Vasectomy reversal — the surgical reconnection of the vas deferens to restore fertility — is one of the most technically demanding and outcome-dependent procedures in andrological surgery. The chances of success vary enormously between surgeons and between patients. Understanding what determines your individual probability of success is essential before making this significant decision.
What Happens During a Vasectomy Reversal?
During vasectomy, the vas deferens — the tube that carries sperm from the epididymis to the urethra — is cut and sealed on both sides. Reversal involves rejoining these two cut ends under high-powered microsurgical magnification.
There are two types of reversal:
Vasovasostomy — the cut ends of the vas are directly rejoined. This is the simpler procedure and is used when fluid containing sperm is found at the testicular end of the cut vas at the time of surgery.
Epididymovasostomy — the vas is connected to the epididymis (bypassing a secondary obstruction in the epididymis caused by back-pressure of sperm over time). This is a significantly more complex procedure, required in approximately 30–40% of reversal operations, and its success rate is heavily dependent on surgical expertise.
In all cases, the decision between vasovasostomy and epididymovasostomy is made at the time of surgery, based on what the surgeon finds. This means your surgeon must be capable of performing both procedures — not just the simpler one.
What Determines Success?
Time since vasectomy is the single most important factor:
- Under 3 years: patency (return of sperm) rates 75–95%, pregnancy rates 55–75%
- 3–8 years: patency rates 50–80%, pregnancy rates 40–55%
- 9–14 years: patency rates 30–55%, pregnancy rates 30–45%
- Over 15 years: patency rates 15–40%, pregnancy rates 15–30%
These figures reflect outcomes in the hands of experienced microsurgeons. Results from less experienced surgeons or centres performing low volumes of reversals are significantly lower.
Female partner factors — the age and ovarian reserve of the female partner are often the limiting factor in whether a successful reversal leads to pregnancy, particularly when the reversal is performed more than 10 years after vasectomy.
Surgical expertise — the calibre of the surgeon is the most controllable variable in reversal outcome. Microsurgical vasectomy reversal performed with a two-layer anastomosis technique under high-power operating microscope magnification consistently outperforms macroscopic or loupe-assisted approaches.
Is Reversal Better Than Sperm Retrieval and IVF?
For couples where the female partner is under 38 and there is no significant female factor infertility, microsurgical vasectomy reversal — when performed within 10 years of vasectomy by an experienced surgeon — is typically more cost-effective than multiple IVF cycles, and offers the additional advantage of natural conception.
Beyond 10 years, or where female factor infertility is present, the decision between reversal and direct sperm retrieval for IVF requires careful individual counselling. We discuss both options openly at consultation, without a preference for either.
Our Approach
Professor Minhas and Professor Yap perform microsurgical vasectomy reversal under high-power operating microscope magnification with two-layer anastomosis technique. Both surgeons are capable of performing epididymovasostomy when required. Their reversal outcomes reflect the international academic benchmark for this procedure.
Contact London Andrology to discuss whether vasectomy reversal is right for you.
