What Is Vasovasostomy?

A vasovasostomy is a micro-surgery and one of two ways to reverse a vasectomy. During a vasectomy, the vas deferens—tubes that carry sperm from the testicles to the point of ejaculation—are cut. So, a vasovasostomy involves reconnecting the two ends of the cut vas deferens.

Men who have undergone a vasectomy use vasovasostomies to regain their fertility. A vasovasostomy is performed by a urologist. Learn more about the uses, side effects, procedure, and results of a vasovasostomy.

Purpose

This procedure is done to restore fertility to a man that has previously undergone a vasectomy. It is also done to help relieve men who suffer from pain after they have a vasectomy done. This pain is often referred to as post-vasectomy pain.

When vasovasostomies are done via microsurgery, they have a success rate of about 85% in terms of the sperm returning, and about 53% in terms of resulting in a pregnancy. The success rate is higher when the time since the vasectomy is shorter.

Vasoepididymostomy is an even more technical surgery than vasovasostomy, and it is done when there is a blockage in the epididymis (where sperm is stored) and other cases where a vasovasostomy would not be successful. 

There is no way to know which of the two procedures you'll undergo until the surgery itself begins and your surgeon has the chance to examine the quality of your vasal fluid (fluid that is released from the testicle when opening up the scar of the vasectomy site).

Risks and Contraindications

There aren't many risks with vasovasostomies. However, it is possible that after the procedure you could experience:

• chronic pain
• infection (which is a risk with almost any surgery)
• bleeding in the scrotum which can then lead to blood pooling and causing the area to swell (hematoma); this can be avoided by following your healthcare provider's post-surgery care instructions properly
• strictures and blockage (it is possible that the vas will become obstructed or strictured following successful reconnection)

It is important to report any of these effects such as chronic pain and bleeding to your healthcare provider immediately.

Before the Procedure

Your healthcare provider will ask you about your medical history to make sure you are a good candidate for the surgery, and will also perform a physical examination.

You should also find out accurate information on the date you had your vasectomy done as well as how much time has passed since then.

Let your healthcare provider know if you’ve had any previous scrotal or penile surgery. Your healthcare provider will request your reproductive history as well—that is, if you have or have ever had any children or pregnancies, at what age, and the ages of your current and/or previous partners.

If your purpose for doing the vasovasostomy is to have children, your healthcare provider may recommend that your partner undergo testing to see if she is still producing any eggs. If you were infertile before you underwent a vasectomy, your healthcare provider may recommend that a testicular biopsy (where a bit of tissue is removed from your testicles and taken for testing) be carried out.

The biopsy may be on a day before your vasovasostomy or it may be done at the beginning of your vasovasostomy. This testis tissue can be cryopreserved and used with IVF as backup option if vasectomy reversal is not successful.

Timing

A vasovasostomy can take anywhere from two to four hours, although it is possible for it to extend beyond that time-frame if the surgery is complicated. The time it takes also depends a bit on the expertise of the surgeon performing the procedure. You can also expect to spend some time filling out consent forms.

Location

The vasovasostomy will either take place in the hospital or at a surgical center. A vasovasostomy is an outpatient procedure, meaning that you can go home that same day.

What to Wear

You'll be required to change into a hospital surgical gown for the procedure, so you can wear your regular clothes to the hospital. It is, however, advisable that you wear clothes that aren't too tight around the crotch area. This is because after the procedure, you experience some pain in your testicles and any clothing pressing hard against that area may make it worse.

Food and Drink

A vasovasostomy most often takes place under general anesthesia, so you may be asked not to drink or eat anything the night before the surgery. This is to reduce the chances of any complications with the anesthesia arising.

What to Bring

If it's possible, you should ask a family member or friend to drive you home when the procedure is done.

During the Procedure

Pre-Procedure

Your urologist and anesthesiologist will discuss your anesthesia options with you beforehand. Vasovasostomies are usually performed under general anesthesia, but in a few cases, local anesthesia is used. However, you should note that medical literature considers using local anesthetics as not optimal.

This is because general anesthesia lets the urologist do his or her work better and more precisely, especially if it turns out the surgery will be more complicated than anticipated or if it turns out that it’s actually a vasoepididymostomy that needs to be performed.

Throughout the Procedure

After the anesthetic is administered, you will be placed flat on your back on the surgical table. The urologist will mark the area he will make an incision in the scrotum (the skin covering your testicles). Using a highly advanced operating microscope, your healthcare provider will magnify the view of your vas deferens. This is mainly why vasovasostomy is called microsurgery because the strong microscope enables the urologist to see very clearly and make tiny, precise cuts and stitches.

The healthcare provider will trim open the ends of the vas that were cut and sealed during the vasectomy. Vasal fluid will be taken from the vas deferens end that is closest to your testicles. The vasal fluid will be tested for sperm. If sperm is found, the urologist will go on to perform the vasovasostomy.

If there’s no sperm present, the healthcare provider will consider some other factors and may decide to switch to a vasoepididymostomy. The urologist will use very tiny stitches to o a small epididymal tubule which allows sperm to flow from testis outward through the remaining vas deferens with ejaculation. This may take anywhere from two to four hours, or in certain cases, even more.

Post-Procedure

Your urologist may use bandages to cover the site of the surgery. As the anesthesia wears off, you may experience some pain, soreness, and swelling. However, it shouldn’t be severe. If it is, report it immediately to the urologist.

You'll likely be given some painkillers to help with the pain. Your urologist may give you or instruct you to buy scrotal support garments like a jockstrap that you wear for some weeks.

After the Procedure

You’ll be asked to rest for two to three days, after which you can resume light activity. If your job requires heavy or strenuous work, you should ask your healthcare provider when you can resume.

You should also ask the healthcare provider when you should take off the bandages and stop wearing the scrotal support. It is likely your healthcare provider will ask you to abstain from sex for a couple of weeks.

Managing Side Effects

As with almost any surgery, you can expect to feel some mild pain, which should go away after some days or a few weeks, tops. You’ll be given some painkillers to help you deal with that.

You may experience some swelling which is normal and should go down after a week or two. If your pain is severe, and/or the swelling is persistent after weeks, you should report it to your healthcare provider.

Interpreting Results

It may take several months or even up to a year (or even more) for sperm to return to your semen and for your partner to get pregnant. You will be asked to come in for an appointment two to three months after the procedure where your semen will be collected for analyses.

Another follow-up appointment may be scheduled for four to six months after the procedure for another semen analyses. If your sperm hasn't appeared yet or your sperm count isn't regular yet, you may be asked to come in for further testing every two to three months.

A Word From Verywell

A vasovasostomy is a very technical surgery and its success somewhat depends on the microsurgical skills of the urologist. As such, it is highly advisable that you find one that has a lot of experience performing this kind of surgery.

If possible, go the extra mile to find a urologist with experience performing vasoepididymostomies, too, in case this ends up being the required route. Ask any questions you have or do your own research on the urologist's background, skill, and experience before committing to the procedure.

While vasovasostomies have high rates of success, you should always have realistic expectations. It is possible that the vasovasostomy may not be successful, and even it is, it’s possible that it may not result in a pregnancy (if that’s your aim).

If the vasovasostomy fails, you can consider using testis biopsy specimens with IVF/ICSI (assisted reproduction). Alternatively, one can consider repeat vasovasostomy, which, depending on the urologist's medical opinion, may have a good chance of success.