: a vasovasostomy or an epididymovasostomy. Both procedures reconnect the pathway for sperm to leave the body and mix with your ejaculate.

Vasovasostomies are the more common of the two procedures. In general, they are a less complicated procedure and have a higher success rate. You won’t know which vasectomy reversal type will be performed until you have the surgery; your urologist determines which type of vasectomy procedure is needed.

Vasovasostomy

During a vasectomy, the two ends of the vas deferens (the tube that transports and releases sperm) are cut so that sperm can no longer leave the body. In a vasovasostomy procedure, these two ends are isolated and sewn back together. This procedure has a high success rate, with over 85% of people regaining fertility after the procedure.

Epididymovasostomy

As part of the vasectomy reversal procedure, a sample of your vasal fluid (fluid in the vas deferens) is examined under a microscope. If sperm is found in the fluid, a vasovasostomy is performed.

If not, that usually means that there is a blockage in your epididymis (a coiled tube that stores sperm and connects the testicle to the vas deferens). In this case, an epididymovasostomy needs to be performed.

During this procedure, the urologist attaches one end of the vas deferens (the side still connected to the urethra) directly to the epididymis to bypass any blockage. This procedure is more complicated, but it can still restore fertility at around a 50% success rate.

If you are considering a vasectomy reversal or have an appointment coming up, your healthcare provider can explain what to expect before, during, and after the procedure. There are also a few ways you can prepare.

Before the Procedure

Your surgeon will discuss what you should do to prepare for the procedure.

The procedure can be done in a clinic under local anesthesia, which means you are awake during the procedure, but the area being operated on is numb. You may be given a light sedative that keeps you awake but relaxes you. In this case, you don’t need to change your diet before the procedure and can usually have a light meal beforehand.

If the procedure is being done under general anesthesia, meaning you will not be awake, you will have to refrain from eating and drinking for several hours before the procedure.

To prepare the area for the procedure, your pubic hair may be trimmed, and a chlorhexidine gluconate/isopropyl alcohol mix may be used to clean the groin area. You will lie down on your back for the procedure. Vasectomy reversals vary in length, but you can expect the procedure to last about two to four hours.

During the Procedure

Because you will either be numbed or under general anesthesia, you will not feel pain during the vasectomy reversal procedure. Here’s what happens during the procedure:

• Once you are numb or asleep under general anesthesia, the surgeon will make a small opening in your scrotum.
• The surgeon will locate the vas deferens inside the scrotum and trim off the ends.
• Next, they will take a sample of your vasal fluid to examine under a microscope.
• If sperm are present, the surgeon will perform a vasovasostomy. If not, they will perform an epididymovasostomy.
• In a vasovasostomy, the two ends of the vas deferens are attached; in an epididymovasostomy, one end of the vas deferens is attached directly to the epididymis.
• Once the reattachment is complete, the surgeon will stitch your scrotum back together.

After the Procedure

If you’ve had local anesthesia, you can leave for home soon after the procedure, but you will likely need someone to drive you home. If you’ve had general anesthesia, you may need to stay in the hospital for some time after the procedure. You’ll also need someone to drive you home.

Your surgeon will give you more details about what to expect after your procedure, as each facility varies in protocol.

Before you book your vasectomy reversal procedure, your urologist will need to determine if this procedure is right for you. This is done mainly by testing your and your partner’s fertility. The aim of a vasectomy reversal is to achieve pregnancy; if there are issues with either of your fertility that might cause difficulty in getting pregnant naturally, the procedure is unlikely to be recommended.

There are no clear guidelines to test female fertility before vasectomy reversal. Usually, those over the age of 35 will have some basic testing done, such as ovarian reserve determination or a procedure called hysterosalpingography (HSG), which allows the uterus and fallopian tubes to be viewed.

Males who have had a history of infertility before their vasectomy may not be eligible for a vasectomy reversal because it’s unlikely that the reversal will work.

If you had fertility before your vasectomy, you may be offered blood tests to check your hormone levels (including testosterone) and a physical exam to ensure that your reproductive system looks healthy. Your healthcare provider will also discuss any medication or lifestyle factors that could influence your fertility going forward.

Most people find the recovery after a vasectomy reversal to be tolerable. Pain medication will be offered to control any discomfort. The majority of people find that pain after the procedure is similar to pain after their original vasectomy.

In most cases, you’ll be able to return to your normal routines within about a week, though you’ll be advised to only perform light activities for two to three weeks. You’ll need to refrain from sex during this time period as well and will likely be asked to wear a jockstrap as you recover.

It can take between four months and one year for your fertility to return after a vasectomy reversal and for you and your partner to achieve a pregnancy. However, some couples may become pregnant sooner or later than this range. The longer it’s been since the reversal, the more likely you are to be successful.

Your urologist will likely test your sperm every few months after your reversal to ensure that your fertility is returning. Once your fertility returns, it should last for many years.

Your fertility success after a vasectomy reversal depends on which procedure you had, how your surgery heals, and your overall fertility. The longer it’s been since your procedure, the more likely it is that your fertility has returned.

If you had a traditional vasovasostomy, you are more likely to experience a return to fertility, as the success rate of that procedure is about 90%. Success rates for an epididymovasostomy are about 50%.

About 5% of men experience scars at the site of the vasectomy reversal, which can block the flow of sperm out of the body.

If your vasectomy reversal is not successful, there are other options for you. This usually involves retrieving your sperm directly from your testes (testicular sperm extraction or testis biopsy).

This can be done during the vasectomy reversal or afterward, if the procedure is not successful. Then, the sperm sample can be used in artificial insemination techniques like in vitro fertilization (IVF) to impregnate your partner. You will likely need to use IVF along with intracytoplasmic sperm injection (ICSI).

Though rare, complications can occur with a vasectomy reversal. One complication is an infection at the operating site, which can be treated with antibiotics. Another is scrotal hematoma, which is when blood collects in the scrotum, causing pain, swelling, and bruising. Scrotal hematomas are treated by draining the area.

Contact your healthcare provider promptly if you notice any unusual pain, swelling, or changes in appearance in your scrotal area. Also, contact your provider if you experience fever or flu-like symptoms, as these could be signs of an infection.

Vasectomy reversals are a good choice for many people who decide they’d like to conceive a child after having a vasectomy. Although vasectomy reversals have a relatively high rate of success, they can be expensive and insurance doesn’t usually cover them.

If you are interested in a vasectomy reversal, you should connect with a urologist for more information and to determine if the procedure is right for you.